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Eyelid Surgery
Blepharoplasty | Eyelid Tuck


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Eyelid surgery is a common cosmetic plastic surgery procedure that is designed to remove excess skin and fat from the upper or lower eyelids.  With time, the upper eyelids or lower eyelids begin to sag, causing premature wrinkles, a loss of normal skin tone, and excessive bulging fat.  An eyelid surgery removes the excess skin and redistributes the fat in order to recontour the eyelid area and make it more youthful.  Eyelid surgery procedures are known as blepharoplasty surgery in the medical and surgical communities and provide lasting solutions to facial aging.


Eyelid surgery can remove extra skin and fat from the upper and lower eyelids, leading to a more youthful look.


The eyelid area is a common zone of facial aging, according to Board Certified Plastic Surgeon Dr. Raffy Karamanoukian.  The eyelids age because the thin skin and hyperactivity of the orbicularis oculi muscle act in unison to form fine wrinkles around the eyes.  In addition, fat bags begin to form, leading to characteristic bulging fat in the lower eyelids and heavy eyelid hooding in the upper eyelids. Dr. Raffy Karamanoukian performs both upper and lower eyelid rejuvenation with a blepharoplasty surgery.  


The eyelid skin is one of the thinnest on the body and is prone to premature aging and droopiness with time.  Sun damage, chronologic age, and chronic inflammation can cause the upper and lower eyelid skin to wrinkle and sag.  Dr. Raffy Karamanoukian is an expert in minimally-invasive and natural eyelid surgery that maximizes rejuvenative improvement of the eyelids without looking unnatural.  Eyelid blepharoplasty procedures remove excess skin and fat from the eyelids and help tighten the skin in a natural way. 



Eyelid Surgery Los Angeles

Demonstration of technique used for lower eyelid blepharoplasty using a subciliary approach to remove excess skin and fat from the lower eyelids.  Dr. Raffy Karamanoukian is a specialist in surgical and non-surgical lower eyelid rejuvenation using laser, eyelid surgery, and laser assisted lower eyelid blepharoplasty. Image courtesy of BK Plastic.




An upper blepharoplasty can be performed with carefully placed incisions in the tarsal crease which will maximize the cosmetic results of your eyelid surgery.  The result of a tarsal crease blepharoplasty is a fine line incision that corresponds to your normal creases in your upper eyelid, thus minimizing scars.  The incisions placed by board certified Los Angeles plastic surgeon Dr. Raffy Karamanoukian will also extend laterally to incorporate the excess skin on the side of the eyelids that contribute to lateral hooding.  Both the orbital fat and excess eyelid skin can be removed with these very fine incisions. 


Dr. Karamanoukian places considerable attention and detail to the incisions used in blepharoplasty surgery.  The above photo illustrates the fine incision line that occurs after blepharoplasty surgery with Dr. Karamanoukian. Although patient characteristics differ, most incisions are barely noticeable with the naked eye.  The upper blepharoplasty incision is well-hidden within the tarsal crease, as illustrated above.  The tarsal crease provides an excellent camouflage for a blepharoplasty incision line. 



  1. Excessive skin or wrinkling on the upper eyelids
  2. Droopiness of the upper eyelids
  3. Hooding of the upper eyelids
  4. Fullness and fat bags in the most medial part of the upper eyelid
  5. Visual field obstruction (hooding that causes you to lose sight when looking upward




A revision blepharoplasty is sometimes needed when a previous blepharoplasty, on the upper or lower eyelids, has caused scarring or unnatural results.  Patients requesting revision blepharoplasty can have too little skin on their remaining eyelids and may not be able to close their eyes normall, causing a condition known as dry eye syndrome.  In some cases, the scar tissue along the eyelids is excessive, causing keloids and thickening of the incision lines.  If you are considering revision blepharoplasty surgery, Dr. Raffy Karamanoukian is an obvious choice as he is a double board certified plastic surgeon and an expert in cosmetic facial surgery.  Revision blepharoplasty can be performed after a complete examination, eyelid evaluation and measurement, and assessment of tearing, dryness of the eyes, and incision examination.  Dr. Karamanoukian will custom tailor a corrective eyelid procedure that can incorporate medical improvement in vision with cosmetic improvement in eyelid shape and size. 




One of the most exciting new advancements in cosmetic surgical correction of the lower eyelid involves a revolutionary laser resurfacing system known as fractional CO2.  The procedure can take as little as 30 minutes to perform under local anesthesia and can lead to significant correction of lower eyelid wrinkles and lower eyelid skin tone. For those patients who have minimal fat bags and skin wrinkling, laser skin resurfacing can provide immediate improvement without surgery.  Results are immediate, but patients will require approximately 5 to 7 days to recover from the skin resurfacing. 


The Fractional CO2 laser is a safe and effective laser skin tightening procedure that is ideal for the eyelid skin. If you feel that you are aging along the lower eyelids and do not wish to undergo a surgical procedure such as a blepharoplasty or facelift, you may consider a laser tightening procedure such as the Fractional CO2. 



  1. What are my options for anesthesia during blepharoplasty surgery? Blepharoplasty can be performed under local anesthesia, conscious sedation, or general anesthesia.  In the case of conscious sedation or general anesthesia, a board certified anesthesiologist will administer the anesthesia to ensure the highest level of safety during your surgery.
  2. How soon after blepharoplasty (eyelid surgery) can I return to work? The upper eyelids require less downtime than the lower eyelids.  In most cases, patients can return to normal activities within 3 to 5 days, with full recovery after about 7 to 10 days.  During that period, most patients are able to drive, shop, and perform activities.  We would advise you to avoid direct sun exposure for one week.
  3. What is an Asian eyelid surgery? or Asian blepharoplasty? An Asian eyelid procedure or Asian blepharoplasty is a surgical procedure to create a 'double eyelid,' in which a supratarsal crease is created in the eyelid fold.  This major difference in eyelid anatomy defines the difference between a Caucasian eyelid and an Asian eyelid.  Some patients request eyelid Westernization, in which the eyelid is altered naturally so that it has the characteristic Caucasian eyelid crease.  
  4. How soon will I begin to see results after a blepharoplasty? Results are seen immediately after surgery.  Blepharoplasties can be performed under local anesthesia and patients notice an improvement in their eyelids immediately after the procedure.  There may be some swelling and bruising the first 24 hours after blepharoplasty, but once the swelling subsides, a noticeable difference is seen. 
  5. Can I use Arnica supplements after blepharoplasty for bruising? Dr. Raffy Karamanoukian recommends that all patients take Bruise-Pak Arnica supplements after eyelid surgery in order to minimize swelling and bruising associated with surgery.  The Arnica montana contained in Bruise-Pak is more standardized than other homeopathic formulations and is available in chewable tablets that promote compliance. 
  6. What can be corrected with a blepharoplasty? A blepharoplasty is an eyelid tuck that can be performed on the upper or lower eyelids and can improve sagging skin and eyelid heaviness.  During an upper eyelid lift, excess fat and skin is removed from the upper eyelids, thus improving the visual field and reducing heaviness and upper eyelid hooding.  On the lower eyelids, a blepharoplasty can improve lower eyelid bags, fatty deposits, and can remove excess skin from the lower lids.  In some cases, the lower eyelid tear trough or hollowing can be directly filled and improved. 
  7. Can I undergo a blepharoplasty if I take aspirin? Aspirin and blood thinners are to be avoided immediately before a blepharoplasty or eyelid lift.  It is best to discuss the medications you are on with Dr. Karamanoukian before your surgery. In some cases, he will determine whether you may continue to take blood thinners if there is an absolute medical necessity. 
  8. What medications should I avoid with a blepharoplasty? Patients who have thin blood or who bleed excessively should be monitored before the procedure to assess the bleeding time and reduce the risk of surgical bleeding.  If you are taking any blood thinners, including aspirin, motrin, advil, ibuprofen, or similar medicines, you should stop taking them prior to your blepharoplasty.  During your consultation with Dr. Karamanoukian in our Los Angeles plastic surgery office, he will review these instructions prior to your surgery. 
  9. What type of anesthesia is used for a blepharoplasty procedure?  A blepharoplasty procedure is performed using local anesthetic or IV sedation in an accredited operating room.  Dr. Raffy Karamanoukian is a trusted and experienced board certified plastic surgeon practicing in Santa Monica and Beverly Hills.  During your consultation with Dr. Karamanoukian, you will be provided with many options for the blepharoplasty surgery itself and the types of anesthesias used during blepharoplasty.  During the procedure, upper eyelid blepharoplasty consists of a surgical procedure in which skin and fat is removed from the upper eyelid.  The lower eyelid blepharoplasty is performed in a similar manner, wherein skin and fat is removed from the lower eyelids.  In lower eyelid blepharoplasty surgery, there is some additional skin tightening along the lower edge of the eyelashes in order to soften the line of the lower eyelids and cheek junction.  If you have questions about blepharoplasty surgery and the anesthesia types use during blepharoplasty, please call our Los Angeles plastic surgery patient care coordinator at 310-998-5533.
  10. How do I know if I'm a candidate for a medical eyelid lift of the upper eyelids? In most cases, if the eyelid skin is touching or resting upon the eyelash margin, you have a loss of peripheral vision that may be a medically necessary procedure to improve visual field.  Dr. Raffy Karamanoukian will first examine you during your plastic surgery consultation and then recommend a visual acuity test or visual field test, if appropriate, to determine the percentage loss of peripheral visual field.  
  11. What is pain like after a blepharoplasty surgery? Blepharoplasty procedures are not very painful.  Postoperatively, you will experience discomfort but will be able to see normally.  We advise patients to refrain from strenuous activity, apply ice with a towel to the eyes and cheeks, and to take non-narcotic pain killers such as Tylenol after the surgery. Most patients will not minimal pain and discomfort in the period after blepharoplasty. 
  12. Is a blepharoplasty the same as an eyelid tuck? A blepharoplasty procedure is the technical term used to describe an eyelid tuck.  There are two types of blepharoplasty procedures, one for the upper eyelids and one for the lower eyelids.  The basic goals of a blepharoplasty surgery include removal of excess skin and fat. 


Dr. Raffy Karamanoukian is a board certified plastic surgeon in Beverly Hills and Santa Monica.  He performs cosmetic blepharoplasty and redo blepharoplasty procedures for the upper and lower eyelids and obtains exceptional results that appear natural with the rest of the face. Dr. Karamanoukian performs blepharoplasty alone or in combination with laser resurfacing or facelift procedures.  To schedule an appointment for a blepharoplasty consultation, please call our office at (310) 998-5533 and speak to one of our patient care coordinators. 


Some patients also ask about options for non-surgical blepharoplasty to correct wrinkling and crepiness of the lower eyelid skin.  There are some very effective options for lower eyelid rejuvenation that do not require surgery, such as laser skin resurfacing.  Dr. Karamanoukian believes that outstanding results speak for themselves and has researched the most effective lasers to treat undereye wrinkling.  The Fractional CO2 laser by SmartXide is manufactured in Italy and is touted as the number one anti-aging breakthrough of the decade by WebMD. The Fractional CO2 laser ablates the skin and allows for newly formed skin to resurface the undereyes and face. Results are outstanding for patients who request non-surgical rejuvenation of the lower eyelids without blepharoplasty. 


  1. Can I undergo an upper eyelid blepharoplasty (eyelid lift) under local anesthesia?
  2. Are both the upper and lower eyelid surgeries performed together?  Everyone is a little bit different in terms of what they need and how much they can tolerate.  Upper and lower eyelid surgery can be performed as separate procedures, but it is often more convenient for patients to have both procedures performed at the same time.  Blepharoplasty is a very gratifying surgical procedure that has medical and cosmetic benefits. Dr. Raffy Karamanoukian performs blepharoplasty surgery as an outpatient surgical procedure under local anesthesia in some cases; and under general anesthesia or sedation if requested by patients. 


Blepharoplasty and eyelid surgery is performed by Raffy Karamanoukian, MD FACS, a double board certified plastic surgeon practicing in Beverly Hills and Santa Monica.  Dr. Karamanoukian is a graduate of the UCLA School of Medicine and is currently on faculty at the University of California Irvine Department of Plastic Surgery. 

Raffy Karamanoukian, MD FACS

1301 20th Street, Suite 240

Santa Monica, CA 90404

Phone: (310) 998-5533

Related procedures for eyelid rejuvenation include Belotero facial fillers for fine lines around the eyes, Fractional CO2 laser skin resurfacing for loose skin around the eyes and cheeks, and Botox or Xeomin injections for smile lines and Crow's feet around the eyes and mouth.  All of these options can provide further enhancement of cosmetic results with minimal downtime or recovery. For information, Contact Us by calling our office to schedule an appointment at (310) 998-5533.

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