Eyelid Surgery (NatraEye Blepharoplasty)

Dr. Philip Miller performs upper and lower blepharoplasty under the NatraEye methodology from his Midtown East Manhattan practice. Upper eyelid surgery removes redundant skin and herniated fat to restore an open, refreshed appearance, and may qualify for insurance coverage when functional field obstruction is present. Lower blepharoplasty addresses under-eye puffiness from prolapsed orbital fat and fine skin crepiness. Procedures last approximately one to two hours, with most patients resuming light activity within seven to ten days and applying make-up from day five. Exercise may be resumed at three weeks.

Eyelid surgery at Gotham Plastic Surgery follows Dr. Philip Miller's NatraEye approach, which prioritises subtle, well-balanced periorbital rejuvenation rather than overcorrection that can leave the eyes looking hollow or startled. Dr. Miller's exclusive focus on the face for more than 20 years, combined with double board certification spanning facial plastic and reconstructive surgery and otolaryngology, gives him a nuanced understanding of periorbital anatomy — the orbital septum, fat compartments, levator mechanism, and canthal tendons — that underpins safe and aesthetically refined blepharoplasty. Upper blepharoplasty addresses the accumulation of redundant eyelid skin that occurs as the brow descends and skin loses elasticity with age. Mild cases may present primarily as a heaviness of the upper eyelid; more advanced cases result in the overhanging skin draping over the eyelid margin and obstructing the superior visual field — a functional impairment that can be documented with formal visual field testing and may qualify the procedure for partial insurance reimbursement. The surgical technique involves a precisely placed incision within the natural upper eyelid crease, allowing the resulting scar to be concealed within the fold. Calculated amounts of excess skin and orbicularis oculi muscle are excised, and prolapsed fat from the medial and central orbital compartments is conservatively reduced or repositioned. Preserving adequate eyelid skin is essential to avoid post-operative lagophthalmos. Lower blepharoplasty targets the three compartments of lower eyelid fat — medial, central, and lateral — that herniate through the orbital septum with age, creating the bulging appearance of under-eye bags. The transconjunctival approach, performed entirely through the inner eyelid surface without any external incision, is preferred for patients with good skin tone whose primary concern is fat prolapse; the fat may be conservatively excised or, more commonly, repositioned over the orbital rim to simultaneously fill the adjacent tear trough hollow, avoiding the skeletonised appearance that results from over-aggressive fat removal. For patients with concurrent lower eyelid skin excess or fine crepiness, a subciliary external approach with conservative skin pinch resection is used. Blepharoplasty at the practice is frequently combined with brow lift surgery, facelift, or both when a more comprehensive facial rejuvenation is planned, reducing the patient's total number of anaesthetic events and recovery periods.