Why is eyelid surgery and periocular rejuvenation needed?

The periocular area is very important from an aesthetic point of view. This is the first area to show signs of aging on the face due to its thin structure. The skin in this area gets thinner over time, and dynamic wrinkles, called crow’s feet, begin to appear on the lateral (outer) side of the eyes. Afterwards, the laxity of the upper eyelid increases, and sagging begins. If these sagging are advanced, visual field of the person narrows. In the lower eyelid, with the loosening of the support structure called the orbital septum, bags begin to form, and wrinkles increase. Fat distribution in the lower and upper lids changes and fat herniations occur. The depth of the under-eye groove increases.

This change that occurs around the eyes makes the person look older and tired than they are. Aesthetic applications around the eyes have a very positive effect on the rejuvenation of the face and make the people look younger, healthier, and more aesthetic.

What are the conditions evaluated in the pre-operative examination before the surgery?

Previous eye surgeries, dry eye symptoms and comorbidities are questioned. In the physical examination, the aesthetic measuremetns of the periocular area, excess skin, sagging, excess or deficiencies of fat, bags, depressions, and dark circles are evaluated. Periocular area should be considered as a whole and evaluated together with the surrounding tissues.

What is upper eyelid aesthetics?

Aesthetic surgery of the upper eyelid (upper eyelid blepharoplasty operation), is the process of removing excess skin which causes sagging, narrows the visual field, prevents make-up, and causes a tired/aged appearance. If needed, herniated excess fat tissue is also excised.

How is upper eyelid blepharoplasty performed?

Before the operation, the fold in the upper eyelid (supratarsal crease), the amount of tissue to be removed and preserved are determined. Drawings are made in accordance with the plan. The remaining skin tissue within the lines is removed. If necessary, herniated fat pads are also removed. The incision is then repaired with appropriate sutures. This procedure takes about 30-45 minutes and can be performed under local anesthesia. However, if patient does not prefer local anesthesia or if there are some combined surgical procedures such as lower eyelid blepharoplasty, sedation or general anesthesia may be preferred.

How is lower eyelid aesthetics (lower eyelid blepharoplasty) performed?

There are different approaches in lower eyelid blepharoplasty and physical examination is very important in determining the method. If the situation is the appearance of bagging caused by fat herniation without excess skin, the surgery is performed from the inner surface of the lower eyelid (with a transconjunctival incision). It is entered from the posterior surface of the eyelid and herniated fat tissues are removed. If there is also excess skin, an incision is made just below the lower eyelash line and the excess skin on the lower eyelid is removed (subciliary incision). The condition of the under-eye groove should also be evaluated. If there is depression and dark circles in the under-eye groove, the fat injection will contribute to the correction of these deformities (See Fat Injection (Lipofilling) Section). Lower eyelid blepharoplasty takes about 1 hour but this time varies according to the combined procedures. Lower eyelid aesthetics is a slightly more complex procedure than upper lid aesthetics, so this procedure is recommended to be performed with sedation or under general anesthesia.

How is the post-operative period after eyelid surgery?

Immediately after the eyelid surgery, special bands are placed around the eyes and the eyes can be kept closed for 1-2 hours if needed. Then the patient’s eyes are opened, eye drops and ointments are started. The patient is re-evaluated after he/she starts to eat if he/she has been anesthetized. After these surgeries, there is usually no need to stay in the hospital, the patient can go home if he/she feels well. Swelling and bruising can be seen due to the thin skin structure of the eyelids. These problems are very rare in patients who apply ice in the early period and who do not smoke. Swelling and bruising will be maximum on the post-operative 3rd day and will begin to decrease rapidly after that. Patients can usually return to their social lives at the end of the first week. In this surgery, no intervention is made on the eye itself, so any deterioration in vision is not expected. The burning and stinging sensation that starts right after the surgery will pass as soon as possible with the use of eye drops and ointments. You can take a shower from the 3rd day. One week after the surgery, the patient is re-evaluated, the bands and the sutures are removed. Color changes will be greatly reduced at the end of the 2nd week and the edema at the end of the 1st month. However, at least 3 months should be waited for full recovery.

Will there be any visible scars after eyelid surgery?

In the upper eyelid blepharoplasty procedure, the incision will be hidden within the upper eyelid crease. In lower eyelid blepharoplasty, incision varies according to the approach. No external scar is visible in the incision made from the inner part of the lower eyelid (transconjunctival incision). In the incision made just below the lower eyelashes, there is a hidden scar at the bottom of the eyelashes. Due to the localization and healing nature of the scars, these scars will be quite indistinguishable within 3-6 months.

What are the complications that can be encountered in eyelid aesthetics?

The most common condition after eyelid surgery is swelling and bruising, which is maximum on the 3rd day and gradually decreases. Another situation that should be mentioned is “ectropion”. Ectropion is a downward displacement of the lower eyelid that may occur due to surgical technique and patient-related factors. Although very rare, this condition may resolve or may require correction surgery.

What are the combined aesthetical procedures in periocular area?

Periocular area shows signs of aging together and deformities are usually seen together. Upper eyelid blepharoplasty can be combined with lower eyelid blepharoplasty, fat injection to the under-eye grooves (See Fat Injection (Lipofilling) Section), brow lift and almond eye aesthetics.

What is brow lift aesthetics and how is it done?

Brow lift aesthetics can be performed surgically (brow lift surgery, reverse brow lift surgery), with the help of specially designed threads or with non-invasive methods (Botox injection). In this section, surgical methods will be discussed. The position of the eyebrows can be changed with incisions made from inside the hair or from the upper eyelid. In the physical examination, the current position of the eyebrows is evaluated, and the places where the eyebrows should be mutually determined.

In brow lift surgery (“temporal brow lift”), an incision is made through the hair. From these incisions, suture threads specially produced for eyebrow lifting, are advanced and the eyebrows are fixed by hanging them in the desired position. Reverse brow lift surgery (“transpalpebral internal browpexy”) is generally preferred if upper eyelid aesthetics will also be performed. In this method, the eyebrows are reached in the same operation without an extra incision, and the eyebrows are fixed by suturing them to a higher position.

These procedures can be performed under local anesthesia, sedation or under general anesthesia. The duration of the procedure is approximately 30 minutes. After the procedure, there will be stripes in the eyebrow and forehead area. These stripes are important in fixing the eyebrows to their new position, reducing edema and pain. There is no need for special dressing or corset after the procedure. You can take a shower 2 days after the procedure. Pain, edema and bruising are minimal. In the 1st week control your stripes will be removed, and the new position of the eyebrows will be evaluated. The recovery period is very short, and the rate of significant complications such as nerve damage is very low. The visibility of the scars in the hair and in the eyelid crease will decrease over time and these scars will be hidden.

Permanence varies depending on age, genetic factors, the method, and the quality of the products used. Eyebrow lift aesthetics satisfies patients for a long time, but it should be noted that gravity and aging continue, so it will not be realistic to expect the eyebrows to remain in the same position for many years. It may need to be repeated in the coming years.

What is almond eye aesthetics and how is it done?

In normal eye anatomy, the outer edge of the eye, called the “lateral canthus”, should be located 1-2 mm higher than the inner edge of the eye, called the “inner canthus”. If the outer edge is located lower genetically / structurally or with aging, the person will have an older and tired look. Almond eye (cat eye) aesthetics is preferred to obtain more lively, larger and attractive looks at younger ages

or to obtain a younger look by combining it with other procedures that can be applied around the eyes in middle ages.

In “cantopexy” operation, a small incision is made on the outer edge of the upper eyelid. With the help of this incision, the “lateral canthal tendon” on the outer part of the eyelids is reached and this structure is fixed by suturing to a point above and outside. Therefore, an almond shape is given to the corner of the eye. In the thread suspension method, no incision is made. The outer edge of the eye is suspended with the appropriate method and positioned above and outside from its current location.

These procedures can be performed under local anesthesia, sedation or under general anesthesia. It takes an average of 30 minutes. When the procedures are finished, special bands (strips) are placed to fix the new position. You can be discharged after the procedure. After 2 days, you can take a shower over the bands and return to social life. Pain is not expected. The bands placed around the eyes are removed after 1 week. Almond eye aesthetics can be considered as a permanent procedure, but permanence varies depending on age, genetic factors, the method, and the quality of the products used. Almond eye aesthetics satisfies patients for a long time, but it should not be forgotten that gravity and aging continue, so it will not be realistic to expect the eye edges to remain in the same position for many years. It may need to be repeated in the coming years.


Blepharoplasty and periocular rejuvenation techniques are surgical procedures with a high rate of happiness. With correct planning, correct technique selection and good patient-doctor communication, they provide a rapid recovery time and make the person look younger, healthier, and more aesthetic. However, these procedures should not be considered as “simple”. It should not be forgotten that these procedures are surgical operations and the doctor’s recommendations should be followed. You can browse the related articles in the References section. Best regards.