Eyes that look as rested as you feel.
Dr. Kim sees Rochester-area patients for upper and lower eyelid surgery consultations at the historic Oliver Culver House on East Boulevard. One of the most important steps at that consultation is distinguishing what the eyelids are doing from what the brows are doing — they are anatomically separate problems.
The upper eyelid is bounded above by the brow and below by the lid margin. Between them, the skin and the orbicularis muscle (the circular muscle that closes the eye) occupy a narrow space. With time, the skin of the upper lid begins to accumulate and fold downward, and in some patients the orbital fat beneath the skin begins to herniate forward, creating fullness at the inner corner or across the lid. The result, viewed from the outside, is a tired, heavy or hooded appearance — a look that often does not reflect how the patient actually feels.
The lower eyelid's structure is governed by the orbital septum, the fibrous layer that holds the orbital fat in place. As that septum weakens with age, the fat it has been holding begins to herniate forward, creating the characteristic bags below the eye. At the same time, the junction between the lower lid and the upper cheek begins to deepen, creating a groove that adds to the tired appearance.
For a complete account of eyelid anatomy and the full range of blepharoplasty approaches, see our full blepharoplasty overview. The Rochester consultation examines upper and lower lids together and also examines brow position, which changes what operation is appropriate.
The consultation names both sides of this question before any operative plan is set.
Upper blepharoplasty removes excess skin from the upper lid through an incision placed within the natural lid crease. When fat is also herniated, it can be reduced at the same time. The result is a lid that opens more fully and looks more alert, without any change to the shape or character of the eye itself.
Lower blepharoplasty removes or repositions herniated orbital fat. The transconjunctival approach places the incision entirely inside the lower lid, leaving no visible scar; it is appropriate when skin removal is not needed. When excess skin is also present, a very conservative amount can be removed through an incision just below the lash line.
Dark circles that arise from pigmentation or from shadowing at the lid-cheek junction are not addressed by blepharoplasty. The surgery removes or repositions fat; it does not change the color or thickness of the overlying skin.
Brow ptosis — a descended brow — creates the illusion of upper lid fullness but is in a different anatomic plane and requires a different procedure. Operating on the lid in this situation will remove skin that the brow continues to push downward. Patients traveling to the Rochester consultation from Buffalo, Pittsford or the Finger Lakes should expect this distinction to be raised if it is relevant to their anatomy.
Upper blepharoplasty is among the procedures most reliably performed under local anesthesia alone. Lower blepharoplasty adds IV sedation when warranted.
Upper blepharoplasty is performed under local anesthesia, without sedation in many cases. The local infiltration is the most uncomfortable moment; once the area is anesthetized, the procedure itself is not painful. The incision is placed in the natural crease of the upper lid; when healed, it sits in a shadow and is difficult to detect. Operating time for upper lids alone is typically under an hour.
Lower blepharoplasty through the transconjunctival approach — from inside the lid — leaves no external incision. The orbital fat is accessed through the conjunctiva and removed or repositioned. When a skin-only lower lid resection is also planned, a very small amount of skin is removed from just below the lash line; conservative resection is the governing principle, because removing too much lower lid skin creates a complication (lower lid malposition) that is difficult to correct.
Surgery takes place at the accredited Syracuse suite. The first post-operative visit is the morning after surgery, and subsequent follow-up can be scheduled at the Rochester office to reduce the number of trips patients from Rochester, Buffalo and the Finger Lakes need to make to Syracuse.
Blepharoplasty recovery is faster than facelift recovery. The acute phase is measured in days; the final settling in weeks.
Head elevated, cold compresses to reduce swelling. Swelling and bruising develop within the first day and peak at 48 to 72 hours. The lids may feel tight. Vision is not affected by the surgery itself, but swelling can make the lids heavy. A responsible adult must be present for the first night.
Bruising is at its peak and begins to shift color as it resolves. Reading and screen time in moderation are usually permitted. No contact lenses until the lids have settled; glasses are fine. Incision care follows office instructions. No makeup on the incision sites until approved.
Bruising resolves in most patients by the end of week two. Sutures, if present, are typically removed at the one-week post-operative visit. Most patients feel comfortable going out in public at this point with light coverage. Residual swelling, particularly of the lower lids, continues beyond week two.
Lower lid swelling continues to resolve. Scars mature over this period; they are usually pink and slightly firm before fading toward skin color. Sun protection on the incision sites during the first year reduces hyperpigmentation. Return to exercise is typically permitted by three to four weeks.
The final appearance of upper blepharoplasty is usually evident by six weeks. Lower lid results continue to settle over a longer period, and any residual swelling at the lid-cheek junction may take several months to resolve completely. The photographs at three months typically show a more refined version of what was visible at six weeks.
Inability to fully close the eye, sudden significant worsening of vision, rapidly spreading redness or increasing pain after the first 48 hours warrants a call. Dry eye symptoms that are worsening rather than improving also warrant a call. The office number is 315-471-8404; an on-call physician covers after hours.
Questions about the Rochester consultation, travel logistics, and what eyelid surgery can and cannot achieve.
Yes. Blepharoplasty consultations and follow-up visits take place at the Rochester office on East Boulevard. The consultation includes a detailed evaluation of the upper and lower eyelids, brow position and the relationship between lid and brow that can make distinguishing them the most important step of the assessment. Surgery is performed at the practice's AAAHC-accredited office-based suite in Syracuse.
Yes. The Rochester office is about seventy-five minutes from Buffalo. Many patients from Buffalo, Canandaigua, the Finger Lakes region and Pittsford use the Rochester office for their initial consultation and long-term follow-up rather than traveling directly to Syracuse. The consultation is typically sixty to ninety minutes.
Blepharoplasty is eyelid surgery. Upper blepharoplasty removes excess skin from the upper lid and, when indicated, addresses the orbital fat beneath it. Lower blepharoplasty removes or repositions excess fat that creates bulging of the lower eyelid, with or without skin removal. The result is a more rested appearance without changing the shape or character of the eye.
It does not correct a heavy brow. If the brow has descended, the skin it pushes down onto the upper lid creates fullness that looks like excess eyelid skin but is actually brow ptosis. Operating on the lid alone in this situation removes skin that the brow will push back down; a brow lift addresses the correct anatomic plane. Distinguishing lid from brow is one of the most important steps of the consultation.
Not if the dark circles arise from pigmentation, thin skin, or shadowing from the cheek-lid junction rather than from fat bulging. Blepharoplasty removes or repositions the fat that creates the bulge under the eye; it does not address skin pigment or the hollow that develops between the lid and the cheek with age. Those require different treatment.
No. Upper blepharoplasty is routinely performed under local anesthesia alone. Lower blepharoplasty can also be performed under local anesthesia with or without IV sedation. All procedures take place at the practice's accredited office-based suite in Syracuse without general anesthesia. The absence of intubation and general anesthesia reduces the risk profile and shortens the operative day.
Swelling and bruising peak in the first 48 to 72 hours. Most bruising resolves within ten to fourteen days. Swelling, particularly of the lower lids, takes longer and may be noticeable for several weeks. Most patients feel comfortable returning to work and social activity within ten to fourteen days, depending on the extent of the procedure.
The most common concerns are prolonged swelling, bruising, asymmetry and a scar that takes longer than expected to mature. More serious risks include lower lid malposition, dry eye that worsens after surgery, and over-resection of skin that makes the eye difficult to close. Pre-operative evaluation of dry eye symptoms and tear production is part of the assessment for lower lid surgery.
Upper eyelid skin removal addresses skin that has already been present for years and skin laxity is a progressive process, so the lids will accumulate further skin over time. The correction is durable in the sense that the removed skin does not return, but aging continues. Most patients who have an upper blepharoplasty remain satisfied with the result for many years. Lower lid fat removal through the transconjunctival approach results in a permanent reduction of that fat.
Blepharoplasty is an outpatient procedure and patients go home the same day. However, the first follow-up visit is typically the next morning, and we ask patients to remain near the practice for that visit. Most Rochester-area patients plan to stay near Syracuse overnight. After the first post-operative visit, returning to Rochester is generally fine for uncomplicated recoveries.
Yes. Blepharoplasty is commonly combined with facelift, brow lift or facial fat transfer. The combination is efficient: one anesthetic, one recovery period, and a result that addresses the face and eyes together. The consultation identifies what the anatomy warrants and whether combining procedures is appropriate for the individual patient.
Upper blepharoplasty addresses excess skin and occasionally fat of the upper eyelid, which creates a heavy, tired appearance. Lower blepharoplasty addresses fat that creates bulging below the eye, through an incision inside the conjunctiva (transconjunctival approach) or through the skin just below the lash line. The two procedures may be done together or independently, depending on what the anatomy requires.
The Rochester office at 70 East Boulevard serves patients from Rochester, Buffalo, the Finger Lakes and across western upstate New York. See our Rochester office page for directions and what to expect, or explore our Syracuse surgical home.
4939 Brittonfield Pkwy, Bldg B, Ste 208
East Syracuse, NY 13057
Surgery and main office
347 E 53rd St, Suite Lobby A
New York, NY 10022
Consultations and follow-up
"I had a natural facelift and blepharoplasty about 3 months ago. I just wanted to look as young as I feel. Dr. Kim is a wonderful surgeon and a very lovely person. I felt total confidence in his care."
"Dr. Kim is the only plastic surgeon that I'm completely comfortable with and trust. He performed surgery that was so natural that people couldn't believe I had it done."
"The level of care and attention I received was exceptional. Dr. Kim explained everything thoroughly and I felt at ease throughout the entire process. The results speak for themselves."