Blepharoplasty / Eyelid Surgery in San Diego – Dr. Gary H. Manchester

Blepharoplasty, more commonly known as eyelid surgery or an eyelid lift, is a surgical procedure which restores a more youthful, refreshed appearance to the eye area. Of all plastic surgery procedures, eyelid surgery can provide one of the most dramatic final results. Due to factors like age and heredity, the eyelids can appear puffy, sagging or tired-looking which can make you appear much older than your actual age. Drooping upper eyelids may even interfere with a patient’s field of vision and, in these cases, eyelid surgery can improve eyesight. Either the upper eyelids, the lower eyelids or both may be treated in order to improve excess skin of the upper eyelids and excess fat and skin of the lower eyelids.

You may be a San Diego eyelid surgery candidate if you are physically healthy and have realistic expectations for improving puffy under-eye bags or drooping upper eyelids. Eyelid surgery may be combined with other procedures such as a facelift or Botox injections for improvement of wrinkles, crow’s feet or dark under-eye circles. In addition, this procedure can help raise the eyebrow position.

Dr. Manchester performs the eyelid surgery at his clinic in San Diego, California. Surgery is performed with local anesthesia and can often be completed within one hour. Dr. Manchester places the incisions in very inconspicuous locations within the natural lines of the eyelids, either in the upper eyelid crease or just beneath the lower lash line. Working through these incisions, excess fat and skin are removed and the muscles are unaltered. Patients with no excess skin and only pockets of fat beneath the lower eyelids may be able to undergo a less invasive transconjunctival blepharoplasty in which the incisions are confined to the inside of the lower eyelids.

In most cases, patients can return home within three hours of their surgery. A tight feeling of the eyelids may result in the first few days. Medication will be prescribed to help with any discomfort that may occur. Some patients may experience temporary dryness, itching, burning, or tearing of the eyes. Less than 5% of all San Diego blepharoplasty patients experience mild bruising, and this sensation can be minimized by keeping the eyes at rest with the supplied eyepads. Work may be resumed after one to five days while strenuous activities and exercise will need to be suspended for about three weeks.


You are about to undertake a delicate operation upon the tissues surrounding your eyes. This narrative is intended to help you understand this procedure and to serve as a reference for the many questions you might have concerning your treatment and convalescent period. It is not a substitute for my personal attention, for I shall see you during each office visit. Please refer to this letter both before and after surgery.

Since everyone is different, each operation is tailor-made and receives special attention and thought. This is because no two people are exactly alike. An individual is really made up of two separate halves and no one is exactly symmetrical.

Due to this asymmetry, I personally try to take early preoperative photographs during the week prior to surgery in order to be able to study your particular needs. There are many details which we will discuss and you will forget. This letter has been designed to refresh your memory and serve as a reference for you to learn more about this procedure at your leisure.

This operation, blepharoplasty, is designed to remove excess skin and fat from the eyelids and to improve the appearance of your eyes. If you have heavy folds hanging over your upper lids, this will be trimmed away along a crease so that the scars should be unnoticeable. If you also have slack and excessive wrinkling of the skin of your lower lids, then this, too, will be trimmed away along a line just under the eyelashes. This scar may extend out into a wrinkle in the “crow’s feet” to varying degrees depending on the amount of excess skin that has to be removed. If bulges and “bags” are apparent, they will be removed. Once the skin and fat are gone, all incisions are closed with tiny sutures which are passed beneath the skin. No visible sutures will be present except for suture ends which will appear as cat whiskers on either side of your eye. The end result will give you a more youthful and alert appearance. The eyes will be trim, and the surrounding tissues will create a “saucer-like” appearance for them.

The operation is usually performed at my clinic and takes about one hour. One hour before your surgery, you will be asked to come to the clinic. Please come at the designated time wearing a shirt or blouse that buttons in the front, warm socks, and no make-up. My nurse will then give you medication which will allow you to relax. An hour later, you will be taken to the operating room sedated. You are asleep during the entire procedure. Following your surgery, you will be observed in the office for one to two hours. At this time, you bandages can be removed, if you desire, but I encourage you to keep them on until the next morning. They will prevent a great deal of bruising and swelling.

Upon leaving the office, you should go straight home and rest for the next twelve hours. You must have an adult stay with you the first night.

All operations around the eyes are followed by some degree of swelling and discoloration, so do not be alarmed. It will pass in about a week. Most patients are presentable in four days. You are not to wear contact lenses for three to four weeks following surgery since removing them will tend to pull your incisions apart.

An appointment will be given to you upon leaving the office for forty-eight hours so that your sutures can be removed. There may be some itching, but do not rub your lids as there is the danger of pulling open the tiny incisions. If this should happen, DO NOT PANIC. They can be closed again.

The skin of the eyelids is elastic, but a little excess is required for normal opening and closing of the eyes. The lids are like window awnings, smooth when down or shut, slack when up and open. For normal function there must be some slack for winking, so do not expect your lids, when your eyes are open, to be without any wrinkles at all. This would look unnatural. At first, the lids may feel a little tight and drawn and even show a pull, but this is due to the swelling and will disappear in a few days as the swelling subsides. The scars will be pink at first but will soon fade and should be unnoticeable in three to six weeks. Make-up is permissible after four days.

The excess skin and fat have been removed and thrown away, so, of course, it cannot come back. You will have to earn new wrinkles, but this will come through the everyday laughing and squinting. Avoid strong sunshine in large amounts, not only because of the continuous squinting but the drying effect to the skin. Soothing facial creams to the eyelids are permissible. How much you make of your new appearance will depend on your happiness, health, eye sparkle, hair style, and make-up. These are beyond your surgeon’s domain, but, remember, they are the ICING ON THE CAKE.

Thank you Gary Manchester, M. D.


What is eyelid surgery?
Eyelid surgery, or blepharoplasty as it is also known, is a surgical procedure which removes excess skin of the upper eyelids and excess fat and skin of the lower eyelids to rejuvenate the eye area. Surgery can provide a more youthful and refreshed appearance by improving puffiness, sagging, drooping and tired-looking eyes which may occur from age or heredity. Eyelid surgery often produces some of the most dramatic results of all the plastic surgery procedures.

How do I know if I’m a candidate for eyelid surgery?
If you are in good physical health and have realistic expectations for improving drooping upper eyelids and/or puffy under-eye bags, then you may be a candidate for eyelid surgery. In some cases, sagging in the upper eyelids may be severe enough to interfere with the field of vision and, thus, surgery can help to improve eyesight. Patients with just excess fat of the lower eyelids may be candidates for a less extensive eyelid surgery procedure known as transconjunctival blepharoplasty. Other procedures can be combined with eyelid surgery for additional improvement, including the facelift or Botox’ injections.

Where is eyelid surgery performed?
Dr. Manchester commonly performs eyelid surgery at his clinic, the Manchester Clinic of Plastic Surgery, which is located in San Diego, California.

As one of the more accomplished plastic surgeons San Diego patients turn to when in need of leading-edge facial rejuvenation procedures, Dr. Gary Manchester performs a variety of procedures that can improve the harmony of the facial features, reduce the appearance of lines and wrinkles, and add a youthful glow to the face. Over the years, he has treated thousands of San Diego brow lift, eyelid surgery and face lift patients. In addition, he has helped numerous San Diego neck lift, nose surgery and ear surgery patients realize their dreams of an improved appearance.

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