Blepharoplasty in men and women: the aesthetic and technical differences

Ageing around the eyes in men and women

Ageing affects all the tissues around the eye, but how it shows clinically differs between the sexes. These differences have to be taken into account when planning surgery, to avoid unwanted changes to the facial expression.

In men, ageing usually shows as follows:

• Greater enlargement of the orbicularis muscle.
• More marked pads of fat in the lower eyelids.
• An upper eyelid that droops progressively, with no marked folds.
• A low, straight brow, closer to the eyelid.
• A more severe or tired expression.

In women, the most usual pattern is:

• Excess skin with multiple folds in the upper eyelid.
• Fine lines appearing, and thinner skin.
• Drooping of the eyelid associated with loss of volume.
• A more arched brow, further from the eye.
• Changes that produce an expression of tiredness or sadness.

These anatomical and functional differences shape both the choice of surgical technique and the final result expected. A surgical approach not adapted to the sex of the patient can give unnatural results, with a loss of expression or unwanted feminisation in male patients.

Aesthetic goals by sex

One of the fundamental pillars of blepharoplasty is respecting facial identity. It is therefore essential to understand that the notion of beauty and harmony around the eyes differs between men and women.

In men, the aesthetic goals most valued are:

• Removing the bags without changing the shape of the eye.
• Keeping the brow straight and low.
• Keeping an upper eyelid with a minimal crease.
• Avoiding results that soften the masculine features too much.
• Correcting the tired look without feminising the eyes.

In women, priority goes to:

• Restoring the natural crease of the upper eyelid.
• Lifting the eyes slightly while respecting the brow.
• Softening fine lines without over-correction.
• Reducing the bags with techniques that keep the natural volume.
• Bringing the eyes into harmony with the rest of the face.

These aesthetic goals have to guide every surgical decision, from the design of the incision to the amount of tissue to be removed. The success of the procedure lies in the result being coherent with the face and with the patient’s expectations.

What the anatomy measures

That blepharoplasty is approached differently in a man and in a woman is not a matter of style: the measurements of the eyelid and the brow are different to begin with, and that has been measured.

An anthropometric analysis of 164 people, published in Plastic and Reconstructive Surgery, found differences between men and women in exactly the measurements that define the design of an upper blepharoplasty: the height and width of the palpebral fissure, the height of the pretarsal skin — the visible strip between the lashes and the crease — and the height of the crease itself. Also in the tilt of the fissure and in the position of the brow.

On the male eyelid there is also a recent reference with 600 periocular regions analysed: the male brow is flat and low, sitting on the orbital rim with its highest point displaced towards the outer third. It is a brow that does not draw an arch.

From that comes the practical consequence. In men the crease is designed lower and more skin is kept between the crease and the brow, because there is less distance available and because the result has to go on looking like a male eyelid. It is not operating less: it is respecting a geometry that was already different before anyone entered theatre.

Technical differences in upper blepharoplasty

In upper blepharoplasty, the most relevant technical variations between the sexes relate to the position of the brow, the shape of the eyelid crease and the amount of skin to be removed.

In men:

• The excess skin is removed without creating a high or pronounced crease.
• The incision follows the natural line of the eyelid, without changing the shape of the eye.
• Part of the fat volume is preserved, to avoid a hollowed look.
• The brow is not raised, since an arched brow can alter the masculine expression.

In women:

• The aim is to restore the eyelid crease, removing the surplus skin with more freedom.
• Fat removal is more selective, allowing greater definition of the eyelid.
• In some cases it is combined with brow-lifting techniques to rejuvenate the upper third.
• The design of the incision is chosen to sit well with the patient’s usual make-up.

The surgeon has to be extremely precise in deciding how much tissue to remove, since excessive removal in a man can result in an unnatural look, while insufficient removal in a woman can leave an incomplete result.

Technical differences in lower blepharoplasty

Lower blepharoplasty is one of the most technically demanding operations, and it too shows notable differences between men and women.

In male patients:

• The skin is usually thicker and more resilient, which allows the bags to be dealt with without removing skin in many cases.
• Wherever possible (if there is no excess skin) the transconjunctival technique is preferred, to avoid external scars and keep a natural appearance.
• The volume is maintained and only the surplus fat is acted on.
• Any change to the shape of the eye or the tilt of the outer corner is avoided.

In female patients:

• The skin is thinner and more prone to laxity, so in many cases skin has to be removed.
• It is combined with rejuvenating techniques such as laser or fat transfer into the tear trough.
• The aim is to soften the relief without changing the character of the eyes.
• The technique may be transconjunctival or subciliary, according to the quality of the tissue.

In both sexes the priority is to preserve the function of the lower eyelid and to avoid complications such as retraction or the round eye, which can compromise both the aesthetic result and the protection of the eye.

Natural results in men and women

Whatever the sex, the key to a satisfactory result in blepharoplasty is a natural appearance. The procedure has to rejuvenate the eyes while respecting the patient’s features and emotional expression.

To achieve that, the surgeon has to:

• Adapt the technique to the anatomical characteristics of each sex.
• Use conservative methods that avoid over-correction.
• Keep the natural volume in key areas.
• Attend to symmetry without chasing artificial perfection.
• Tell the patient clearly what the limits of the procedure are.

At the Instituto de Cirugía Plástica del Mediterráneo, every blepharoplasty is designed individually, fitted not only to the patient’s physical characteristics but also to their sex, age, ethnicity and lifestyle. This integrated view allows results that are coherent, lasting and aesthetically harmonious.

Assessment before surgery, by sex

Before surgery, a thorough assessment is carried out, including:

• Analysis of the position and shape of the brow.
• Review of the eyelid crease and skin elasticity.
• Assessment of the fat volume and of the orbicularis muscle.
• A study of facial symmetry and emotional expression.
• An eye examination to rule out associated conditions.

In men, particular attention goes to not raising the brow or creating exaggerated folds. In women, the possibility of complementary procedures to enhance rejuvenation of the upper third is assessed.

Blepharoplasty is an operation with highly satisfactory results, provided it is carried out with an individual approach adapted to the patient’s sex. The differences between men and women in this surgery are profound, and affect both the technique and the aesthetic result expected. Only a surgeon experienced in facial surgery and with an understanding of the anatomical and aesthetic variations can guarantee a natural, balanced result.

If you are considering a blepharoplasty, we invite you to book a medical consultation at the Instituto de Cirugía Plástica del Mediterráneo. Our team will give you a professional assessment fitted to your face, your expression and your identity. Because rejuvenating the eyes should not mean losing what makes you yourself.