Quad Blepharoplasty

Home » Quad Blepharoplasty

Four Lid Blepharoplasty

Quad blepharoplasty, also called combined upper and lower eyelid blepharoplasty surgery, removes excess eyelid fullness and heaviness by removing bulk and fat from both upper and lower eyelid areas.  Often referred to as a “4 lid blepharoplasty,” this is a procedure that can improve both the upper and lower eyelids at the same time.  This offers a full eyelid rejuvenation in one surgery, allowing for a single recovery, and helping patients achieve their goals more quickly.

  • The upper eyelid part of the surgery addresses extra skin and fat that can make the eyes look closed or tired.
  • The lower eyelid blepharoplasty removes fat and bulk from the lower eyelids, often referred to as “eyelid bags.”
eyelid surgery
Dr. Dewan approaches each patient and each eyelid with a custom recommendation and takes the time to ensure your goals can be achieved.  You will look more natural andyouthful, not overdone, surprised, or “hollowed out.” This is a safe outpatient procedure that can help restore a youthful look.

Why should I get Quad blepharoplasty surgery?

If your concerns include looking tired all the time, and having bags under your eyes, you might be a candidate for quad blepharoplasty. Perhaps you can no longer see your eye makeup, or just feel like you don’t look like you used to. Or maybe you look older than you feel in pictures. Quad blepharoplasty can help address all of these concerns in one combined surgery. This prevents you from having multiple surgeries and multiple recoveries. You will look younger and have more inviting eyes by removing excess fat and skin that creates wrinkling and puffiness in the upper and lower eyelids.

What is the surgery like?

We perform four lid blepharoplasty in one of two locations – our office or in an outpatient surgery center. The primary difference between these two locations is the use of sedation during your surgery. In our office, we are unable to provide you with systemic sedatives and rely only on a local anesthesia to keep you comfortable. In the operating facility, you will get sedation through an IV that will relax you, in addition to the same local anesthesia as with the office procedure. Prior to beginning surgery, Dr. Dewan will confirm the surgical plan that was discussed during your consultation, and then make appropriate marks on your eyelids for surgery. Surgery then begins with Dr. Dewan numbing your eyelids with the anesthetic. As the surgery progresses, Dr. Dewan will make adjustments to the eyelids as necessary and may ask you to look in various directions to achieve the best results. You will leave with bandages covering the incisions, though you will be able to see around them. Quad blepharoplasty can take up to two hours.

Can I wear makeup afterward?

One of the driving desires for surgery includes being able to wear makeup. By removing the excess skin and fat in the upper and lower eyelids, blepharoplasty surgery provides a new, better contoured eyelid for you to apply makeup. Following surgery, we ask that you do not use makeup until the stitches have dissolved completely – usually 2 weeks. After this time, you are free to apply makeup on the eyelids. Additionally, we encourage patients to use sunscreen on the eyelids to protect the rejuvenation that is achieved during surgery.
Located in the Twin Cities

What is the recovery like for Quad BLEPHAROPLASTY?

Most patients have minimal pain and only need the occasional Tylenol or ibuprofen to treat it. Any stitches that are used will dissolve between 7-10 days after surgery and swelling and bruising last about the same amount of time. Early application of ice packs helps to minimize the swelling. Even with modest swelling, most people are able to perform normal activities within 1-2 weeks, with most activities able to be done within just 1-2 days. One week after your surgery, you will return for a post-operative visit, which will allow Dr. Dewan to check that everything is healing well.

Will my eyelids have scars after surgery?

Dr. Dewan’s expertise combined with the unique features of the eyelid skin ensure that scarring is minimal in the eyelids

  • For upper eyelid blepharoplasty, the incision Dr. Dewan makes is hidden within your natural eyelid crease. This makes for a virtually invisible scar after it has had a chance to heal.
  • For lower eyelid blepharoplasty, if skin is necessary to remove, the incision is made just underneath your eyelashes. This incision is designed to fall into the natural lines of the eyelid skin created by eyelid muscle contraction, and is typically not visible after you have had a chance to heal.
  • If no skin removal is needed, the incision for lower eyelid blepharoplasty will often be made on the underside of the lid, allowing the fat to be removed without making a skin incision at all. This heals very nicely and patients will never feel or see a scar.
Located in the Twin Cities

What other surgeries are performed with combined Quad blepharoplasty?

  • Occasionally patients choose to have additional procedures performed to further enhance their eyelid rejuvenation.  These include:
    • Some patients would like to have a “mini-facelift” at the same time as lower eyelid blepharoplasty, so cheek lifting and support are a common procedure done simultaneously.
    • Other patients would like to alter the shape of the eye, creating a sharp, upswept outer corner of the eye, referred to as canthoplasty.

    Some patients may also have a droopy eyebrow or need a muscle repair (ptosis repair) for an eyelid. These procedures can also be performed at the time of a blepharoplasty.

Before and After

Our before and after photos are from right before the surgery to about 5-10 days after. All our photos are unretouched. You can expect additional improvements for several weeks after surgery, and most patients are so happy with their surgeries that they don’t come in after the immediate post-operative visit (though we always are happy to see them).

Will insurance pay for this?

Upper and lower eyelid blepharoplasty are treated differently by insurance companies. Upper eyelid surgery may be covered by your insurance company if we can prove that your vision is being affected by your eyelids. There are specific measurements and testing that Dr. Dewan will conduct if it appears that your eyelids may be affecting your vision. We send this information to your insurance company for prior authorization for surgery, and if approved, your insurance will cover the upper eyelid blepharoplasty portion of a combined eyelid surgery. Lower eyelid blepharoplasty is typically considered a cosmetic surgery and, as such, is not covered by insurance. During your consultation, Dr. Dewan will make measurements and provide an opinion on the best approach for your lower eyelid surgery. He will also provide you with a quote for your surgery, including estimates for the surgery center fees.

An oculoplastic surgeon will give you
the best results.