What Is Blepharoplasty?
Cosmetic eyelid surgery, also known as Blepharoplasty or Eyelid Lift, is a surgical procedure designed to restore a more youthful, bright, and energetic appearance to your eyes. Blepharoplasty consists of the removal of precise and appropriate amounts of excess skin and fat pockets in the upper eyelids, the lower eyelids, or both, along with appropriate tightening of the involved structures.
Am I A Candidate?
The eyes are a prominent facial feature, to which we are immediately drawn when we look at someone’s face, including our own. As the “window to the soul”, our impression of a person’s face will be heavily influenced by the appearance of the eyes. It is the surrounding skin, in addition to the eyes themselves, that conveys emotion. The eyelid skin, muscle, fat, brow, and lashes all contribute to the wide array of expressions. Age, sun exposure, and hereditary factors all contribute to loss of skin elasticity. This in turn leads to the development of wrinkles, deep lines, and puffiness or “bags” around the eyes. The aging process can cause unwanted changes in expression, causing us to look fatigued or angry, and prematurely older than we really are. These changes in appearance often begin in the early to mid-30’s, and are frequently the first sign of aging. Relaxation and descent of the mid-facial tissues and muscles around the eyes allows the normal fat surrounding the eye to become more visible. Occasionally, patients may suffer visual impairment because of the excess hanging skin of the brow and eyelid region, which in some cases may overhang the eyelashes. As the upper eyelid skin loosens, it obscures the normally-visible upper eyelid crease, and makes the eyebrow appear to lie closer to the eyelid. The upper eyelid begins to appear heavier. As the lower eyelid skin and musculature relax, the lower eyelid fat begins to bulge, producing “festoons” of skin and fat with dark circles under the eyes, which cannot be hidden by make-up. Occasionally, the lower eyelid will begin to droop down and away from the eyeball, exposing the “white” of the eye below the iris.
Good candidates for Blepharoplasty are men or women who have any of the following characteristics:
- Excess skin that covers the natural fold of the upper eyelids
- Loose skin that hangs down from the upper eyelids, especially along the sides
- A tired, puffy appearance of the upper eyelids
- Excess skin and fine wrinkles of the lower eyelids
- Bags or dark circles under the eyes
- Drooping lower eyelids that reveal excessive “white” of the eyes
Although eyelid surgery will usually correct these problems, other additional treatments may need to be considered. For example, sagging of the forehead may contribute to, or worsen, the appearance of loose upper eyelid skin, for which Your plastic surgeon may recommend a Forehead Lift. Dark circles under the eyes or crow’s feet may require treatment with a combination of Botox, Chemical Peel, or Laser Resurfacing.
During your initial consultation, Your plastic surgeon will ask you to describe your concerns and wishes regarding the appearance of your eyelids. Realistic goals and expectations are important. Your plastic surgeon will conduct a careful and thorough evaluation of your general health. Your plastic surgeon will then fully evaluate your eyes to determine whether there are any associated conditions which may complicate your surgery and recovery, such as visual impairment or inadequate tear production, thyroid diseases, allergy, and glaucoma. He will also advise you if there are any other surgical procedures, such as Brow Lift, laser resurfacing, or canthopexy (a surgical procedure to tighten excessively lax lower eyelids), which may be more appropriate for you, or may be warranted in light of your individual physical examination findings, in order to achieve the best possible result. Blepharoplasty can be performed as an isolated procedure, in conjunction with other facial cosmetic procedures, or in addition to other procedures (e.g., Liposuction, breast surgery, etc.) elsewhere on the body.
In some cases, Your plastic surgeon may ask you to have a complete evaluation by your personal physician or ophthalmologist prior to surgery; if necessary, Your plastic surgeon will provide you with a referral. Our office will provide you with thorough pre- and post-operative instructions and all necessary prescription medications in advance of your surgery date, as well as a list of vitamins and homeopathic medications which may prove helpful in promoting faster recovery and healing following surgery. You will also be given a list of anti-inflammatory and aspirin-containing medications, which should be avoided for at least three weeks before and after surgery.
Options and Alternatives: New and Traditional Techniques
Traditional Blepharoplasty: An incision is made in the crease of the upper lid toward the corners of the eyes. Once healed, it is not noticeable when the eye is open. On the lower lid, the incision is made just below the lash line toward the corner of the eye, and is hidden by lashes when healed.
Trans-Conjunctival Blepharoplasty: This is a newer technique for lower eyelid Blepharoplasty, involving an incision inside the lining of the lower lid. Fat can be removed through this incision; in order to address excess skin, a “pinch” of skin can be taken, or the lower eyelid skin can be tightened using chemical peeling or laser resurfacing, without actual removal of skin. The upper eyelids are treated using traditional techniques, if required.
Lateral Canthopexy or Canthoplasty: This procedure is done in conjunction with a traditional lower Blepharoplasty. It is generally reserved for patients with excessive laxity of the lower eyelid. Canthopexy is sometimes required when large amounts of excess lower eyelid skin require removal, and where lower Blepharoplasty alone might result in an abnormal appearance of the lower eyelid. It may make the eye appear somewhat narrower or less rounded.
Laser Eyelid Resurfacing or Chemical Peel: This procedure is a non-surgical alternative that may delay the need for a surgical Blepharoplasty. Laser or chemical peel resurfacing results in significant tightening of the skin around the eyes, but will not affect the fat around the eyes. It may also help improve dark pigmentation accumulating around the eyelid region. Laser or chemical peel resurfacing can be performed alone or in conjunction with traditional or trans-conjunctival Blepharoplasty techniques.
Please ask Your plastic surgeon if you have any questions about which procedure is right for you.
Blepharoplasty is performed on an outpatient basis at a surgical center. The procedure can be performed under intravenous sedation (twilight sleep), or under a light general anesthesia. Local anesthesia is administered around the eyes in all cases, and in certain cases, the entire procedure may be done under local anesthesia.
While you are awake prior to surgery, Your plastic surgeon will carefully mark the location of the planned incisions. Every effort will be made to assure that the incisions are placed in the most inconspicuous location, in order to maximize cosmetic healing and to preserve natural eyelid shape and mechanical function. The precise amounts of skin and fat to be removed from each eyelid will be measured, to assure symmetry. Dissection and fat removal are performed with pinpoint electrocautery, insuring a virtually bloodless operation, in order to minimize bleeding and subsequent bruising and swelling, which leads to a speedier recovery. All incisions are then carefully closed with ultra-fine sutures.
In the lower eyelid, excess fat may be removed either through the traditional skin-muscle flap technique, or through the lining tissue of the lower eyelid (trans-conjunctival technique). In some cases, the lower eyelid fat may be preserved and used to fill the hollow, dark circle or prominent lower border of the bony orbit (arcus marginalis release technique). Excess lower eyelid skin can then be either directly trimmed, or resurfaced and tightened using chemical or laser resurfacing techniques.
The Blepharoplasty procedure takes from one to two hours, depending upon the extent of the areas to be treated.
For the first hour or two after surgery, you will be cared for in the recovery room, where the nurses will apply cold compresses to the surgical area to minimize swelling. When you are fully alert and awake, you will be discharged from the facility. It is important to arrange a friend or family member to provide care for you after the surgery. If you will not be staying in an aftercare retreat, someone must drive you home and be available to care for you continuously for the first 24 hours. The area surrounding the eyes may remain puffy and slightly discolored for a few days following the surgery. You should keep your head elevated at all times for the first several days after surgery, and continue to use the cold compresses, to minimize swelling and bruising, which should begin to subside after the second or third day. There should be minimal or no pain after surgery, although you will be given pain medications for use if needed. Occasionally, you may experience a dry and scratchy sensation on the eye, with excessive tearing, and sensitivity to bright light. This condition is usually limited in duration, and is controlled with the use of eye drops during the daytime hours, and eye ointment at bedtime. Some blurring of vision or transient double vision is normal, and the eyes may fatigue more easily while reading or watching television.
The stitches will be removed in 4 – 7 days. Swelling and bruising may persist for up to 10 days, but women can begin wearing makeup to help conceal it after about five days (or after healing of the skin is complete, if you have had laser or chemical peel resurfacing of the eyelid skin). You may expect to resume normal work and social activity within a week to ten days, and you may return to strenuous exercise activities approximately 10 – 14 days after surgery. You may wear contact lenses after approximately 10 days. Your incisions will gradually fade over the first six months to a year.
Deeper wrinkles around the outer eye extending onto the temple (“crow’s feet”) are only modestly improved by the Eyelid Lift. These areas may require further treatment with chemical peel or laser resurfacing, and may also benefit from Botox therapy.
Significant complications from aesthetic eyelid surgery are infrequent. Most patients are extremely pleased with the results. Although complications are unlikely, they include: bleeding and swelling, delayed wound healing, infection, drooping of the upper or lower eyelid, asymmetry, double vision, and dryness or irritation of the eyes. Occasionally, additional surgery will be required to correct these complications.
Your New Look
The improvement achieved by cosmetic eyelid surgery is often dramatic, and can be expected to last for many years. Although the aging process will continue, there will be less likelihood of experiencing the same concerns of puffy fat pockets and excess skin. Secondary procedures may be required in later years, to maintain the benefits. By correcting the problem areas that detract from the appearance of this important area, you will achieve a more youthful, alert, and rested appearance as a result of cosmetic eyelid surgery.
Q: Will Blepharoplasty improve my peripheral vision?
A: In most cases, compromise of the peripheral vision is caused by a combination of excessive upper eyelid skin and a drooping lateral brow. In this circumstance, Blepharoplasty of the upper eyelids alone will not improve the peripheral vision, and a combination of Brow Lift and Upper Blepharoplasty will be required.
Q: Can Upper or Lower Blepharoplasty change the shape of my eyes?
A: In some cases, Blepharoplasty can change the shape of the eyes by producing a more “open” appearance, or a “rounding” of the slanted appearance of the lids. It is not unusual for the two eyes to appear somewhat different from one another after the procedure, and any existing asymmetry may be magnified after the procedure. As your healing progresses and the swelling resolves, you will adjust to your improved appearance.
Q: Is it normal for my eyes to be unable to close completely after Blepharoplasty?
A: In the first few days after your Blepharoplasty, your eyelids may not close properly or completely because of swelling and tightness. During this time, it is important to protect your eyes against excessive brightness or wind exposure by wearing dark, protective sunglasses when you are outside. Sleep with your head elevated on two pillows, massage your eyelids as instructed, and use iced compresses to speed the resolution of your swelling. If your eyes feel dried-out, Your plastic surgeon will prescribe a soothing eye drop or eye ointment to moisturize the corneal surfaces.
Q: How soon after Blepharoplasty can I shower or bathe?
A: You may shower, bathe, or gently wash your face and eyelid area immediately after your Blepharoplasty, since soap and water will not harm your sutures. If the eyelids and eyelashes become somewhat stuck together, gently blot the area with warm compresses or wash with soap and water. After bathing, showering, or washing, you may apply a thin layer of ophthalmic ointment to your external suture lines in order to soften any small collections of dried blood on the suture lines.
Q: How soon after Blepharoplasty can I resume wearing make-up?
A: As soon as the sutures are removed, you may resume the wearing of your normal make-up and eye shadow. Most bruising and swelling of the eyelids will be resolved within the first two weeks after surgery.
Q: When can I resume normal activities after Blepharoplasty?
A: If you have normal blood pressure, you may gradually resume your usual physical activities approximately one week after Blepharoplasty. If your blood pressure is controlled by medications, you must be certain that your baseline blood pressure is within the normal range and well-controlled by medications before resuming exercise activities. In any case, all patients should avoid activities requiring prolonged straining, or any activities requiring bending where the head will be below the heart level, which tends to increase the pressure in the small veins surrounding the eyes, and may lead to delayed bleeding complications.
Q: When can I wear contact lenses again after Blepharoplasty?
A: Occasionally, patients develop a transient, gelatinous-appearing swelling of the lining layer over the white portion of the eyes called “Chemosis”, after Blepharoplasty. This swelling gradually resolves within the first ten days after surgery. At that time, patients may resume the use of contact lenses. At the time of your suture removal, Your plastic surgeon will tell you if you may resume wearing your contact lenses.
Q: Is Blepharoplasty painful?
A: Generally, there is minimal discomfort for the patient after Blepharoplasty, which is usually easily-controlled with Tylenol or mild narcotic pain medications. Occasionally, the patient will experience a scratchy sensation in the eye due to dryness or possible irritation of the cornea during surgery, which is usually controlled by the use of eye drops or ointment. Extreme pain in one or both eyes is rare, and must be reported immediately to Dr. Cambre.
Q: Will Blepharoplasty resolve my “Crow’s Feet”?
A: No. Generally, “crow’s feet” are caused by excessive muscular activity, which will not be treated by Blepharoplasty. Wrinkling due to crow’s feet may require treatment with Botox, both before and after your Blepharoplasty.
Q: Will insurance cover all or a portion of my Blepharoplasty?
A: Generally, insurance will not cover Blepharoplasty unless there is a documented impairment of lateral (peripheral) vision. This usually requires a consultation with an Optometrist or Ophthalmologist, who will perform formal visual field testing to document the deficit. Most patients do not meet insurance carrier qualification criteria.