Eyelid Surgery: A Comprehensive Approach by Dr. Lara Devgan

Periorbital Rejuvenation Through Surgical Precision and Anatomical Expertise

The periorbital region plays a critical role in facial expression and perceived age. Over time, structural changes—including upper eyelid ptosis, lower lid pseudoherniation of orbital fat, brow descent, and volume loss in the periorbital hollow—can contribute to an aged or fatigued appearance. Surgical correction of these changes requires a nuanced approach that considers both functional and aesthetic outcomes, ensuring balance between soft-tissue support, volume preservation, and skin integrity.

Dr. Lara Devgan, a board-certified plastic surgeon with elite training from Yale University, Johns Hopkins School of Medicine, the Harvard Surgical Leadership Program, and the Columbia/Cornell Plastic and Reconstructive Surgery Fellowship, applies an anatomically precise, data-driven approach to periorbital rejuvenation. With tens of thousands of surgical cases and extensive experience in facial aesthetics, her techniques aim to restore natural contour and light reflexes while avoiding iatrogenic hollowness or distortion of facial identity.

Anatomical Considerations in Eyelid Surgery

A comprehensive approach to eyelid and brow rejuvenation must address the multi-layered changes of aging, including:
-Redundant upper eyelid skin and attenuation of the levator aponeurosis, which contribute to heaviness and reduced tarsal show.
-Inferior displacement of infraorbital fat leading to pseudoherniation and under-eye shadowing.
-Lateral brow ptosis, which can exacerbate upper lid fullness and alter brow-lid relationships.
-Volume loss in the periorbital and midface region, which affects lid-cheek junction integrity and the transition between the orbital and zygomatic structures.

Dr. Devgan employs a multimodal surgical strategy to correct these concerns while preserving structural support, facial balance, and natural expression.

Surgical Techniques and Their Applications

Dr. Devgan’s approach integrates customized surgical interventions based on the patient’s anatomical presentation and desired outcomes. These include:

Upper Blepharoplasty: Precise excision of redundant upper lid skin, with or without levator advancement, to restore lid contour and tarsal show while preserving natural lid position.

Lower Blepharoplasty: Fat repositioning or conservative resection to smooth the lid-cheek junction, combined with orbicularis suspension to maintain lower lid integrity.

Temporal Brow Lift: A minimally invasive technique to elevate lateral brow ptosis, improving periorbital openness without disrupting brow dynamics.

Coronal Brow Lift: A more comprehensive forehead and brow elevation approach, indicated in cases of frontal rhytides and significant brow descent, with careful attention to frontalis muscle function and scalp incision concealment.

Autologous Fat Grafting: Restoration of orbital and midface volume to address hollowness in the tear trough and periorbital region, ensuring a natural convexity and light reflection.

Postoperative Recovery and Functional Considerations

Patients typically experience edema and ecchymosis for 7–10 days, with progressive resolution of swelling over several months. Long-term outcomes depend on individual healing patterns, soft tissue compliance, and adjunctive treatments such as erbium laser resurfacing or neuromodulators to optimize skin texture and dynamic rhytides.

Conclusion

Periorbital rejuvenation is a complex interplay of surgical precision, anatomical preservation, and functional restoration. A data-driven approach that integrates skin excision, volume redistribution, and dynamic soft-tissue repositioning allows for optimal long-term results with preservation of facial identity.

For patients considering upper and lower eyelid surgery, brow lifting, or volume augmentation, a comprehensive anatomical assessment is essential to achieve functional improvement and aesthetic refinement in a balanced, natural manner.