Dr. Michael Baumholtz offers upper and lower eyelid surgery to address heaviness, puffiness, and shadowing around the eyes. His approach is steady and conservative. He chooses the right operation for the real problem, places the smallest incision in the smartest location, handles tissue carefully, and guides patients through an aftercare plan that fits daily life. He prefers clear explanations to medical jargon and makes sure each person understands what the operation can and cannot accomplish, from the first visit to the last stage of scar maturation.
Quick Facts
Blepharoplasty may involve upper lids, lower lids, or both during one visit. Anesthesia is chosen case by case. Some patients do well with local anesthesia and light sedation, while others are better served with general anesthesia based on procedure scope and comfort. All surgery occurs in an accredited facility with a trained anesthesia provider and an experienced nursing team. Operating time for upper lids typically ranges from about one to two hours, with a similar range for lower lids. Combined surgery takes longer. When external stitches are used, removal usually occurs at about one week. Many people appreciate several quiet days at home before returning to light desk work within three to five days if they feel ready. Gentle walking begins right away. Strenuous activity waits for about two weeks and then increases gradually after clearance. Contact lenses are usually reintroduced after one to two weeks when the eyes feel comfortable and the team has approved the timing. While early pinkness and swelling settle within weeks, scars continue to mature for up to twelve months. Pricing is individualized after consultation, and the practice does not take insurance.
What It Treats
Upper eyelid surgery removes extra skin that hangs or feels heavy and can cause makeup to smudge or the lid to rest on the lashes. Lower eyelid surgery reduces bags caused by forward shifting fat and, in select cases, can tighten a small amount of loose skin right under the lashes. The operation can soften the shadow at the lid to cheek transition and help the area look less tired. It does not treat forehead lines, crow’s feet, or generalized cheek laxity. Those concerns are better handled with tools such as neuromodulators, resurfacing, or lifting procedures, which Dr. Baumholtz reviews during consultation when appropriate. If you are exploring related procedures, he may recommend reading the pages on Brow Lift, Facelift, or Skin Treatments for complementary options.
How Scars Are Planned To Look
Incisions are placed where the eye naturally hides a line. On the upper eyelids, the incision sits inside the natural crease. When your eye is open the line tucks into that fold and reads like a normal crease rather than a surgery mark. On the lower eyelids, an internal approach hides the incision on the inside surface of the lid so there is no outside line. When a small amount of skin needs smoothing, a conservative skin pinch just under the lashes creates a fine outer line that blends with lash shadow as it settles. During the first week the incision often appears pink and slightly raised and then calms steadily. By one month most people find the line is hard to notice at conversational distance. Between three and six months the color fades toward surrounding skin tone and the line relaxes. At one year the upper crease usually reads like a soft pencil line that disappears into the fold, and a lower lid skin pinch line typically settles into a thin, quiet seam.
Who Is A Good Candidate?
Good candidates are in overall good health, understand the expected course of healing, and are willing to follow a straightforward aftercare plan. Reported concerns such as upper lid heaviness or lower lid puffiness should match the exam so the chosen operation addresses the true problem. Brow position is crucial. A brow that has drifted low can crowd the upper eyelid and create the appearance of extra skin. If too much upper lid skin is removed in this setting, the eyelid can be shortened and the eye may look round or hollow. For this reason, Dr. Baumholtz evaluates brow position at every upper lid consult and may recommend a brow lift as the primary step or a combined plan when it better serves both function and appearance. Relative considerations such as dry eye symptoms, prior refractive surgery, thyroid eye disease, previous lower lid surgery, use of blood thinners, and nicotine exposure are discussed in detail so risks are clear and the plan fits the patient’s health profile. If brow descent is the main issue, his Brow Lift guidance explains why lifting the brow can protect eyelid shape and limit the length of the crease incision.
How To Prepare (2-4 Weeks Before)
Preparation begins with a focused medical review. Patients share eye history, current eye care providers, contact lens habits, and any drops or ointments in use. Medications and supplements are reviewed with prescribing clinicians to plan safe timing around blood thinners, anti inflammatory drugs, high dose vitamin E, fish oil, and herbal products that may increase bleeding. Prescription medicines are not stopped without explicit guidance. Nicotine exposure is paused before surgery and throughout healing because it impairs blood flow and can delay recovery. Sun protection is set up in advance with a wide brim hat, quality sunglasses, and a mineral sunscreen that is comfortable to use near the eyes. Transportation for surgery day and a responsible adult to help the first evening are arranged ahead of time. Standard photographs are taken with consistent lighting so changes in swelling, color, and scar quality can be tracked objectively over time.
Day Of Surgery - What To Expect
On the day of surgery, marking is performed while the patient is sitting upright so crease position and the amount of skin to be removed are accurate in a natural posture. Anesthesia follows the plan made during consultation. The eyes are prepped carefully and protected as indicated. During the operation, Dr. Baumholtz uses sharp, controlled dissection with meticulous control of bleeding. On the upper lids he removes the planned skin and, when appropriate, a small strip of underlying muscle to keep the crease honest. On the lower lids he trims or repositions fat to smooth the lid to cheek junction without creating hollows. When an external line is present, closure is performed in fine layers with small sutures to reduce marks at the skin surface. After surgery, patients rest in recovery with the head elevated and cool compresses in place. Before discharge, the team reviews written instructions, demonstrates ointment placement, confirms follow up timing, and provides direct contact information.
Eyelid Surgery Before and After Photo Gallery
Surgical Approach
For upper eyelids, the incision sits in the natural crease and the goal is to keep a familiar eyelid shape while relieving heaviness. For lower eyelids, an internal transconjunctival approach is preferred when skin quality is good and forward shifted fat is the main issue. This route allows access to the fat pads without placing a line on the outer skin. If mild skin laxity is present, a conservative skin pinch beneath the lashes is added to smooth the surface. Dr. Baumholtz does not perform midface lifting through the lower lid incision because lower lid support and shape are priorities. When midface work is indicated, he considers other strategies that respect eyelid mechanics and explains those options during consultation or refers to the appropriate page, such as Facelift, for more detail. Across both upper and lower lids his technique priorities remain the same. He favors controlled dissection, precise hemostasis, gentle handling, and layered closure designed to encourage thin, supple scars.
Anesthesia And Setting
Anesthesia is individualized. Some patients do best with local anesthesia and thoughtful sedation which allows comfortable surgery with a short recovery room stay. Others benefit from general anesthesia for complete sleep and stillness. The decision weighs medical history, procedure extent, and patient preference after a balanced discussion of pros and cons. All procedures take place in an accredited facility with modern monitoring and a dedicated anesthesia professional. The environment is organized and familiar to the team and is designed around patient safety.
Risks And Considerations
Every operation involves risk. Expected early effects include bruising, swelling, and temporary dryness or tearing as the eyelids and tear film adjust. Infection and delayed healing are uncommon but possible and are treated promptly if they occur. Swelling can cause temporary changes in eyelid closure or symmetry while tissues settle. Bleeding can occur and, rarely, a collection of blood called a hematoma may need attention. Although eyelid scars often heal favorably, a thicker or more noticeable segment can occur and is managed with time and targeted care. Ointments and swelling can blur vision briefly in the early period. Persistent or concerning visual changes are unusual, but they are treated as urgent and evaluated immediately. Dr. Baumholtz explains these topics in clear language so patients know what to expect and when to reach out between scheduled visits.
Recovery Timeline (Typical)
The first forty eight hours are quiet by design. Patients keep the head elevated, use cool compresses as directed, and take short indoor walks to maintain circulation. Ointment is placed as prescribed, and sleep is on the back with extra pillows. Bending, straining, heavy lifting, and rubbing the eyes are avoided. Over days three through seven the swelling recedes and bruising often drifts downward as it fades. Light screen time is acceptable as comfort allows, and preservative free artificial tears can ease temporary dryness. External stitches, when used, are removed at around one week. Weeks two and three bring steady improvement in color and contour. Light makeup can be introduced after clearance, and many patients return to low impact exercise while deferring strenuous activity and contact sports. Around one month most people feel presentable without sunglasses, though ongoing sun protection remains important. Between three and six months the incision lines continue to fade and soften, and skincare returns to baseline under the team’s guidance. Final scar maturity is expected by twelve months, and any discussion of small touch ups typically waits until that process has finished unless a medical issue demands earlier attention.
Scar Care That Helps
Once incisions are closed and dry, the program focuses on simple steps done consistently. Sun protection is central in South Texas. A comfortable mineral sunscreen, a reliable pair of sunglasses, and a hat become part of the daily routine, and planning outdoor time for earlier or later hours helps with scar color. Silicone therapy, either a thin layer of gel or an ultra thin sheet, can help the line flatten and fade over time. Gentle fingertip massage starts only after the team clears the timing and demonstrates the technique, which helps the tissue glide and softens early firmness. Skincare stays mild in the first phase with fragrance free cleanser and moisturizer. Products containing retinoids or acids are delayed until approval. Some patients ask about additional tools. In those cases Dr. Baumholtz may discuss microneedling or energy based treatments on a conservative timeline after full healing. Around the eyes, timing and technique are cautious to protect the skin and the ocular surface. The Skin Treatments page outlines non surgical options that can be appropriate once healing has stabilized.
Activity, Vision, And Daily Life
Reading and computer use begin in short sessions as comfort allows. Driving resumes only after sedatives have cleared and vision feels normal. Glasses are used immediately, while contact lenses are typically reintroduced after one to two weeks when the eyes are comfortable and the team has approved the change. Showering is modified during the first day by keeping water below the neck. After that the face is cleansed gently without directing water pressure at fresh incisions. Sleep remains on the back with the head elevated for at least the first week to limit swelling. These choices make the early days easier and support calm scars.
When To Call The Office
The practice encourages questions and provides direct contact information for after hours concerns. Worsening redness, warmth, or pain after an initial period of improvement deserves attention. New visual changes that do not make sense given ointment use are addressed immediately. Thick or persistent drainage, fever, or a sudden increase in swelling on one side are also reasons to reach out. Photographs sent through the practice portal help the team triage and advise between visits.
FAQs About Eyelid Surgery In San Antonio
Where will the upper lid scar sit if I wear eye shadow daily?
The line is placed inside the natural upper lid crease. When your eyes are open it hides in the fold, and when makeup is allowed again after the first phase of healing, the line sits where shadow naturally blends.
If my lower lids are done from the inside, what will I see?
A transconjunctival incision sits on the inner surface of the eyelid, so there is no outside line at the lash margin. You may notice temporary pinkness on the inside that fades as swelling settles.
I tan easily. Will my scars darken?
Fresh scars can darken with sun exposure, which is why hats, sunglasses, and mineral sunscreen are part of the routine for several months. On the eyelids, long term dark staining is uncommon when protection is consistent.
Can a brow lift reduce how much upper lid scar I need?
When a low brow is crowding the eyelid, lifting the brow can reduce how much upper lid skin needs removal and can shorten the crease incision. Brow position is assessed at every upper lid consultation so the plan fits the anatomy. You can read more on the Brow Lift page.
Will I need a tiny outside scar if I have puffiness and fine lines?
Some patients benefit from a small skin pinch at the lash line to smooth mild laxity. That addition leaves a fine line under the lashes that usually settles into a subtle seam over time.
How soon can I attend outdoor events?
Sunglasses feel natural in the first two weeks and many people are comfortable without them for about a month. Sun protection remains important at outdoor events while scars are maturing.
What if a segment of the scar stays thick?
Time is the first tool, since eyelid scars remodel for a full year. If a short segment remains firm after that period, modest in-office options such as a limited trim, a conservative steroid injection, or gentle resurfacing may help.
Will this help with crow’s feet?
Crow’s feet are not directly treated by eyelid surgery. They are typically addressed with skincare, neuromodulators, or resurfacing, which can be discussed in consultation and explored on the Skin Treatments page.
Can I pair this with a facelift or neck lift?
Combined procedures are possible for the right patient. Dr. Baumholtz explains how added procedures change incision placement, anesthesia time, and recovery so each person can weigh the tradeoffs. See the Facelift page for broader information.
How are costs handled?
The office provides a detailed estimate after consultation based on the agreed plan. Dr. Baumholtz does not take insurance.
Medical References
- Evaluation of the Risk of Hypertrophic Scarring and Keloid Formation Following Cosmetic Eyelid Surgery. Aesthetic Surgery Journal. https://academic.oup.com/asj/article-abstract/43/8/820/7043566
- Scar Formation After Lower Eyelid Incision for Reconstruction of Periocular Skin Defects. PubMed Central, NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC8721435/
- Patient-reported Aesthetic Outcomes of Upper Blepharoplasty: A Randomized Controlled Trial. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S090150272200042X
- Upper Blepharoplasty Scar and Patient Satisfaction Study. Scientific Research Publishing. https://www.scirp.org/journal/paperinformation?paperid=100692
- Complications of Blepharoplasty: Prevention and Management. PubMed Central, NIH. https://pmc.ncbi.nlm.nih.gov/articles/PMC3357590/
- Double-eyelid Blepharoplasty-induced Scar Treated with a Long-pulsed Fractional CO2 Laser. Journal of the Korean Society for Laser Medicine & Surgery. https://www.jkslms.or.kr/journal/view.html?uid=27&vmd=Full
- Complications in Blepharoplasty: How to Avoid and Manage Them. ScienceDirect. https://www.sciencedirect.com/science/article/pii/S1808869415308600
Revision And Touch Up Philosophy
Most eyelid scars do not require revision when the operation is planned carefully and aftercare is steady. Even so, scars are living tissue and can behave unpredictably. Dr. Baumholtz gives biology a full year to remodel unless there is a medical reason to intervene sooner. If a small dog ear at the outer corner remains or a short segment stays thicker than expected after that window, the solution is usually modest and can often be handled in the office. Minor trimming of extra skin, a conservative steroid injection, or light resurfacing on the correct timeline can improve a persistent area without a larger procedure. The philosophy remains measured and patient first.
How To Prepare For Your Consultation
A focused visit produces the best plan. Patients are encouraged to bring a clear description of what bothers them in the mirror, such as heaviness, puffiness, or the sense of looking tired late in the day, and to share realistic reference photos if they find them helpful. A complete medication and medical history, including details about eye care providers and any prescription drops or lubricants, helps tailor the approach. During the examination, Dr. Baumholtz evaluates skin quality, fat pads, eyelid position and tone, and brow position. He then outlines the operative plan, reviews scar placement, and explains aftercare in a way that is easy to follow.
Why Choose Dr. Michael Baumholtz
Dr. Baumholtz is double board certified in General Surgery and Plastic Surgery and completed fellowship training in Hand and Microsurgery. Experience in high volume trauma centers shaped his respect for tissue handling, precision, and careful follow through. He is known for planning that matches anatomy, a balanced lower lid strategy that favors the internal route when appropriate, and a refusal to perform midface lifting through the lower lid to protect eyelid support and shape. Patients see him before and after surgery, and the practice builds time into visits so questions are answered without rush.
Next Steps
If you are considering blepharoplasty and want a clear plan for where incisions will go and how they will heal, the team can schedule a consultation. Call 210-660-5579 or email info@bplasticsurgery.com to find a convenient time. Appointments include time for questions before and after surgery. The goal is steady, safe care and incision lines that settle into the background of everyday life.
