Question 1

Which eyelid correction techniques are available?

Accepted Answer

It is essential that the treating surgeon has extensive experience in all relevant eyelid correction techniques. These include endoscopic brow lifting, conventional upper and lower eyelid blepharoplasty, transconjunctival lower eyelid correction, eyelid tightening procedures (canthoplasty), laser resurfacing of the eyelid skin, and volume restoration of the tear trough using fillers.
In particular, both conventional and transconjunctival lower eyelid blepharoplasty require a high level of expertise and clearly distinguish an experienced surgeon from a less experienced one.

Question 2

How are blepharoplasty techniques performed?

Accepted Answer

Upper and lower eyelid corrections can be performed under local anesthesia, sedation, or general anesthesia. The procedure is carried out on an outpatient basis. Most of my patients choose sedation.
Several established techniques exist for upper and lower eyelid correction. In the upper eyelid, this may include removal of excess skin alone, removal of skin and muscle, and/or removal of orbital fat. The incision can be made using a scalpel, an electrosurgical device, or a laser.
For the lower eyelid, a distinction is made between open and transconjunctival techniques. In open techniques, the incision is placed just below the eyelashes. In the transconjunctival approach, the incision is made on the inside of the lower eyelid. Both approaches allow excess fat contributing to under-eye bags to be repositioned beneath the tear trough (fat transposition) or removed.
The choice of the cutting instrument is widely discussed in the medical literature. Lasers function similarly to an extremely fine beam of energy and allow contact-free cutting. However, disadvantages include the risk of injury to surrounding tissues and the need to place metal eye shields on the eyeballs, which may alter eyelid anatomy and complicate intraoperative assessment.
I have experience with all mentioned techniques and instruments. Based on the balance of risk and benefit, I prefer the classic scalpel for most open upper and lower eyelid procedures. For transconjunctival lower eyelid blepharoplasty, I favor a very fine radiofrequency device. It must be emphasized that all techniques, when performed by an experienced surgeon, are safe and can lead to excellent results. Surgical quality cannot be judged solely by the technique or instrument used.

Question 3

How is laser treatment used in eyelid surgery?

Accepted Answer

There are two principal applications of laser technology. First, lasers may be used as an alternative cutting tool during conventional or transconjunctival blepharoplasty, as described above.
Second, lasers may be applied for resurfacing the eyelid skin. CO₂ and Erbium:YAG lasers are particularly suitable for this purpose. Both allow precise removal of the uppermost skin layers and can improve skin texture, color, and fine wrinkles. Laser resurfacing may be combined with transconjunctival lower eyelid surgery or used as a standalone treatment, particularly in younger patients. However, in many cases, laser treatment alone does not achieve a complete result. I routinely use both a CO2 and an Erbium : YAG Laser to treat eyelid skin.

Question 4

When is upper eyelid surgery advisable?

Accepted Answer

A precise analysis of eyelid changes and surrounding tissues is essential for successful treatment planning. Age-related changes in skin and connective tissue often lead to laxity of the upper eyelid skin, which may begin to droop over the eyelid margin. As this progresses, eyelashes may be affected and, in advanced cases, the upper eyelid skin can partially obstruct the visual field.
Reasons for seeking upper eyelid correction include a tired or sad facial expression. Active and athletic women, in particular, often notice that their face and eye area age more visibly than the rest of the body, as facial aging cannot be counteracted through exercise or muscle training. A typical sign of premature eyelid aging is the need to lift excess eyelid skin or raise the eyebrow to apply eye makeup properly.

Question 5

When is a simultaneous endoscopic brow lift recommended?

Accepted Answer

The position of the eyebrows significantly influences the appearance of the eyes and eyelids. With aging, the eyebrows descend—often more pronounced in the lateral portions—causing the brow to press excess skin onto the upper eyelid.
If brow descent is pronounced, upper eyelid blepharoplasty alone is no longer advisable, as too much eyelid skin would need to be removed. This would result in an unnatural appearance, leaving the eyebrow in a low position. Additionally, the amount of eyelid skin that can be safely removed is limited. Excessive skin removal may involve thicker brow skin, leading to visible scarring.
In such cases, I recommend a simultaneous endoscopic brow lift. Repositioning the eyebrows to a natural level often significantly reduces the amount of eyelid skin that needs to be removed. This effect can easily be simulated in front of a mirror by gently lifting the outer brow to a natural position just above the bony orbital rim.
In approximately half of all upper eyelid blepharoplasty patients, I perform an endoscopic brow lift at the same time.

Question 6

When is lower eyelid surgery advisable?

Accepted Answer

Changes prompting lower eyelid correction include tear trough formation, under-eye bags, skin laxity, wrinkles, and dark discoloration. Depending on severity, treatment options include laser resurfacing alone, filler injections, transconjunctival blepharoplasty, conventional blepharoplasty, or a combination of these approaches.

Question 7

What other eyelid corrections can be performed?

Accepted Answer

I also perform reconstructive procedures following skin cancer removal, facial nerve paralysis, trauma, or previous eyelid surgeries. These include eyelid weight implantation, various eyelid reconstructions, and complex reconstruction of eyelid defects.

Question 8

When is eyelid surgery medically indicated?

Accepted Answer

Visual field restriction may occur when the eyebrows and upper eyelids descend to the extent that upward vision is impaired. In such cases, private health insurance may reimburse part of the cost of upper eyelid surgery and/or brow lift.
Correction of lower eyelid laxity (ectropion) may also constitute a medical indication for reimbursement.
You are welcome to send front and side photographs of your face, taken from approximately 2 meters against a neutral background, to praxisteam.gassner (at) gmail.com. Please include your name, gender, age, and treatment request. You will receive a complimentary preliminary assessment.

Question 9

Is anesthesia necessary for blepharoplasty?

Accepted Answer

Blepharoplasty may be performed under local anesthesia, sedation, or general anesthesia. Most patients choose sedation. The procedure is typically performed on an outpatient basis, also when combined with an endoscopic brow lift.

Question 10

What should be considered before eyelid surgery?

Accepted Answer

You can significantly contribute to the success of your eyelid surgery. Please bring any ophthalmological reports to your consultation, if available.
Medications and supplements that may thin the blood should be avoided for three weeks prior to surgery. These include aspirin®, ibuprofen®, diclofenac®, herbal supplements such as ginkgo and garlic, vitamin preparations, and certain alternative or traditional Chinese medicines. Excessive sun exposure should also be avoided.
All makeup should be removed with gentle products on the evening before surgery.

Question 11

What should be considered after eyelid surgery?

Accepted Answer

The surgical technique and aftercare are tailored to your individual anatomy and treatment goals. Sauna and solarium use should be avoided for six weeks. Sun exposure should be moderate for six months, and makeup with sun protection is recommended during this period.
Light physical activity may be resumed after two weeks and gradually increased. Concealing makeup may usually be applied after one week, at which point swelling has often subsided enough that surgery is barely noticeable in public.
Incision sites must not be mechanically stressed or massaged. Incisions near the outer orbital rim typically heal more slowly and may remain red longer. Their placement is generally aligned with the deepest crow’s-feet wrinkle.

Question 12

Before-and-After Photos

Accepted Answer

Under current German law, comparative before-and-after images of cosmetic procedures may not be publicly displayed online. This regulation protects patient privacy. If you wish to view treatment results, please email VorherNachherGassner (at) gmail.com with your name, age, gender, and a brief description of your treatment interest. We will respond individually.

Question 13

Costs and Preliminary Inquiry

Accepted Answer

If you send us photographs of your face and eyelids, I will be happy to provide a non-binding preliminary assessment of the procedure and costs. Photos should be taken from the front and side, approximately 2 meters away, against a neutral background, with the face and neck filling most of the frame. Please include your name, gender, date of birth, address, and treatment request, and indicate whether you have private health insurance.
I will respond personally. Please note that by submitting your data electronically, you consent to electronic communication and acknowledge that data transmission occurs in both directions at your own risk.

Question 14

Expertise

Accepted Answer

The only surgeon trained in the USA as a fully certified Facial Plastic Surgeon (ABCFPRS) currently practicing in Europe
Eight years of training at the Mayo Clinic, USA
Advanced subspecialty fellowship in Facial Plastic Surgery (AAFPRS), University of Washington, Seattle
Ten years as Head of the Section of Plastic and Reconstructive Head and Neck Surgery, University ENT Department Regensburg
Director of over 20 international conferences and courses in facial plastic and aesthetic surgery, including eyelid surgery
Close collaboration with leading U.S. centers of excellence, including Dr. Neil Gordon, Dr. Jonathan Sykes, Dr. Andrew Harrison and Dr. Kofi Boahene
Specialized training in oculoplastic surgery during fellowship at the University of Washington
Extensive experience in all major techniques of periocular surgery
Editor of a globally recognized surgical textbook “Analysis and management of the paralyzed eyelid” together with his world – renown colleagues Dr. Andrew Harrison and Dr. Kofi Boahene.

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