Eyelid Surgery (Blepharoplasty)

Westlake Dermatology's West University Houston plastic surgeons perform upper and lower blepharoplasty to address excess eyelid skin, drooping upper lids, under-eye fat pad prolapse, and tear trough hollowness. Upper blepharoplasty removes redundant skin from the upper eyelid through an incision in the natural crease, restoring a more open and alert eye appearance. Lower blepharoplasty addresses under-eye puffiness via a transconjunctival approach (no external scar) or excess skin removal via a subciliary incision. Fat repositioning corrects tear trough depression without volume loss. Frequently combined with facelift for comprehensive periorbital and facial rejuvenation.

Blepharoplasty at Westlake Dermatology West University Houston addresses the periorbital region — often the first area of the face to show visible signs of biological ageing — through precise surgical removal or repositioning of excess skin, muscle, and fat in the upper and lower eyelid zones. Upper eyelid blepharoplasty begins with a pre-operative marking in the natural supratarsal crease — the fold that appears when the upper eyelid opens — at which the elliptical incision for skin and, where indicated, a thin strip of orbicularis oculi muscle is placed. The resulting scar falls precisely within the crease and becomes imperceptible as it heals over four to six weeks. The amount of skin removed is carefully calculated to restore an open, refreshed upper eyelid platform while preserving adequate skin for full, complete eyelid closure — under-resection leaves residual heaviness; over-resection risks lagophthalmos (failure to fully close the eyelid), which has consequences for corneal health. Prolapsed medial and/or central orbital fat pads are excised or repositioned to eliminate internal eyelid fullness. Where brow descent is a significant contributor to upper eyelid skin redundancy — a common presentation — the clinic's surgeons may recommend addressing the brow position concurrently through a brow lift procedure rather than compensating by removing excess upper eyelid skin that is fundamentally driven by the low brow position. Lower eyelid blepharoplasty at Westlake Dermatology is performed primarily via the transconjunctival route — an incision on the inner surface of the lower eyelid provides direct access to the three lower orbital fat compartments (medial, central, and lateral), which are the source of the 'bags' or under-eye puffiness that is the most common lower eyelid complaint. The transconjunctival approach produces no external scar, preserves the structural integrity of the lower eyelid, and avoids the risk of lower eyelid malposition (ectropion) that is associated with transcutaneous approaches in patients with poor lower eyelid tone. Where the patient's lower eyelid tear trough depression creates a shadowed hollow beneath the fat pad rather than simple fat excess, the surgeon may perform fat repositioning — redistributing the prolapsed fat over the orbital rim and into the tear trough rather than excising it — to provide smooth, well-supported lower eyelid contour without the hollow appearance that simple fat removal can create. Where excess lower eyelid skin is present, a subciliary approach (incision immediately below the lash line) allows concurrent skin excision. Recovery from blepharoplasty involves bruising and oedema over ten to fourteen days, with most patients comfortable for social or professional interactions at two weeks.