Eyelid Surgery

Some of the most common types of eyelid surgeries that Dr. Burroughs performs are:

• Upper eyelid surgery for cosmetic and reconstructive purposes, primarily for anti-aging to remove excess hanging skin or bulging fat.
• Droopy (ptosis) eyelid surgery to correct an upper eyelid that hangs low over the eyes to open them wider providing a refreshed, alert, and younger appearance.  Ptosis surgery can also dramatically improve one’s peripheral vision as well.
• Lower eyelid surgery can restore a youthful and beautiful eye shape, texture, and contour.  Other times it is done to help raise up the lower eyelids or restore their optimal positioning and shape against the eye surface.   This can also improve eye dryness, redness, and irritation.
• Double eyelid surgery, most commonly performed in Asian patients, helps create a skin fold or crease in “mono” eyelids that did have them.  This can improve the aesthetic and restore a more youthful appearance.

The average cost of cosmetic eyelid surgery varies, based on the nature of the procedure and the degree of correction that is needed. Eyelid surgery varies from patient to patient and best results are achieved through customized planning, incision making, and sometimes with additional adjunct procedures (e.g., fat grafting, laser skin tightening). Dr. Burroughs is amongst the most experienced eyelid and facial plastic surgeons in Colorado, and teaches at both national and international symposia. Oftentimes, cost is not as significant as many would guess given that the cosmetic surgeries and procedures performed at Dr. Burroughs’ office are all inclusive and known up front without additional anesthesia or surgical center or hospital fees that can run in the several thousand dollars. Additionally, postoperative procedural adjunct treatments are most often included (e.g., IPL bruise treatments, lymphatic massage, LED Red Light) at no additional cost for cosmetic treatments and available at reduced cost for insurance patients that may wish to have them. These post adjunctive procedures can speed healing and “getting back out into public.”

• Blepharoplasty
  • Dr. Burroughs is well-known for his expertise in blepharoplasty and ptosis surgery procedures and has authored textbook chapters and is an internationally invited speaker to teach his advanced techniques.
• Ptosis Surgery

Typically eyelid surgery does not hurt, and discomfort afterwards can be treated with tylenol and more rarely stronger medication if needed for a few days. Dr. Burroughs cares about patient comfort and employs many techniques to improve patient comfort.  In addition, to sedation, Dr. Burroughs has mastered injection techniques to include: “distractesia,” that reduces injection discomfort by such methods as tapping or vibration during injections that “silence out” the discomfort (gate theory mechanism); diluted and/or buffered local anesthetic prior to stronger anesthetic to make the first injections more comfortable; slow and precise injections; employing Pro-Nox nitrous oxide (“laughing gas”); utilizing long-lasting and alternative local anesthetic customized to an individual’s needs; and use of ice/coolness prior and during injections. Most cosmetic eyelid surgery is done by Dr. Burroughs in his office operating rooms under local with oral or IV sedation.

Recovery from eyelid surgery varies and final results may take between a few months to a year. Dr. Burroughs operates on many professionals and even fellow physicians and surgeons, so his technique protocols are designed, beyond achieving the intended results, to expedite healing and return to normal activities.  Many patients can comfortably go out in public by a week after surgery especially if LidLift compression goggles are used to reduce bruising, rebleeding risks, and swelling. During the first days, you may have reduced use of your eyes and your vision may be blurred while using special eyedrops or ointment.  After a few days, many patients can read, use their computers, and drive themselves.  Much of this depends upon severe swelling that can oftentimes be mitigated by carefully avoiding blood thinning medications, herbals, supplements, vitamins, and even alcohol prior to surgery. Antibiotics may be rarely prescribed to protect against infection. We will outline before and after care prior to the time of your eyelid surgery to optimize safe and quick healing.

• Aged or other unattractive eyelid issues such as sagging or wrinkled skin, ptosis (drooping), displeasing contours, and other eyelid or periocular concerns from areas of fat atrophy or excess.
• Entropion/Ectropion are disorders of the eyelid in which the lid turns inward or outward respectively. Both conditions typically develop in the lower eyelid. Oculoplastic surgeons, like Dr. Burroughs, are the most experienced in surgically improving these eyelid malpositions to avoid eye discomfort, eye damage, and even vision loss.
• Dry Eye may be a temporary or chronic condition that can lead to complications when left untreated. Dry eye can be managed with optimizing the best ocular surface lubricants, minimally invasive with punctal (tear drain) closure, IPL treatments to improve oil gland dysfunction providing healthier tears, and surgical eyelid improvements to improve eyelid blinking and coverage over the eyes.
• Eyelid Reconstruction
  • Eyelid reconstruction may be beneficial simply by removing excess skin impacting vision or be needed after facial trauma or as part of a skin cancer removal treatment plan.  Dr. Burroughs also performs scar revision surgery and procedures.
• Skin Cancer Removal
  • Dr. Burroughs has extensive experience performing eyelid and facial skin cancer removal and reconstruction that preserves or restores the aesthetics of the treatment area.

In nearly all cases of upper eyelid blepharoplasty surgery, there is excess skin in the upper eyelids, so removal of extra skin is only possible with an incision. Fortunately, the skin of the upper eyelid is the thinnest skin in the body and typically heals with little to nearly invisible scarring over time. Further, the incision site can be hidden in the fold of the upper eyelid allowing the incision to be hidden while healing. The incisions usually have to extend to the lateral crows feet area to avoid unwanted excess skin at the outside corners of the eyes. When a brow or forehead lift is performed, the incisions do not typically need to extend as far into the crows feet.

Dr. Burroughs has used lasers, steel and diamond scalpel blades, bovie (electric needles), and radio frequency needles. His preference is to make the incision with a scalpel blade or with an electric (bovie) needle set at a low setting to optimize the wound shape and architecture while minimizing collateral heat damage that other modalities can cause. Once the initial skin incisions are made, depending on the circumstance and patient needs, the other modalities can be used. One problem with lasers is they can instantly become uncalibrated, causing the incision to be inaccurately placed, and they also can cause heat damage that leads to slower wound healing and, rarely, more scarring. Dr. Burroughs advocates for incisions to be made lower on the eyelid than many surgeons that just put them wherever a crease is present. Dr. Burroughs’ incisions heal more hidden and are designed to create a new more youthful and aesthetic crease, which can change as we age or acquire ptosis. Further, it is not widely known by all surgeons performing eyelid surgery that upper eyelid incisions migrate upward with time, so he often has corrected incision scars by other surgeons that were placed excessively high to begin with and only worsened and became more visible over time.

Dr. Burroughs finds eyelid wounds heal cosmetically better and faster with non-dissolving sutures that are removed between 7-14 days after surgery. Dissolvable sutures “dissolve” by causing local inflammation and can sometimes leave the incisions looking more red and “bumpy” in the initial phases of healing. Dr. Burroughs also finds that performing a “running” suture to be easier on patients for removal than a series of interrupted sutures that must be individually removed one at a time. He often will put a few interrupted dissolving sutures that fall out usually by 10-14 days as “safety” sutures to mitigate against accidental wound separation after the regular sutures are removed.

Aesthetic-minded surgeons tend to leave as much fullness in the upper eyelids as possible. Removal of too much fat from the upper eyelids can give a hollow appearance that is not desirable and aged-appearing. Often the fat pad in the upper eyelid adjacent to the nose is bulging forward and is cosmetically reduced in size or shifted to smooth the contours, at the time of upper eyelid blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow appearance. Most patients benefit with removal of the excess skin while leaving the underlying muscle, which can be helpful in older patients or those with pre-existent muscle weakness before surgery as this muscle is important for proper eyelid closure and blinking. Sometimes, a small amount of lateral eyelid muscle is removed to: reduce the crows feet appearance; provide a stabilization to the brow position and sometimes even a subtle and pleasing brow elevation can be achieved; and to smooth the outer lateral interface between the upper and lower eyelids.

Yes, they can be improved but never completely eliminated as the deep dermal attachments may have become permanent. There are several options to include wrinkle blocker, laser resurfacing, filler, fat grafting, and surgery to improve these areas. Dr. Burroughs published in 2006 an article in the Archives of Facial Plastic Surgery Journal, detailing a technique to address these concerns at the same time as upper blepharoplasty surgery.

Yes. It is very common for patients to have surgery done to improve function simultaneously as cosmetic surgery. A famous architectural quote by Louis Sullivant (1856-1924) is “form follows function,” but a plastic surgery reality is that “function follows form” as well. They are both important. Most of Dr. Burroughs’ surgery is cosmetic, but any portion(s) of the surgery done to improve eyelid function and eye comfort may possibly be covered by one’s insurance if the strict medical criteria is met and coverage is available.

Many other procedures can be done just before, during, or after your upper eyelid surgery. This can include wrinkle blockers (neuromodulator botulinums), chemical peels, and fillers. Additionally, through an upper eyelid incision, Dr. Burroughs can gently raise the eyebrows, improve eyebrow shape, reduce the wrinkle lines between the eyebrow, improve frontal area headaches, raise the lower eyelids, and improve the crows feet areas. There are timing issues that may impact surgical planning and results that will be discussed at the time of your consult. Some important factors include but are not limited to botulinum injections still impacting muscle function in the forehead or eyelids and if filler has been injected into the lower eyelid tear troughs or upper cheeks. Filler can remain in the lower eyelids for many years and impact the results and significantly prolong healing after lower eyelid surgery.

Yes. It is optimal when medically appropriate (you can see well enough to function) to have eyelid surgery first. Very rarely, eyelid surgery can change one’s vision and cause the need for glasses or an adjustment to one’s glasses or contact lens prescription. Usually by 4-8 weeks, the eyes are stable and no further refractive (eyeglass) changes occur. It is quite rare for major shifts to occur, but because both laser and cataract surgery depend upon very accurate and stable preoperative measurements, it is best if one is thinking of doing refractive/cataract eye surgery and eyelid surgery to do the eyelid surgery first. If you have already had laser (e.g., Lasik) or cataract surgery performed, then generally no substantial visual changes will occur, but there is a slight risk of change. Patients that have had prior laser surgery are at a higher risk for dry eyes, which can be exacerbated following eyelid surgery and need to be carefully monitored during healing. Typically, it is safe to do eyelid surgery 6-12 months, sometimes earlier, after cataract or laser refractive eye surgery has been performed. Dry eyes can happen in any patient after laser eye, cataract, and eyelid surgery. Therefore, it is important to have a plan to address these issues should they arise and Dr. Burroughs often assesses for even subtle early dry eye problems in all his patients as their healing and postoperative comfort is imperative. His ophthalmic background helps him help his patients in this regard. For most plastic surgeons.

This varies from patient to patient, but it may be made either in the upper eyelid, the lower eyelid, or at the temporal hair line. You should discuss this with Dr. Burroughs during your consultation. Dr. Burroughs typically explains himself or his staff the locations and shapes of incisions. Dr. Burroughs often sketches on paper his incisions placement and shows with a mirror or with their photos to his patients during consultations.

This varies from patient to patient and their desired goals. Generally, if the eyebrows are resting at or below the orbital rim, then some form of brow or forehead lifting will be required for the best and longest lasting result. Dr. Burroughs discusses this during your consultation. Rarely, browlifting can be medically necessary, but complete forehead lifts are cosmetic. The benefit to a forehead lift is that the incisions are often hidden behind the hairline and can smooth the forehead rhytids (lines) and improve brow shape and contours.

Asian patients have different anatomy than occidental patients. Some Asian patients are born with a fold in the upper eyelid and others are not. When the fold is present, it is called a double eyelid. The absence of a fold is sometimes referred to as a mono-lid. The fold in the upper eyelid of Asian patients is much nearer to the eyelashes than it is in the occidental eyelid. It is often said that Asian patients wish to have their eyelids “westernized.” In Dr. Burroughs’ experience, most Asian patients seeking double lid surgery want their eyelids to look like Asian patients born with an eyelid fold and not be westernized or made to look like they have occidental eyes. This form of cosmetic eyelid surgery is performed by Dr. Burroughs. If you are considering this type of surgery, it is helpful to bring a photograph of a model with the appearance you hope to achieve, so that this can be discussed and decided if it may be safely and reasonably achieved. Dr. Burroughs’ stepmother is Korean, and while he was still in the Air Force, he performed blepharoplasty surgeries particularly on Filipino and Korean patients. He has also surgically treated patients over the last 20+ years from Japanese, Chinese, Taiwanese, Cambodian, and Vietnamese descent.

Yes, but this is usually a temporary issue that improves greatly upon suture removal in most cases. The upper eyelids are central to form and to visual function. Removal of too much skin from the upper eyelids does not look natural and can cause problems with lid closure. Additionally, Dr. Burroughs wants all his cases to look natural and better after surgery, so he preserves the majority and oftentimes all of the orbicularis eyelid muscle so that aesthetic fullness is maintained and the muscle that closes the eye is left to function normally. Dr. Burroughs carries a board certification in ophthalmology and subsequently trained 2 years in eyelid and facial plastic surgery, so he is acutely aware of the need for the lids to both look and function normally after cosmetic eyelid surgery. The most serious complications of facial cosmetic surgery occur with eyelid surgery. Some patients with medical issues such as weak facial muscles require an even greater concern for properly performed eyelid surgery to enable the best and safest result. In the early stages of healing, sometimes the eyelids will not completely close, but after the sutures are removed, generally the skin loosens up and muscle strength returns allowing full closure of the eyelids. During this time, utilization of artificial tears, gels, and ointments can improve eye comfort, appearance, and vision.

Recovery varies by the exact procedure(s) performed and the individual patient. Generally, eyelid surgery is minimally painful but results in some bruising and swelling. Patients should plan on being home on the day of surgery and for two additional days. During these first few days, lid compression goggles will be recommended and provided for all cosmetic eyelid surgeries to reduce swelling, bruising, and risk of wound rebleeding or separation. After 2-3 days, the goggles are worn only while sleeping for the first week. If the compression goggles are not utilized, then cool compresses are applied to the eyelids to reduce bruising and swelling. After the third day, many patients can drive a car and get about easily on their own. Postoperatively, patients should avoid heavy lifting and strenuous exercise for 10-14 days after their procedure. The lid goggles improve healing by 3-4x, and most patients have minimal bruising or swelling by a week as compared to 3-4 weeks when cold compresses are done instead. Another advancement to speed the recovery process and decrease rebleeding risks, is the use of a medication (tranexamic acid) that can be given orally, IV, topically, or injected in the local. It also has some anti-inflammatory properties, and many patients hardly bruise as compared to times past when it can be used. Dr. Burroughs was amongst the first plastic surgeons to introduce its use in facial plastic surgery, and shared his multi-year findings at his 2021 subspecialty meeting to help other surgeons be aware of its benefits for their patients. Dr. Burroughs and his team will discuss and provide you with detailed written instructions prior to your procedure. A safe, comfortable, and expeditious healing is of highest priority so we provide the information and “coaching” to help you achieve this.

Yes. All medical and surgical procedures carry risk. You should discuss the risk of complications with your doctor prior to surgery so you can make an informed decision on how to proceed. Many patients select Dr. Burroughs for their surgery because of his ophthalmic background and extensive experience as they believe the risk of complications with cosmetic eyelid surgery may be lessened when performed by a surgeon with special plastic surgery training of the eyelids and who is extensively trained and vastly experienced in performing these procedures. A careful ophthalmic history and exam is critical before any eyelid surgery. Each year, Dr. Burroughs often is the first to diagnose eye and other health problems prior to surgery that could cause suboptimal results, healing, or worse yet vision loss or even loss of life whether surgery was performed or not. Dr. Burroughs will appropriately refer to the most appropriate eye or other specialist if he detects a problem that needs to be addressed prior to eyelid or facial surgery. Nothing is more important than your overall health, and Dr. Burroughs wants his patients to thrive in every manner possible. He aims to practice every day as a “doctor” before and alongside as a “plastic surgeon.” Further, protecting the eyes is second nature to him as he has operated inside, upon, and around the eyes for nearly 30 years.

Insurance will sometimes pay, less copays and deductibles, for certain eyelid surgery that is performed to improve vision or eye health. For instance, if your upper eyelids are drooping and this is blocking your vision, your insurance company may pay for upper eyelid surgery. Insurance coverage requires standardized medical photographs be performed to ensure patients are looking in primary straight-ahead gaze, without head tilt, and aren’t squinting. Flash photography is required to evaluate that the lid margin to pupillary reflex is congruent with the recorded chart measurements. The photos are so important that they will deny coverage if the photos don’t show findings consistent with what the visual complaints, visual field results, or measurements reported. If the upper eyelids are blocking vision, insurance companies generally require a visual field test be obtained to demonstrate that the eyelids block the peripheral vision and that the vision is improved by elevating the eyelids. These are reviewed by the insurance company during the preauthorization process.

If your lower eyelids are droopy and this is causing eye irritation or watering of the eyes, your insurance company may pay for correction of this problem. Some problems like wrinkles, swelling or lower eyelid bags, that do not affect vision, are not covered by insurance companies. Again, some problems like excess upper eyelid skin impeding vision may be paid by insurance when first and most importantly the photographs demonstrate medical necessity and secondary testing and measurements are corroborative. Dr. Burroughs’ office can act as your advocate to provide your insurance company the information to confirm medical necessity if the criteria are met. Most of the procedures he performs are done to improve appearances, and these cosmetic procedures are not paid for by your insurance company and will not be submitted to insurance. During your consultation, Dr. Burroughs will determine what procedures will offer the best cosmetic and if any medical benefit and discuss the range of options as these vary from patient to patient.