Eyelids (Blepharoplasty)

Upper lids – the ‘Bright Eyes’ procedure

It is important to understand that laxity around the eyes is not actually caused by excess skin – you don’t suddenly develop more skin around the eyes as you age, even though it may look that way. What actually happens, is that the support layer beneath the skin looses its attachment to the face’s internal structure, which causes it to sag. Instead of the skin curving into a neat fold above the eye, it droops over where the curve used to be.

The aim of quality blepharoplasty surgery is to bring the skin back to where it was before, to a nice, clean fold above the eye. The tarsal fixation technique performed by Dr Mendelson does exactly that. It returns the skin to its natural position prior to ageing and provides a natural result.

We call this our ‘bright eyes’ procedure because it brings freshness and life back to flat, dull eyes which have lost their expression under a layer of droopy skin. This is probably the most common problem of middle age and the main contributor to that much disliked look of ‘tiredness’ that comes with ageing.

The Procedure: Tarsal Fixation

Surgery to the upper lids restores an attractive contour above the eye, so the shape is again revealed and the eyes look bright and full of life.

The only way to naturally restore the eye’s appearance is to re-attach that skin, which again reveals a nice clean skin fold above the eye. This is the ‘tarsal fixation technique’ – the name demonstrates that it recreates the skin’s internal fixation which was lost in ageing. It requires only a short incision concealed in the eyelid crease which heals so perfectly it is undetectable within four months, even with the eyes are closed.

The procedure takes an hour in Day Surgery and is virtually painless, with only modest post-operative swelling (it looks as if you have a slight allergy) which resolves in the third week. After that, the depressing problem of ‘tired eyes’ has been handled and for most patients that is a profound relief.

A note of caution. As in all facial surgery, skin must never be pulled or stretched, as it can lead to distortion and scarring. Unfortunately, this outdated way of operating – skin pulling – is still being performed and is frequently performed on the upper lids. Pulling skin more tightly and then cutting the excess skin does not address the cause of the problem and will not produce a lasting, scar-free or natural result. It is not recommended for patients who want a quality, natural, lasting result.


To help you understand more about this advanced technique, we have produced Patient Information Notes: What to Look for in a Blepharoplasty. If you would like a copy mailed or emailed, please contact our practice.