Blepharoplasty, commonly called eyelid surgery, is a cosmetic procedure used for correcting defects, deformities and disfigurations of the eyelids, and for aesthetically modifying the eye region of the face. It gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert. Upper eyelid surgery can remove excess fatty deposits that appear as puffiness in the upper eyelids. Lower eyelid surgery can correct droopiness of the lower eyelids, showing white below the iris.
Blepharoplasty Techniques
Blepharoplasty is usually performed through external surgical incisions made along the natural skin lines of the upper and lower eyelids. Creases hide the surgical scars from view, especially when effected in the skin creases below the eyelashes of the lower eyelid. Incisions can be made from the conjunctiva, the interior surface of the lower eyelid, as in the case of a transconjunctival blepharoplasty.
Upper Blepharoplasty
Excess skin and fat are removed through an incision hidden in the natural eyelid crease. If the lid is droopy, the muscle that raises the upper lid can be tightened. Fine sutures are used from closing the incision.
Lower Blepharoplasty
Fat in the lower eyelids can be removed or repositioned through an incision hidden on the inner surface of the eyelid. To smooth and tighten the lower lid skin, laser resurfacing or a chemical peel can be performed at the same time if desired. If there is excessive skin in the lower eyelid, the incision will be made just below the lashes. Fat is repositioned or removed through the incision and the excess skin is removed. The surgeon will then close the incision with fine sutures.
Upper and Lower Blepharoplasty
These procedures can be performed together and can also be combined with other procedures, such as: eyebrow or forehead lift, midface lift, facelift, neck lift or laser skin resurfacing.
A blepharoplasty operation usually requires 1-3 hours to complete. The post-operative initial swelling and bruising consequent to the surgery will subside and resolve with 1-2 weeks and final, stable results will become apparent after several months.
Blepharoplasty Surgery Steps
Anesthesia
You will discuss with your doctor prior to the surgery whether you will be undergoing local or general anesthesia for your eyelid surgery. Local anesthesia means you will be awake during the procedure, but the area around your eyes will be numbed with a drug administered through a needle. You may require general anesthesia if the blepharoplasty is more complicated or if you plan to undergo other cosmetic procedures at the same time.
The Incisions
The incision lines for eyelid surgery are designed for scars to be well concealed within the natural structures of the eyelid region. Droopy conditions of the upper eyelid can be corrected through an incision within the natural crease of the upper eyelid allowing repositioning of fat deposits, tightening of muscles and tissue, and/or removal of excess skin.
As for conditions of the lower eyelid, these may be corrected with an incision just below the lower lash line, through which excess skin in the lower eyelids is removed. An alternate technique to correct lower eyelid conditions and redistribute or remove excess fat is the transconjunctival incision, hidden inside the lower eyelid.
Closing the Incisions
Eyelid incisions are typically closed with removable or absorbable sutures, skin adhesives or surgical tape. Sometimes the surgeon may use a laser chemical peel to erase dark discoloration or the lower eyelids.
Risks and Safety
A possible complication of eyelid surgery is a temporary inability to close your eyelids completely. This means that your eyes may become abnormally dry but usually, this condition resolves after a few weeks or months, during which time you will need eye drops and humidifiers. Your plastic surgeon will explain potential eyelid surgery risks and complications in detail and will ask you to sign consent forms to ensure that you fully understand the procedure you will undergo. Other potential complications or blepharoplasty include:
- anesthesia risks (breathing problems, reactions to medications)
- bleeding
- infection
- damage to the eye or loss of vision
- difficulty closing the eyes while sleeping
- double or blurred vision
- temporary swelling of the eyelids
- tiny whiteheads after stitches are removed
- slow healing
- uneven healing or scarring
- numbness of the eyelids
- undercorrection
- overcorrection
- malpositioned eyelids
If you experience shortness of breath, chest pains, or unusual heart beats, seek medical attention immediately. You may require hospitalization and additional treatment should any of these complications occur. Following your physician’s instructions is key to the success of your surgery. It is important that the surgical incisions are not subjected to excessive force, abrasion or motion during the time of healing. Careful! There are a few medical conditions that make blepharoplasty more risky:
- diabetes
- dry eye or insufficient tear production
- Graves disease, hypothyroidism and other thyroid problems
- heart disease or disorders of the blood vessels
- high blood pressure or other circulatory disorders
You will be provided with specific instructions on how to care for yourself after the blepharoplasty procedure.
Preparing for Consultation and Surgery
During your consultation, you will be asked a number of questions about your health, desires and lifestyle. You should be prepared to discuss:
- expectations and desired outcome
- medical conditions, drug allergies, previous medical treatments
- previous surgeries
- use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
- why you want the surgery
During the consultation, your surgeon may also evaluate your general health status and any pre-existing health conditions or risk factors. Photographs will be taken for your medical record, and the surgeon will discuss your options and recommend a course of treatment. Likely outcomes will be discussed, together with risks or potential complications. You will need to clarify with your doctor whether you will be undergoing local or general anesthesia for your eyelid surgery. Prior to the day of the procedure and particularly if you will be undergoing general anesthesia, you may be asked to take steps such as the following:
- do not eat or drink anything after midnight
- do not wear makeup of any kind on the day of the surgery
- eat only a light meal such as soup the evening before the surgery
- make sure someone is available to transport you home and watch after you during the first several hours after surgery
- stop taking any medication that can thin your blood and prevent it from clotting normally, such as pain relievers: aspirin and ibuprofen – you will need to stop taking them 1-2 weeks beforehand
- take essential medications such as for blood pressure on the morning of your procedure
Am I a Candidate for Blepharoplasty?
If you do not have a medical reason for a blepharoplasty, you can discuss with your ophthalmologist any concerns or interest you might have regarding cosmetic eyelid surgery. You might consider eyelid surgery if you have excessive drooping and sagging skin around the eyes. Sagging skin also can be exaggerated when you have other conditions such as puffy eyes caused by eye allergies or edema.
If you are interested in eyelid surgery strictly for cosmetic reasons, your doctor will advise you to keep expectations realistic. Keep in mind that, while cosmetic procedures can sometimes dramatically improve appearance, the aging process will continue and, as with any cosmetic procedure, your appearance will not last indefinitely. Good candidates for cosmetic eyelid surgery are:
- individuals with serious eye conditions
- individuals with a positive outlook and specific goals in mind for blepharoplasty
- non-smokers
- healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
Smokers are at increased risk of surgical complications because they heal more slowly. Your surgeon may advise you to quit smoking for at least several weeks prior to the procedure.