Blepharoplasty (Eyelid Surgery)

What is Blepharoplasty?

Blepharoplasty (eyelid surgery) is a plastic surgery procedure for correcting sagging or drooping eyelids. The eyelid, because its skin is much thinner than that in other parts of the face, is often one of the first facial areas to exhibit signs of aging. Eyelids that sag or droop can affect peripheral vision, making daily activities such as driving more difficult. Blepharoplasty may become necessary when various factors, which include aging, sun damage, smoking, and obesity, cause the muscles and tissue that support the eyelids to weaken.

What Can Blepharoplasty Correct?

A blepharoplasty is ideal for correction of the following:

• Loose, sagging and/or folded upper eyelids that may interfere with vision
• Puffy fat deposits in the eyelids
• Undereye bags
• Sagging lower eyelids that may show the whites of the eyes below the irises
• Excess skin in the lower eyelids
• Fine wrinkles in the lower eyelids

A blepharoplasty cannot raise the eyebrows, or treat deep wrinkles, dark circles under the eyes, or crow's feet.

Reasons For Eyelid Surgery

Blepharoplasty tightens the eyelid's muscles and tissue and removes excess fat and skin. Blepharoplasty eliminates the drooping of skin into the visual field, greatly improving peripheral vision. It is also performed for strictly cosmetic reasons.

Best Candidates for Eyelid Surgery

The best candidate for a blepharoplasty is in good overall health, does not smoke, does not have serious eye conditions, and has healthy facial tissue and muscle.

A person with eye disease, glaucoma or retinal detachment, thyroid disorders, diabetes, cardiovascular disease or high blood pressure may not be a good candidate for a blepharoplasty.

It is important for a patient to have realistic expectations before undergoing a blepharoplasty. Although it can enhance the appearance and improve self-confidence, it does not radically alter the look of the face.

Different Types of Blepharoplasty

Functional Blepharoplasty

If the eyelids begin sagging into the field of vision, a functional blepharoplasty may be required. The procedure may be covered by medical insurance if it is deemed medically necessary. A determination of how much vision is affected is done by checking the peripheral visual field with an instrument called the Humphrey Visual Field (HVF) Analyzer.

Cosmetic Blepharoplasty

Blepharoplasty can be performed on either the upper or lower eyelid, or on both, for cosmetic purposes. For a lower eyelid that needs fat rather than skin removed, a transconjunctival blepharoplasty is performed. During transconjunctival blepharoplasty, an incision is made inside the lower eyelid, so there are no visible scars, and the fat is removed. This procedure has no effect on vision, but results in a person's looking younger and more refreshed.

It is important for a patient to have realistic expectations before undergoing cosmetic blepharoplasty. Although the procedure can enhance the appearance and improve self-confidence, it does not radically alter the face.

How Is Blepharoplasty Performed?

Blepharoplasty is typically performed as an outpatient procedure requiring local anesthesia and sedation. General anesthesia may be used for anxious patients. Patients can choose to have this procedure on their upper or lower eyelids or both. The procedure can take anywhere from 45 minutes to 2 hours, depending on whether both the upper and lower eyelids are operated on.

If the upper eyelid is being operated on, an incision is typically made along its natural crease. Once the incision is made, fat deposits are repositioned or removed, muscles and tissue are tightened, and excess skin is removed. For the lower eyelid, an incision is usually made just below the lash line so that excess skin can be removed.

After the procedure, the incisions are closed with sutures, tissue glue or surgical tape, and usually loosely covered with gauze so the area can heal.

Recovery After Blepharoplasty

After blepharoplasty, patients may be advised to apply lubricating drops/ointment and cold compresses to aid in healing and minimize side effects. Most patients return to work within a few days to a week, but should avoid exercise and strenuous activities for at least 2 weeks. Stitches are usually removed after 3 or 4 days. Most swelling and other side effects typically subside within 2 weeks. Contact lenses and eye makeup may not be worn for 2 weeks after surgery. Patients are typically advised to wear dark sunglasses outside or in bright light for 2 weeks to protect their eyes from sun and wind.

Risks and Side Effects of Eyelid Surgery

Although there may be swelling and bruising around the surgical site, they will subside on their own, and the eyelids will improve in appearance for up to a year. Uncommon side effects include infection, reaction to anesthesia, and double or blurred vision. Eyes may be irritated and dry due to a temporary change in tear distribution. Side effects such as uneven healing and permanent scarring are rare but, if they occur, may require surgical correction. The scars from blepharoplasty are well-concealed and usually fade with time until they are virtually undetectable. Although the eyelids are still subject to aging, blepharoplasty produces long-lasting results.

Lower Eyelid Blepharoplasty

Blepharoplasty, also known as eyelid surgery, is a surgical procedure that improves the appearance of the eyelids by tightening muscles and tissue or removing excess fat and skin. A lower eyelid blepharoplasty is used to treat the following:

• Under-eye bags
• Drooping lower eyelids
• Excess skin
• Fine wrinkles
• Circles under the eye

A lower eyelid blepharoplasty can be performed on adult men and women alike and offers a younger, more refreshed look that reflects across the whole face.

Blepharoplasty is one of the most commonly performed facial plastic surgery procedures. The popularity of this procedure reflects the importance of the eyes in perfecting overall appearance. If the appearance of the eyes causes a patient to be unhappy, they may want to consider lower eyelid blepharoplasty to improve their look and boost their confidence through a safe procedure with minimal downtime.

Best Candidates For A Lower Eyelid Blepharoplasty

The best candidates for lower eyelid blepharoplasty are those individuals who meet the following conditions:

• Are in good overall health
• Do not smoke
• Do not have any serious eye conditions
• Have healthy facial tissue and muscle

If a patient has loose, sagging skin or puffy bags beneath their eyes, this procedure can help reduce these unwanted effects and leave the eyes looking young and fresh.

It is important for patients to have realistic expectations before undergoing a lower eyelid blepharoplasty procedure in order to be satisfied with their results. While the procedure can enhance their appearance and may improve self-confidence as a result, it cannot alter a patient's entire appearance or change the structure of their face.

How Is A Lower Eyelid Blepharoplasty Performed?

The lower eyelid blepharoplasty procedure is performed with either local or general anesthesia. The method or procedure to be used will be determined by the amount of fat that needs to be removed, the location of the fat and how tight to make the eyelid. The procedure typically takes from 45 minutes to an hour.

Lower Eyelid Blepharoplasty Approaches

There are several different surgical approaches that can be used in a lower eyelid blepharoplasty. They are as follows:

Transconjunctival Lower Lid Blepharoplasty

Often chosen when no skin needs to be removed, a transconjunctival lower lid blepharoplasty creates an incision on the inside of the lower eyelid, leaving no visible scar or other evidence of the surgery.

Transcutaneous Lower Lid Blepharoplasty

A transcutaneous lower lid blepharoplasty is performed with a subciliary incision, also known as a pinch technique, to remove protruding fat and excess skin.

Transconjunctival Arcus Marginalis Release

A transconjunctival arcus marginalis release moves the fat within the lid to maintain some volume in the soft tissue. It prevents the ridge of orbital bone from becoming too prominent, which causes the eyes to look hollow and the face to appear older.

After the lower eyelid blepharoplasty procedure is performed, the incisions are closed with sutures and usually wrapped in gauze to allow the area to heal.

Recovery After A Lower Eyelid Blepharoplasty

After the lower eyelid blepharoplasty procedure, the surgeon may recommend applying lubricating drops or ointment and cold compresses to aid in the healing process and minimize side effects such as:

• Swelling
• Bruising
• Irritation
• Dry eyes

The eyes may be wrapped in gauze after the procedure as well. Patients can usually return to work within a few days, but should avoid exercise and strenuous activities for at least two weeks. Stitches are usually removed three or four days after the procedure. Swelling and other side effects usually subside within two weeks after surgery. Contact lenses and eyelid make-up may not be worn for two weeks after surgery. The surgeon will give specific instructions on how to care for the eyes post-procedure.

Results Of A Lower Eyelid Blepharoplasty Procedure

The results of a lower eyelid blepharoplasty procedure are visible as swelling and bruising subside and will continue to improve for up to a year after surgery. The lower eyelid blepharoplasty procedure is designed to produce long-lasting results. While surgery cannot prevent the eyes from aging, most patients are satisfied with their results and do not seek a repeat procedure.

What Are The Potential Risks of a Lower Eyelid Blepharoplasty?

As with any surgical procedure, there are certain risks associated with a lower eyelid blepharoplasty procedure. While rare, these risks include the following:

• • Bruising
  • Swelling
  • Blurry vision
  • Malposition of the eye
  • Bleeding
  • Infection
  • Dry eyes
  • Skin discoloration
  • An inability to fully close the eyes

For more information about Blepharoplasty (Eyelid Surgery), or to schedule an appointment, please contact our office.