Upper blepharoplasty, also known as eyelid surgery, is a procedure that removes excess skin, muscle, and fat from the upper eyelids. The goal is to improve vision obstructed by sagging upper eyelids and create a more youthful, rested eye area. As part of the aging process, the eyelid skin stretches, and the muscles supporting the eyelid weaken. The fat around the eyes also descends, causing the upper eyelids to sag. While blepharoplasty improves the appearance of the eyelids and periorbital region, some patients wonder if the eye shape itself is altered by the procedure.
What is the eye shape?
The eye shape refers to the visible part of the eye when looking directly at someone. This includes the palpebral fissure length, which is the distance between the inner and outer corners of the eye, and eye height, which measures from the upper to lower eyelids. The palpebral fissure slant, whether the eyes tilt up or down at the outer corners, also impacts overall eye shape. Round, almond, downturned, and upturned are some of the common eye shapes. The shape of the eye opening and placement of the eyes on the face are distinguishing characteristics that comprise an individual’s eye shape. Genetics primarily determine one’s eye shape, but aging changes can alter it over time.
Does blepharoplasty change eye shape?
Upper blepharoplasty does not significantly alter the fundamental eye shape. The procedure focuses on removing excess upper eyelid skin, fat, and muscle. Only tissue in excess is excised or repositioned. Surgeons take care to preserve enough bulk and structure to avoid an unnatural hollowness or flattening of the upper eyelid region. When performed properly and conservatively, patients maintain their natural eye shape with blepharoplasty. The goal is a refreshed, well-rested version of the eyes, not a dramatic change in appearance.
Are there exceptions?
There are a few exceptions where blepharoplasty may subtly change some aspects of eye shape:
Canthal tilt
The lateral canthus refers to the outer corners of the eyes where the upper and lower eyelids meet. Some patients have a natural downward slant to their lateral canthi. During upper blepharoplasty, surgeons can make small adjustments to rotate the lateral canthus slightly upward. This minor change can give the illusion the eyes appear less droopy. However, this will not significantly change the palpebral fissure slant if the downturned eyes are a genetic trait.
Scleral show
Many patients seek blepharoplasty to reduce scleral show, which is the exposed white area beneath the iris. Excess upper eyelid skin can hang low and limit the visible iris, increasing scleral show. Removing this excess skin raises the upper eyelid, revealing more of the colored portion of the eye. This adjustment may subtly enlarge the visible iris size.
Eyelid creases
The upper eyelid crease refers to the fold where the movable eyelid meets the forehead skin. Some patients have no visible crease, a low crease, or more than one crease on each upper lid. During blepharoplasty, surgeons can create a single upper eyelid crease at a desirable height to open up the eyes. This enhances the framework around the eyes but does not fundamentally change the eye shape.
Are there surgical techniques that do change eye shape?
There are more invasive eyelid surgeries that aim to reshape the eyes:
Canthoplasty
This targets the outer corners of the eyes to elongate the palpebral fissure and create a wider eye shape horizontally. It is often combined with blepharoplasty.
Eye width enhancement
Incisions made at the outer canthi can move the corners laterally for wider-set eyes. Fillers may also be used.
Levator muscle resection
This lifts lowered eyelids by tightening the levator muscle. It can raise droopy eyelids for a rounder, more open look.
These techniques directly modify eye shape but have longer recovery periods and visible scarring. Traditional upper blepharoplasty is less invasive and creates a refreshed version of the natural eye shape.
What about lower blepharoplasty?
Fixing baggy lower eyelids via lower blepharoplasty does not significantly impact eye shape. The lower portion of the eyes is not a major determinant of eye shape. Lower blepharoplasty primarily removes under eye bags, excess skin, and wrinkles on the lower lids. The midface tissues around the lower eyelids can descend with age, so repositioning these during lower blepharoplasty can create a subtle lift. But the palpebral fissure length and other metrics that define eye shape remain unchanged.
Can blepharoplasty be customized to alter eye shape?
While standard blepharoplasty preserves natural eye shape, surgeons can customize the procedure for patients who want more dramatic changes. This may involve:
- Modifying lateral canthi position to slant eyes up or down
- Narrowing or widening the palpebral fissure
- Raising or lowering the crease height
- Adding eyelid fillers to augment certain areas
These personalized techniques can reshape the eyes. However, they involve more complex planning and often leave visible scarring at the lateral canthi. Patients may also look very different from their natural eye shape. Customizing blepharoplasty to significantly alter eye shape should be approached with caution.
The takeaway
Standard upper blepharoplasty focuses on removal of excess eyelid skin, muscle, and fat. The goal is to “turn back the clock” and restore a youthful, vibrant eye area. Experienced surgeons take a conservative approach that preserves the patient’s natural eye shape. Minor improvements, like smoothing eyelid creases or lifting the lateral canthus slightly, may occur. But blepharoplasty will not drastically alter the unique eye shape determined by genetics and ethnic background. Those desiring significant reshaping of their eye geometry require customized techniques that are more complex and risky. When considering blepharoplasty, be realistic about outcomes and maintain your naturally beautiful eyes.
References
- American Academy of Ophthalmology. Eyelid Surgery. Accessed August 14, 2022. https://www.aao.org/eye-health/treatments/eyelid-surgery
- American Society of Plastic Surgeons. Eyelid Surgery. Accessed August 14, 2022. https://www.plasticsurgery.org/cosmetic-procedures/eyelid-surgery
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