Blepharoplasty & Eyelid Surgery — Abbotsford, BC

What Is Blepharoplasty?

Blepharoplasty is surgical repair or reshaping of the eyelids. It can address a wide range of concerns — from drooping upper lids that obstruct vision, to puffiness below the eyes, to aesthetic changes in the eyelid crease. As an ophthalmologist with specialized training in oculoplastics, Dr. Sundaram approaches eyelid surgery with a deep understanding of the anatomy and function of the eye and its surrounding structures.

Eyelid surgery may be performed for purely functional reasons (to restore vision or relieve eye discomfort), purely aesthetic reasons, or a combination of both. The appropriate procedure depends on the specific anatomy, concerns, and goals of each individual patient, which are assessed during a thorough pre-operative consultation.

Upper Eyelid Surgery

Upper eyelid blepharoplasty addresses two distinct but often coexisting problems:

Dermatochalasis (Excess Eyelid Skin)

With aging, the skin of the upper eyelid becomes lax and redundant, creating a hood of excess tissue that hangs over the lash line. Mild cases are a cosmetic concern; more severe cases cause the overhanging skin to rest on the lashes or interfere with the superior visual field, causing fatigue, a heavy sensation, or difficulty with activities such as driving or reading. Surgery removes the excess skin and, when present, redundant orbicularis muscle and fat, restoring an open, unobstructed upper eyelid.

Ptosis (Drooping Eyelid)

Ptosis is a true drooping of the upper eyelid margin below its normal position relative to the pupil. It is caused by weakness, stretching, or disinsertion of the levator palpebrae superioris muscle — the muscle responsible for raising the eyelid. Ptosis can be congenital (present from birth) or acquired (developing over time, often related to aging, contact lens wear, or prior eye surgery). Patients with ptosis may tilt their head back habitually or raise their eyebrows to compensate, causing neck discomfort and forehead strain. Surgical correction involves reattaching or tightening the levator muscle (levator advancement) or, in more severe cases, using a frontalis sling procedure.

Lower Eyelid Surgery

Lower eyelid blepharoplasty addresses puffiness, bags, and loose skin below the eye, which can give a persistently tired or aged appearance regardless of how rested the patient actually feels.

The lower eyelid fat compartments — which normally provide padding and support around the eye — can herniate forward as the orbital septum weakens with age, creating visible bulges. These fat pads can be repositioned or partially removed through either a transcutaneous (external, sub-lash) or transconjunctival (internal, no external scar) approach, depending on the patient's anatomy and whether skin removal is also required.

Festoons — bands of lax muscle and skin in the lower eyelid or cheek area — are a more challenging lower eyelid problem that may require a different surgical approach. Dr. Sundaram will assess these individually during your consultation.

Asian Eyelid Surgery (Double Eyelid Surgery)

A significant proportion of individuals of East Asian, Southeast Asian, or South Asian heritage are born without a supratarsal crease — the fold that creates the "double eyelid" appearance. This is a natural anatomic variation, not a deformity, and is equally beautiful. However, many patients seek to create or enhance this crease for aesthetic reasons, and in some cases for functional reasons (such as lashes rubbing against the cornea due to a particular lid anatomy).

Double eyelid surgery creates or reinforces the supratarsal crease by establishing a connection between the skin and the underlying levator aponeurosis or tarsal plate. Two main techniques are available:

• Suture technique (non-incisional): Small puncture sites are used to pass sutures that create the crease without removing tissue. This is less invasive with a faster recovery, but results may be less permanent — particularly in patients with heavier lids or significant fat.
• Incisional technique: A small incision along the planned crease allows removal of excess skin, fat, or orbicularis tissue before the crease is secured. Results are longer-lasting and preferred for patients with heavier lids or those who want a more defined crease.

Dr. Sundaram approaches Asian eyelid surgery with cultural awareness and respect for each patient's individual goals. The aim is always a natural-looking result that enhances the patient's features while preserving their ethnic identity. The height, shape, and definition of the crease are discussed in detail during consultation, and no assumptions are made about what a patient "should" want — the surgery is guided entirely by the patient's personal aesthetic goals.

Functional vs Cosmetic: MSP Coverage in BC

In British Columbia, blepharoplasty and ptosis repair are covered by MSP when they meet documented functional criteria:

• Upper eyelid skin or a drooping lid margin must demonstrably impair the superior visual field on formal visual field testing (typically Goldmann or Humphrey perimetry)
• The visual field impairment must be clinically significant — usually defined as the superior field being constricted by the overhanging tissue
• The patient must experience functional difficulty attributable to the eyelid problem (e.g., difficulty driving, reading, or other activities)

When these criteria are met, the surgeon's fee and facility costs are billed to MSP. When eyelid surgery is desired for cosmetic reasons alone — without documented visual field impairment — it is a private-pay procedure. Many patients have a mixed presentation: some eyelid correction qualifies under MSP, while additional cosmetic refinement is patient-funded. Dr. Sundaram will clarify coverage expectations at your consultation.

The Procedure & Recovery

Upper eyelid blepharoplasty and ptosis repair are typically performed under local anesthesia with or without oral sedation as day surgery or in an outpatient clinic setting. Lower eyelid procedures are usually performed under local anesthesia. The surgery takes approximately 45–90 minutes depending on the extent of work required.

Am I a Candidate?

You may be a candidate for blepharoplasty if you experience any of the following:

• Excess upper eyelid skin that overhangs the lid margin or lashes
• A feeling of heaviness or fatigue in the upper eyelids
• Difficulty with upper peripheral vision due to drooping skin or lid margin
• A drooping upper lid margin (ptosis) that requires lifting the eyebrow or tilting the head
• Under-eye puffiness or fat bags that persist regardless of sleep or hydration
• Desire to create or enhance a supratarsal crease (double eyelid)

Good candidates are in good general health, non-smokers (or willing to stop smoking before and after surgery), have realistic expectations, and have discussed their goals thoroughly with Dr. Sundaram. Certain conditions — such as severe dry eye, thyroid eye disease, or uncontrolled systemic illness — may affect candidacy or timing, and are evaluated at the consultation.