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Age-defying, restorative surgery for the upper eyelid region

We’ve all come to associate a bright-eyed, confident appearance with happiness and youth, but that look is the first to go when it comes to aging. A youthful upper eyelid has very little excess skin around the eyelid, and there is a smooth layer of fat that contours around the bony orbital rim, giving a soft appearance to the superior orbital rim and infrabrow region.

Through younger years, the lateral (outer) aspect of the eyelid is free of hooding, and the supratarsal crease should be clearly visible with a corresponding degree of lid below the crease (this is the space where women apply eyeshadow).

Aging of the upper eyelid involves development of excess skin (dermatochalasis) and volume loss. With age, this extra skin crowds the eyelids and decreases the amount of upper eyelid that can be seen.

The volume loss beneath the eyebrows and upper eyelids results in skeletonization of the superior orbital rim, leading to a hollow, boney appearance. In some cases, there may be mild bulging of a fat pad, which is often unmasked as a result of the regional volume loss.

The ideal surgical candidate is a patient of any age group that exhibits redundant upper eyelid skin to a degree that it is negatively affecting the individual’s appearance. It’s difficult to feel like your confident and best self when your age is showing through your eyes.

The upper lids may appear “tired” and, in some extreme cases, impact the lateral visual field. Younger patients affected by familial blepharochalasis (extra eyelid skin formation) often benefit from upper blepharoplasty between the ages of 20 and 40 years old, but the typical “aging face” patient will benefit from surgical excision once 40 years or older.


Is upper eyelid blepharoplasty right for me?

If you’re looking for these results, upper eyelid blepharoplasty may be your best option:

  • Youthful, natural-looking eyes
  • Removal of heavy, hooded extra skin in upper eyelids
  • Elimination of boney and skeletonized look around eyes
  • Changing your haggard, tired, or aged appearance

Advantages of the upper eyelid blepharoplasty with Dr. Karam

  • Natural-looking results
  • Direct treatment of the change resulting from aging
  • No change in appearance, look or identity
  • Changes leave eyes looking refreshed and youthful
  • Low complication rate
  • Performed comfortably under local anesthesia with IV sedation
  • Short recovery
  • Minimal to no discomfort
  • Long lasting results (10+ years)
  • Convenient San Diego practice location

Complementary combinations to achieve a comprehensive rejuvenation

The upper eyelid blepharoplasty is commonly combined with the lateral brow lift and fat transfer to create a balanced and truly restorative eye rejuvenation.

When the lateral brow begins to descend, it causes crowding and heaviness around the outer upper eyelid area. This hooding cannot be treated with the upper eyelid blepharoplasty alone, but requires the lateral eyebrow to be lifted to open up the corner of the eyes, followed by an upper eyelid blepharoplasty to remove the excess eyelid skin. This is a common combination when both aging changes are happening simultaneously.

Hollowing and volume loss around the temple, upper orbital rim and around the eyes and cheeks are often simultaneously treated with fat transfer to restore the fat loss and create a truly rejuvenated appearance that hearkens back to the fullness of youth.


Perhaps one of the biggest advantages from a safety standpoint is that these procedures can be performed under local anesthesia with IV sedation. With this technique, patients are comfortable and moderately sedated. Most patients choose this method to avoid any of the risks associated with general anesthesia. For those patients who do prefer general anesthesia, our facility is fully-equipped for general anesthesia.

Procedures are performed in our accredited and certified (JCAHO) surgical center, Carmel Valley Surgical Center, located within the suite. The San Diego center offers the highest level of safety and state regulations for outpatient surgery.

Highly-trained and experienced surgical techs, medical assistants, nurses and a board-certified anesthesiologist all work together to create the safest and most comfortable experience possible.

Carmel Valley Surgical Center hosts two state-of-the-art surgical suites and a recovery center. The rooms are equipped with only the best equipment and instruments, and the center also has a separate entrance and exit from the main office, which allows our patients to undergo procedures in privacy. Your comfort is always our priority during these surgical procedures.

Post-procedure care

Following surgery, ointment is applied to the incisions. Patients return to the comfort of their home or hotel room. A cool compress is used to reduce swelling for the first two days following surgery.

Lubricating drops are used during the day and ointment is used at night to help keep the eyes moist and protected from drying. Antibiotic ointment is used on the incisions for one week.

At one week, sutures are removed in the office. At this point, swelling is starting to resolve rapidly. Follow-up appointments are made at one month, three months, six months and one year to monitor healing and make sure all questions are answered.


Recovery is primarily related to swelling. Bruising is not commonly seen in our patients, although it is a possibility. The typical recovery takes between 10 and 14 days. We recommend planning two weeks off of work or social engagements to allow sufficient time to heal.

Although healing is not completely finished by two weeks, most patients are sufficiently healed and can return to work and other occasions. Minor swelling continues to improve steadily for up to one year following the procedure. Exercise is resumed between three to four weeks following surgery, depending on the nature of the activity and the degree of swelling involved.

What to expect from your comprehensive upper eyelid rejuvenation

There are a variety of positive results you can expect from your upper eyelid blepharoplasty and complementary procedures, including:

  • A natural-looking and youthful appearance
  • The elimination of hooding and heaviness of upper eyes
  • A full and healthy upper lid complex (no longer skeletonized, harsh or bony)
  • Long-lasting outcomes that look like your genuine, younger self

Why choose Dr. Karam for your upper eyelid blepharoplasty?

An average board certified plastic surgeon performs approximately 20 eyelid procedures annually. Dr. Karam, on the other hand, performs over 350 every year.

Extensive experience translates to more natural results, more consistency and less variability, plus a distinct knowledge of different ethnicities and facial types and how to change the techniques to best suit the particular facial structure. Dr. Karam’s careful and intentional approach ensures that no one changes their identity, but rather simply looks refreshed and youthful.

Dr. Karam’s comprehensive approach, which involves combining these procedures with others, results in synergistic effects. The entire face looks naturally and vibrantly youthful, rather than hosting a single, unnatural element.

In his textbook, Rejuvenation of the Aging Face, Dr. Karam describes his approach to facial rejuvenation and eye rejuvenation in order to teach the ingenious technique to other surgeons and colleagues.

Dr. Karam’s expertise in the subject has also prompted him to write a number of book chapters and scientific articles on facial plastic surgery topics, including upper and lower eyelid blepharoplasty, fat transfer and rejuvenation of ethnic-specific (for example, Asian) groups.

And perhaps most importantly, Dr. Karam’s caring demeanor, good patient communication skills and responsive and knowledgeable staff ensure you’re always comfortable and informed. It’s these particular skills that have earned Dr. Karam the trust to perform these procedures on his medical colleagues and their families.

Planning your consultation

During the consultation, your expectations will be discussed and a personalized treatment plan will be proposed after careful examination and discussion of your goals. The basic criteria for the timing of this procedure is dependent on two factors: first, whether there is enough skin excess to justify the procedure, and second, the patient’s readiness to move forward.

The average patient defines the changes seen in their 40s as a point where comprehensive eye rejuvenation would make a positive difference. In general, the earlier the better. The advantages of performing the surgery sooner are that the changes are less dramatic and subtler, and the results last longer.

Before & After

Dr. Karam, who is board certified by the American Board of Facial Plastic and Reconstructive Surgery and American Board of Otolaryngology, offers services in San Diego County including San Diego, Del Mar, Carlsbad, Carmel Valley, Encinitas, Rancho Bernardo and La Jolla in Southern California.

If you are ready to schedule an appointment with Dr. Karam, contact us today.

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