Blepharoplasty, or eyelid surgery, is a cosmetic surgery that corrects sagging or drooping eyelids as well as bags and bulges around the eyes. These conditions develop as a result of laxity of the eyelid skin and protrusion of fat around the eyes. It is not limited to older patients. Many individuals inherit a predisposition toward development of fat pouches at an early age. Excess skin is treated by excision or occasionally by laser resurfacing. If excess fat is present, it can be removed simultaneously. Care must be taken not to remove excessive amounts of fat to avoid a hollowing appearance with the increasing age of the patient.
Most patients seeking eyelid surgery want a rejuvenated appearance that requires reestablishing the normal architecture around the eyes that was present when they were younger. Surgical correction is appropriate for all age groups. In some cases, the condition will be caused by other medical problems such as allergy or thyroid disorders. In these patients, the proper treatment may be medical rather than surgical.
The age range for eyelid surgery is wide because of the various factors that predispose one to having the condition. Younger patients who have surgery usually have it because of an inherited condition in which the fat deposits push against a retaining wall (orbital septum) that normally prevents prolapse of fat, resulting in early bulging above or below the eyes. Older patients generally seek surgery because of sagging of the eyelid skin, but can also have bulging fat.
In some cases, patients seek surgery because their drooping eyelids interfere with their vision. If the vision is severely impaired by hanging skin, insurance may cover a portion of the surgical cost. A test known as a visual field exam is typically performed to check the extent of visual impairment for insurance purposes.
Although more women than men elect to have eyelid surgery, the operation is equally suitable for men. Eyelid skin is the thinnest skin on the human body and becomes increasingly loose on almost everyone with time.
The operation is begun on the upper eyelids by making incisions in the natural crease region of the lid and removing the excess tissue above this incision. The location of the incisions, coupled with the excellent healing ability of the eyelid skin, almost always results in scars that are difficult, if not impossible, to see with the passage of time. Through these incisions, excess skin, fat, or muscle are removed, depending on the individual problem. The use of the surgical laser can help to minimize postoperative swelling and bruising.
Following completion of the surgery, the incisions are usually closed with a very fine absorbable suture.
Most patients can anticipate a marked improvement in the appearance of the eyes. They have a fresher, more wide-open appearance. This is often coupled by a similar feeling of lightness in the eyelids. Bags and pouches are significantly reduced if not completely eliminated. Some patients actually experience an improvement in their eyesight or peripheral vision as a result of removal of skin that was hanging over the pupil and obstructing vision.
The lower eyelid may require a wide variety of treatments depending on the pre-operative diagnosis. When the problem in the lower lid is primarily the bulging of fat, without excess skin, the lower lid blepharoplasty is conveniently carried out through an incision made inside the lower eyelid, thus eliminating all visible scarring. This procedure, called a transconjunctival blepharoplasty, has gained popularity because it minimizes the risk of pulling on the lower lid, a complication discussed below.
The transconjunctival approach can be combined with a chemical peel or laser resurfacing of the lower eyelid to help remove some of the lines in the lower eyelid skin. If significant laxity exists in the lower eyelid skin and muscle, then a traditional lower eyelid blepharoplasty (by means of excising excess tissue from an incision along the lash line) is another option that may be indicated. In certain cases, where the lower eyelid is extremely lax, additional work may be required to tighten the lid to prevent postoperative drooping.
Eyelid surgery is almost always an outpatient procedure performed under general anesthesia. In some instances the procedure can be performed under local anesthesia with IV sedation.
Patients apply iced compresses during the day of surgery to minimize swelling. No other dressings are required. Sutures are absorbable and require no removal. Make-up can be worn within three days of surgery if necessary, but one week is preferable. Most patients can return to near-normal activity within a very few days of their surgery. Bruising, coupled with some swelling, often persists for several days beyond that time, but is usually easily camouflaged by make-up or sunglasses. When laser skin resurfacing is combined with the blepharoplasty, the skin beneath the eye will be raw for several days and pink for even longer.
Discomfort is usually relatively mild after blepharoplasty, although this will vary. Most patients require little or no pain medication. Some minor irritation of the eyes is common and may occur for several days after the operation. Blurred vision can occur early after surgery if eye ointment was applied. Close adherence to your postoperative instructions will greatly diminish the discomfort, swelling, and bruising that you will have after your surgery.
Serious complications are most unusual, and those that do occur can usually be corrected. Since there is variation in the scar contracture following this operation, wise and conscientious surgeons are always careful to avoid excessive tissue removal, particularly in the lower eyelids. This minimizes the risk of a complication called ectropion – in which the lower lid is pulled down and outward. This risk is also minimized by the transconjunctival approach, when indicated. Additional risks include bleeding, postoperative dryness of the eye, visible scarring, and, in very rare cases, visual loss.
Patients who are subject to dryness of the eyes should notify us of this problem. Blepharoplasty can exacerbate this problem. Precautions should be taken to keep the eyes moist after surgery if the surgery can still be performed.
Dr. Angelo Cuzalina offers lower and upper eyelid surgery at Tulsa Surgical Arts. See the gallery of eyelid surgery before and after photos for results, and call 918-392-7900 for more information.