Feb. 24, 2026
Beauty and the Beasts | Episode 9 Eyelid Surgery Why Small Does Not Mean Simple
In this episode of Beauty and the Beasts, plastic surgeons Dr. Sam Jejurikar and Dr. Salvatore Pacella take an in depth look at eyelid surgery, one of the most common and most misunderstood procedures in plastic surgery.
Many patients view eyelid surgery as a minor operation, often described as just having a little skin removed. In reality, eyelid surgery is small but powerful, with outcomes that depend heavily on anatomy, judgment, and surgical experience. Dr. Pacella shares why lower eyelid surgery is often the most technically demanding area in facial plastic surgery, emphasizing that careful examination, restraint, and prevention are far more important than aggressive correction when it comes to avoiding eyelid malposition and difficult revisions.
The conversation begins with upper eyelid surgery, focusing on conservative skin removal, brow position, and the importance of preserving fat to avoid a hollow or aged appearance. Dr. Jejurikar explains why less is more in upper eyelid surgery and how overly aggressive fat or skin removal can lead to dry eyes, difficulty closing the eyelids, and unnatural results.
The discussion then shifts to lower eyelid surgery, which both surgeons describe as a surgical no man’s land when performed without proper planning. They explain why lower eyelids are prone to complications, how eyelid laxity is often underestimated, and why a thorough physical examination is critical before surgery. The risks of ectropion, eyelid malposition, and unwanted shape changes are discussed in detail, along with strategies to prevent them.
Dr. Jejurikar and Dr. Pacella review different approaches to lower eyelid surgery, including transconjunctival fat removal, conservative skin pinching, laser resurfacing, and various methods of canthal support. They explain the differences between canthopexy and lateral tarsal strip procedures and when more advanced reconstructive techniques are required.
The episode also covers complex lower eyelid reconstruction, including severe cases where the eyelid support system must be rebuilt entirely. Common postoperative issues such as chemosis are explained, along with prevention strategies, temporary sutures, medications, and when surgical intervention is necessary.
Recovery expectations are addressed in detail, highlighting why upper eyelid surgery often has a short recovery while lower eyelid surgery can involve weeks of swelling. The surgeons discuss the role of ice, supplements, hyperbaric oxygen therapy, and why temporary vision changes can occur after eyelid surgery.
This episode is ideal for patients considering blepharoplasty, those researching upper or lower eyelid surgery, and anyone who wants a realistic understanding of risks, recovery, and outcomes. It is also valuable for clinicians interested in nuanced eyelid decision making and complication management.
Subscribe for honest, experience driven discussions on plastic surgery, facial aging, and evidence based aesthetic care.
Many patients view eyelid surgery as a minor operation, often described as just having a little skin removed. In reality, eyelid surgery is small but powerful, with outcomes that depend heavily on anatomy, judgment, and surgical experience. Dr. Pacella shares why lower eyelid surgery is often the most technically demanding area in facial plastic surgery, emphasizing that careful examination, restraint, and prevention are far more important than aggressive correction when it comes to avoiding eyelid malposition and difficult revisions.
The conversation begins with upper eyelid surgery, focusing on conservative skin removal, brow position, and the importance of preserving fat to avoid a hollow or aged appearance. Dr. Jejurikar explains why less is more in upper eyelid surgery and how overly aggressive fat or skin removal can lead to dry eyes, difficulty closing the eyelids, and unnatural results.
The discussion then shifts to lower eyelid surgery, which both surgeons describe as a surgical no man’s land when performed without proper planning. They explain why lower eyelids are prone to complications, how eyelid laxity is often underestimated, and why a thorough physical examination is critical before surgery. The risks of ectropion, eyelid malposition, and unwanted shape changes are discussed in detail, along with strategies to prevent them.
Dr. Jejurikar and Dr. Pacella review different approaches to lower eyelid surgery, including transconjunctival fat removal, conservative skin pinching, laser resurfacing, and various methods of canthal support. They explain the differences between canthopexy and lateral tarsal strip procedures and when more advanced reconstructive techniques are required.
The episode also covers complex lower eyelid reconstruction, including severe cases where the eyelid support system must be rebuilt entirely. Common postoperative issues such as chemosis are explained, along with prevention strategies, temporary sutures, medications, and when surgical intervention is necessary.
Recovery expectations are addressed in detail, highlighting why upper eyelid surgery often has a short recovery while lower eyelid surgery can involve weeks of swelling. The surgeons discuss the role of ice, supplements, hyperbaric oxygen therapy, and why temporary vision changes can occur after eyelid surgery.
This episode is ideal for patients considering blepharoplasty, those researching upper or lower eyelid surgery, and anyone who wants a realistic understanding of risks, recovery, and outcomes. It is also valuable for clinicians interested in nuanced eyelid decision making and complication management.
Subscribe for honest, experience driven discussions on plastic surgery, facial aging, and evidence based aesthetic care.