The patient is a 63 year old woman who noted excess upper lid skin folding and some wrinkling of the lower eyelid and adjacent Crow’s foot area. There were no “fat bags” of the lower lid but the patient noted some dryness of her eyes and she used liquid tears in the morning and evening. She had Botox in the past but felt that more recently the Botox was not as effective as it had been. 

The patient had a conservative upper eyelid surgery (upper blepharoplasty) with laser treatment of the lower eyelid and Crow’s area. She was very happy with her cosmetic result and there was no worsening of her dry eyes. She found it much easier to wear makeup and found her makeup lasted longer and fewer applications were required. 

Eyelid Surgery and Patients with Dry Eyes

As we all age, there is a decrease in the amount and quality of tears that lubricate and protect the eye. Upper lid surgery can further decrease the beneficial effect of the tear film if too much skin is removed. Patients with dry eyes can still have upper eyelid surgery (upper blepharoplasty) but it must be performed more conservatively (less skin can be removed). Despite this conservative approach, significant improvement can be achieved and patients can “look a lot better”. 

Eyelid surgery cost is the same with the conservative approach and healing time is also about the same as with conventional upper lid surgery.  

When the laser is used to treat wrinkles within the lower lid, there is also some tightening of the lower lid but this generally is not associated with dryness of the eye. That is important to remember when comparing laser treatment of the lower lid with lower eyelid surgery which can have an effect on lower lid function, especially when it is done with the external or flap technique (lower blepharoplasty). It is rather better to approach the removal of the fat pads from inside the lid when patients have dry eyes and to use the laser to tighten the skin.