Blepharoplasty is surgical procedure performed on either the upper
or lower eyelid to improve the appearance of the skin around the
eye. On the upper eyelid, it is used to correct redundant (droopy)
skin of the upper eyelid and forehead. As we age, skin of the eyelid
loses elasticity. Furthermore, the structures that support the skin
of the forehead weaken, leading to excess skin that may hang over
the edge of the brow. Finally, the muscles and the fat of the upper
eyelid can change with age, leading to an unattractive bulge. Traditionally,
blepharoplasty involves removing the excess skin of the upper lid
to restore a sharp eyelid crease and give the upper eyelid a smooth
look. For people with bulging fat in the upper eyelid, blepharoplasty
can also include excision of the bulging fat. Lower eyelid blepharoplasty
is usually performed to correct the appearance of “bags”
under the eyes. So called “bags” are caused from fat
that is normally behind the eye that bulges in front of the eye
muscles because of aging.
How is eyelid surgery performed?
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After |
Upper eyelid blepharoplasty is performed in an
outpatient clinic using local anesthetics. You may also be given
a sedative to relax you during the procedure. Usually, a pre-operative
consultation is performed during which time you meet the surgeon,
discuss the procedure, and are examined. Depending on the nature
of the cosmetic problem, different procedures may be offered. For
example, if your eyelids are droopy because of laxity of the forehead
structures, a brow lift (see next section) may be offered instead
of blepharoplasty. On the day of the procedure, the first step is
examination and marking the upper eyelid. Local anesthetic (usually
lidocaine) is injected into the upper eyelid to numb it. Removal
of the excess skin is then performed using either a scalpel, carbon
dioxide laser, or radiofrequency cutting. For those patients with
bulging fat in the upper eyelid, the fat is then gently removed.
The wound is then closed with sutures. Your surgeon may prefer absorbable
(dissolving) or non-absorbing sutures that will be removed later.
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After
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Lower eyelid blepharoplasty is performed in a
similar manner as described above. However, depending on the nature
of the cosmetic defect, different techniques may be used. For patients
with both bulging and droopy lower eyelids, an incision is made
on the outside of the eyelid, just below the eyelash line. The various
eyelid tissues are separated from one another and the bulging fat
is identified and gently removed. The excess skin is then cut out
and the wound is sutured. For patients with bulging but not droopy
eyelids, an incision is made along the inner side of the eyelid.
The eye itself is anesthetized with eye drops and then the eyelid
skin is injected with local anesthetic. A shield is placed over
the eye to protect it. Incisions are made in the inner lower eyelid
and the bulging fat is gently removed.
More Eyelid Surgery Facts...
What is the recovery period like after eyelid surgery?
Usually, you will need a ride home after the procedure. Your eyelids
will be lubricated and bandages may or may not be applied. After
the anesthetic wears off, your eyelids may feel tight and sore.
Your surgeon may offer you a prescription for pain medication which
you should fill before the procedure. If the post-operative pain
is severe, this may indicate a serious problem and you need to call
your surgeon immediately. Once at home, keep your head elevated
and use cold compresses. It is important to keep your eyes clean;
your doctor will give you instructions on how to do this. Eye drops
or ointments will be provided to lubricate the eyes. Bruising is
normal and peaks about a week after the procedure. The bruises may
last 2-4 weeks but can usually be covered with makeup by about 10
days. Activity can usually be resumed in 3-5 days and most patients
return to work about 10 days after the procedure. Swelling usually
lasts one to two weeks but in some cases can last months. More Eyelid Surgery Facts...
What are the risks of eyelid surgery?
The most important step in any cosmetic procedure is
having a realistic expectation of the outcome and understanding the
potential complications. You should have a lengthy discussion with
your surgeon prior to the procedure so that you have a good understanding
of what to expect. Some of the common complications are discussed
below but this discussion should never replace the discussion with
your surgeon. The most common complaints after blepharoplasty are
asymmetry (one side does not match the other) and removal of too little
skin. It is important to be realistic about how much skin can safely
be removed. If too much skin is removed, the eyelid will not function
properly(see further discussion below). Perfect symmetry is very difficult
to achieve and it is possible that you may need a touch up procedure
after the initial procedure to achieve symmetry. It is also important
to realize that the final result cannot be judged for many weeks after
the procedure because swelling of the eyelid from the procedure can
make the eyelid look abnormal. Bleeding into the skin (called a hematoma)
after the procedure is a common complication. It is critical to stop
all over the counter and prescription medications that increase the
risk of bleeding. Furthermore, after the procedure, you must avoid
vigorous activity, lifting, bending, or any other activity that may
increase the risk of bleeding. The worst complication of blepharoplasty
is called retrobulbar hematoma and occurs after lower lid blepharoplasty.
Bleeding into the space in front of the eye can occur, resulting in
pressure on the optic nerve and its blood supply. When left untreated,
permanent blindness can occur. Early diagnosis—recognized by
eye pain or visual changes—is critical. Another complication
is called lagophthalmos which is the inability to completely close
the eyelid. Lagophthalmos can be transient from eyelid swelling, or
permanent if too much skin from the upper lid was removed. This causes
drying of the cornea and then inflammation of the cornea. Lubricating
ointments are used to treat this temporarily but if it becomes permanent,
a skin graft may have to be used to correct the problem. Scarring
can also occur post-operatively, leading to a poor cosmetic outcome.
Scarring of the lower lid can pull the lower lid out, leading to an
unnatural appearance and dysfunction of the lower eyelid. You and
your surgeon should discuss these and any other risks and decide if
this is the right procedure for you. More Eyelid Surgery Facts...
Eyelid Surgery Related Articles
Disclaimer:
This information is intended only as an introduction to this procedure.
This information should not be used to determine whether you will
have the procedure performed nor does it guarantee results of your
elective surgery. Further details regarding surgical standards and
procedures should be discussed with your physician.
By OnlineSurgery Staff
Updated: May 29, 2007
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Cosmetic/Plastic Surgery
