Tired of Looking Tired? Why Everyone’s Getting Eyelid Surgery

Announcer (00:00):
You're listening to The La Jolla Cosmetic Podcast with Monique Ramsey.

Monique Ramsey (00:03):
Move over lipo. Eyelid surgery just became the most popular cosmetic procedure in the world. Today, we're talking about why blepharoplasty is suddenly everywhere, what's driving the demand and what you need to know before booking your consultation. Joining us today is Dr. Kiersten Riedler, breaking down the trend and what it means for the future of facial surgery. So welcome Dr. Riedler.

Dr. Riedler (00:28):
Thanks for having me.

Monique Ramsey (00:30):
And let's talk about eyelid surgery. So it's kind of been for years that lipo is the most popular procedure consistently for 20 years probably. And so all of a sudden eyelid surgery has sort of dethroned lipo globally for last year in 2024. So what does that tell us sort of about shifting patient priorities and aesthetic goals?

Dr. Riedler (00:56):
So I think it tells us that people are focusing more on the face and especially the eyes. The eyes are central to communication and expression, and people are more interested in looking alert, refreshed, approachable. And so they're prioritizing a relatively low downtime procedure that can impact how people perceive them and their social interactions and maybe focusing a little bit less on their body, especially on, because with selfies and social media, I feel like the focus tends to be a little bit more on the face, but I'm also biased.

Monique Ramsey (01:41):
Right. Your surgery is really limited to above the clavicle, right? Yeah. So now the International Society of Aesthetic Plastic Surgery, which is also known as I-S-A-P-S, their report cited a 13.4% jump in eyelid procedures. And that's a lot, I mean, in one year. So obviously I think your point about selfies and all these zoom meetings that we're all on all the time, it is kind of maybe the first place that people would see aging, do you think?

Dr. Riedler (02:19):
Yeah, definitely. In my opinion. I think for most people, on average, the first area that tends to show aging changes are the upper eyelids and then maybe the lower eyelids and then maybe the neck. But a lot of people in their late thirties, early forties are noticing some upper eyelid aging changes. And so I think that's one reason too why people are focusing on it, seeing younger and younger patients coming in.

Monique Ramsey (02:56):
And I think you see on TikTok and on Instagram, there's influencers and people are, and I love the fact that people are so open about their procedures because it really destigmatizes it. I mean, back in the nineties when I started in this business, people, some people talked about it, but certainly people were a lot more secretive about it. And I think now everybody's like, yeah, why not do it? It's like coloring your hair if you wanted to fix it, do it. Right?

Dr. Riedler (03:25):
Exactly. It's nothing to be ashamed of.

Monique Ramsey (03:29):
I guess for aesthetics, is eyelid surgery for just looking better or is there some function that is helped when you have a upper blepharoplasty?

Dr. Riedler (03:41):
Yeah, so for the upper eyelids, I mean, most of the patients I see are primarily focused on the aesthetic changes, but a lot of patients will notice heavy upper eyelids. Some people can get headaches because they're using their brows to lift their heavy upper eyelids. And so that can cause headaches. That also causes forehead wrinkles. And I mean, sometimes it can be pretty severe and it can actually limit people's peripheral vision in some cases. So there can be a functional component of it as well, for sure.

Monique Ramsey (04:26):
And do you find that patients' motivations for having, are they different whether they're thinking about their upper eyelids or they're lower? Or is it just kind of help me look younger?

Dr. Riedler (04:38):
For the upper eyelids, it tends to be more kind of heavy excess skin, hooding feeling like they look tired for the lower eyelids. People often will also say that the lower eyelids kind of make them look tired, but it's more puffiness or bags or excess skin as well. So it's a little bit of a different kind of goal or complaint that I see regarding upper versus lower eyelids. But in general, I think most people come in saying, I want to look refreshed. I'm tired of people asking me if I'm tired. Even if I am tired, I don't want to look like it. And when I'm not tired, people still ask me if I'm tired. So

Monique Ramsey (05:25):
Right now, how does something like Botox play into eyelids? Sometimes I've heard that sometimes you can relax your forehead, but then your eyelids droop a little bit or is there more heaviness?

Dr. Riedler (05:42):
Yeah, so there's an kind of complicated interplay between the forehead browse eyelids with Botox. And if your brows and your eyelids are basically in a good position and you don't have aging changes, then Botox in the forehead, crow's feet, glabella area isn't really going to affect or shouldn't really affect the position and shouldn't really make it feel any different. However, if as I mentioned, you have heavy upper eyelids and you're using your forehead muscles to raise your brows to alleviate that heaviness, and then you use Botox in your forehead to treat those wrinkles, then because you have decreased ability to lift your heavy upper eyelids, they can feel quite a bit worse. So it's sort of like you're compensating and then you can't compensate, but it isn't necessarily the Botox in itself is causing the heaviness.

Monique Ramsey (06:45):
Well, and I know for me, because I'm kind of getting to the point where that might be helpful because my makeup then it's like you go to make your crease and your makeup and then things start making other creases in places where you're like, I didn't apply it there. Why is it moving? And that can be super irritating. So do you find that the people who is looking for eyelid surgery, is it mostly men, mostly women? What ages?

Dr. Riedler (07:16):
I mean, it's a big range of ages from late thirties to seventies. I'm definitely seeing more. I'm seeing younger people, I'm seeing more men also, but it's really kind of like everyone. There isn't one certain group of people who comes in for eyelid surgery. It's kind of a pretty universal thing.

Monique Ramsey (07:39):
And men really, like you say, it's, I think men are embracing cosmetic procedures more and more, which I think is great because then they don't have to, I saw a guy come in the other day and get his pedicure when I was getting my pedicure. I'm like, good for you.

Dr. Riedler (07:57):
Why not?

Monique Ramsey (07:58):
It doesn't have to be just a girls thing. And it was interesting in the International Society report that more men were starting to do eyelid surgery than they did before. And would you say what percentage of the eyelid surgery you're doing is on men?

Dr. Riedler (08:20):
I'd say probably 20, 25%.

Monique Ramsey (08:24):
Do you think there's any lifestyle factors like excessive screen time or zoom calls or I don't know, whatever wearing masks, I guess even, or people maybe even in medical dental hygienists. That's all you see, is there pretty eyes.

Dr. Riedler (08:39):
Exactly. Yeah.

Monique Ramsey (08:41):
Is there anything that you think might be driving the popularity?

Dr. Riedler (08:45):
Yeah, I think definitely during the pandemic when everybody's wearing masks, only thing you can see is your eyes and your forehead really. So that really put more of an emphasis on the upper face. And that's when we started seeing more lash extensions and microblading and things to enhance the eye area. And then also during zoom meetings, FaceTime, things like that. I think usually you're interacting with people looking at their eyes, and so people are more aware of other people's eyes and they're more aware of their own eyes also. So definitely I think all those things have played a part.

Monique Ramsey (09:30):
So if it's top of mind for people and you're out there listening in the audience and you're thinking, maybe it's time for me, but you don't know, sometimes you think, well, is it just me that's feeling this way or is it too early? A consultation is there's no charge for a consultation in our office. And what would be the tips that you would say to people if they're thinking about having the procedure? What would you recommend for people to do to get started and what to look for?

Dr. Riedler (10:03):
I mean, you want to look for a qualified surgeon, board certified facial plastic surgeon, plastic surgeon who has specialized training in eyelid surgery. You want to look at before and after photos, not necessarily to see somebody who looks exactly like you, but just to look for natural results. You want to see that people have good outcomes and look like themselves, but better in general. And then the consult is a great step because we don't expect you to know what you need to meet your goals or to address what's bothering you.

Monique Ramsey (10:47):
Well, and if we're talking about eyelid surgery, so I know there's different combinations of things. You could have upper and lower, you could have upper skin only or skin and fat. Your lowers could be skin only, skin and fat. So kind of give everybody a little bit of a overview of the types of procedures they can do with their eyes and maybe even sometimes their brow.

Dr. Riedler (11:11):
I mean, I always look top to bottom. So I look at the brows and are the brows in a good position? Is somebody constantly using their forehead muscles to raise their brows? And is that because their brows are low or because their eyelids are heavy or both? So looking at that and then looking at the upper eyelid skin, the fat that can kind of bulge in the center. And then also looking at the lower eyelids. Is there excess skin? Is there bulging fat? Is there Halloween? Everybody's face, everybody's eyes are different, which is why my job is so interesting. But everybody can maybe benefit from a slightly different combination of procedures. And so I would say the main things that I'm considering for patients who come in with eye concerns is brow lift, upper eyelid, upper blepharoplasty, which can either just be the skin or sometimes the fat that's bulging in the center. And then lower blepharoplasty, which can also involve the skin or often the fat that's bulging as well. And I often like to combine the lower blepharoplasty with fat transfer because often people have in addition to bags or bulging, they have some hollowing down here too. And so I think that really is a nice addition to make a fully smooth contour.

Monique Ramsey (12:48):
And speaking of that area, so I know that there's in the past, been maybe still continuing. Now some people put filler under their eyes, and you work in our med spa, you work in our surgery center. So you see both sides of that part of ways to fix things. And to me, long, long, long time ago, I had filler in my lower eyelids and it was like eight or 10 years later that all of a sudden there was this weird greenish, bizarre thing happening, and it was like, you think the filler's gone, but maybe it's not, and there's this weird bulge, and so we ended up dissolving the filler. It was like, oh. So tell us about what do you think about fat versus filler?

Dr. Riedler (13:40):
Well, I will say that I see that kind of situation a lot, and I do see quite a few patients come into the surgery center for lower blepharoplasty. I know there's filler, I can see filler. I mean, patients often think, oh, it was two years ago, it was four years ago. But filler, it really does stick around for a long time. Luckily, it's dissolvable. So if that's causing an issue, we can get rid of it, no problem. I do definitely prefer fat over filler in that area because as you said, it can cause the filler can cause problems later down the line. It can cause chronic swelling. It can cause what's called a tyndall effect, which is kind of like a,

Monique Ramsey (14:29):
Yeah, that's what I had.

Dr. Riedler (14:30):
Exactly, like a bluish discoloration.

Monique Ramsey (14:33):
It's so weird. All of a sudden I was like, what's happening? And I was up in the med spa and Kara was like, oh yeah, this is this filler. I'm like, no, I had that in like "09.

Dr. Riedler (14:44):
Exactly.

Monique Ramsey (14:44):
No joke when it first got indicated. And it was like, how could that be? So she's like, it is.

Dr. Riedler (14:53):
Good job, Kara, for recognizing it.

Monique Ramsey (14:54):
Yeah, right, exactly. Yeah, exactly.

Dr. Riedler (14:58):
And that's not to say that filler's always bad or anything like that, but I do mean, especially when surgery, I really prefer the fat transfer in that area. I think it's kind of replacing with and a good correction for the problem. But filler in some areas also like the cheeks, things like that can help support and balance the face. So that can help camouflage some lower eyelid hollowing too. There are often one option, there's more than one option to address your concerns, and that's one reason I like working in the med spa and in the surgery center, I am able to mix and match and let patients know what their options are.

Monique Ramsey (15:46):
And are they trying to solve something super quickly for an event coming up, or do they have a little bit of time now getting into setting realistic expectations around results and around how long it takes to heal and recovery. How do you talk about that with patients and what tips do you have?

Dr. Riedler (16:09):
Yeah, so we always tell patients in general with facial surgery, it takes a year to see your final final result. That isn't to say that you're in the recovery process actively for a year, but the face takes time to heal. So recovery wise, after eyelid surgery, I would say by two weeks, you look pretty socially acceptable. You're not going to want to take headshot photos or get married two weeks after surgery. Definitely still swollen, still recovering, but most of the bruising's gone. You're just dealing with some swelling still. And it does take, I would say months for all of the swelling to go away, but at two weeks you look socially pretty good, and then it just kind of continues from that point forward. Generally, I recommend not scheduling any major photos or events for about three months after surgery just to give yourself a nice cushion so that it takes a little while for your swelling to resolve that you're in good shape.

Monique Ramsey (17:17):
And everybody's different.

Dr. Riedler (17:19):
Everybody's so different. It's unpredictable.

Monique Ramsey (17:21):
And your age, your habits, your daily life, just how, I don't know. I think it's good to give yourself more time than less. Right?

Dr. Riedler (17:32):
Definitely.

Monique Ramsey (17:33):
It can't go wrong with that.

Dr. Riedler (17:34):
Yeah, more time is never a problem.

Monique Ramsey (17:37):
Yeah. Now, is this something that you do under a local with sedation? Do you do a general anesthetic or does it depend on the patient, tell people a little bit about the OR day?

Dr. Riedler (17:50):
I mean, it depends on the patient in general. We do these procedures under general anesthesia, but some patients prefer IV sedation, which is perfectly fine. Also, occasionally I'll do an upper eyelid surgery under just local anesthesia, I would say less often, but if somebody's had anesthesia in the past and had a lot of nausea, vomiting or everybody, every case is different. So I kind of talk to the patient about what the options are, what the pros and cons of each option is, and see what works best for them.

Monique Ramsey (18:32):
Now, looking ahead at the trends that you see and the things that you're hearing, what patients ask for, do you think, excuse me, eyelid surgery, what kind of might stay there for a while? Is there another procedure that might take its place in the facial rejuvenation department?

Dr. Riedler (18:49):
I mean, I think eyelid surgery, I don't see it declining in popularity because it is kind of universal. It isn't for, there are so many people who can benefit from it, and the results are long lasting, the downtime and recovery is pretty reasonable. And so yeah, I see why it's popular, and I don't know why it would change at this point.

Monique Ramsey (19:19):
Yeah, everybody's got eyes.

Dr. Riedler (19:20):
Everybody has eyes, yeah.

Monique Ramsey (19:23):
It's like, okay, there's lip lifts and you do beautiful, there's so many things that you do on the face that can rejuvenate, but not everybody needs a lip lift or wants a lip lift. So it's like, yes, that's really popular, but it's not going take over eyelid surgery. But this was so helpful, and if anybody in the audience, if you're listening today and you have questions or need help scheduling a consultation, we even have, and I'll put in the show notes, we have a new thing that you can schedule online, which is a call with one of our patient coordinators, you can schedule it yourself. So what's really nice is you're not playing phone tag. You can just schedule that, then one of our patient coordinators who are all very knowledgeable, can talk to you about getting set up with an appointment with Dr. Riedler. It just kind of bypasses the phone tag or being on hold forever. So anyway, so we'll put that in the show notes because kind of new and a lot of patients really like the flexibility of scheduling it on their own time. So thanks Dr. Riedler.

Dr. Riedler (20:30):
Thanks Monique.

Monique Ramsey (20:31):
Thanks everybody for listening, and we'll see you on the next one. Bye.

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