Eyelid Surgery – blepharoplasty

Excess skin around the eyes adds years to the face.

  • after properly planned and meticulously executed blepharoplasty, the eyes should not look unusual, surprised or different but rather bright, youthful and rested
  • four lid blepharoplasty is a common combination of upper and lower lid blepharoplasties
  • the four lid blepharoplasty can be performed under local anesthetic in 1 to 2 hours on an outpatient basis
  • during blepharoplasty we reposition the fat, resuspend the muscles, and remove excess drooping skin.
  • the sutures are removed after 4-7 days
  • you will be presentable in public in 5-10 days with the help of make-up, depending on the extent of surgery.

What are the features of the aging eyelids?

The eye region is the first part of the face to show the signs of aging. The skin around the eyes loses its elasticity, and the muscles become loose. Folds of excess skin develop on the upper eyelids and creases under the lower lids deepen. As the muscles become weaker the fat, which cushions the eyes in their sockets, protrudes forward to give the appearance of bagginess. Some people have an inherited tendency for bags to develop during early adulthood before other signs of aging appear. In extreme cases enlarged puffy bags of skin in the lower lids, known as festoons, can develop. All of these changes can make the face look tired, sad and older than it actually is. In some instances, excess drooping eyelid skin can even impair vision. The patient tries to counter this by lifting the eyebrows which can lead to chronic headaches. Ageing process on the skin is apparent earlier in the eyelids than elsewhere. In thirties, tiny wrinkles on the eyelids and creases radiating from the corner of the eye (crow’s feet) develop. The main cause of the sagging upper eyelids can also be descended eyebrows and this should also be addressed during the procedure.

What is blepharoplasty?

Blepharoplasty is a surgical procedure designed to rejuvenate sagging, puffy or tired looking eyes and restore youthful volume and smooth contours. There are three common types of blepharoplasties – upper, lower and four lid.
To avoid the unnatural hollow look a modern eyelid surgery, reverses the aging structural changes of the eye region by repositioning the fat, resuspending the muscles, and removing the excess drooping skin. After properly planned and meticulously executed blepharoplasty, the eyes should not look unusual, surprised or different but rather bright, youthful and rested. Correction of the upper eyelids may be performed for aesthetic reasons or to improve sight by lifting the eyelids out of field of vision. To reduce tiny wrinkles under the eyes and in the crow’s feet region blepharoplasty can be combined with skin resurfacing. Injections of botulinum toxin may be necessary to maintain reduction of crow’s feet after the procedure.

How is blepharoplasty performed?

Both upper and lower eyelid surgery can be carried out under local anesthesia as an outpatient procedure. However if, the patient prefers it can also be done under sedation or general anesthesia. The incision is made in the natural crease of the upper eyelid and just below the lashes in the lower lids. The skin is lifted from the underlying structures, and redundant fat or muscle is repositioned or removed. If necessary the fat compartments of the lower eyelid are repositioned over the orbital rim, to correct the hollowness under the eyes. A lax lower eyelid can be lifted and properly tensioned by placing a stitch in the corner of the eye (cantopexy). This prevents the eyelid from dropping after surgery. Excess skin is trimmed without tension and incisions are sutured neatly. If only fat is being removed from the lower eyelids, it can be done from the inside of the lower eyelid avoiding an external excision (transconjunctival blepharoplasty).

How long does it take to recover after blepharoplasty?

The pain after the procedure is minimal and healing very rapid. The closure of the eyes in the first few days after surgery appears tighter until the swelling disappears. To reduce swelling it is best to keep the head elevated for a few days and apply cold compresses. The sutures are removed after 4-7 days. There is some bruising which takes up to 2 weeks to disapear, but patients are usually able to return to normal activity within one week. Blepharoplasty incisions tend to heal very well with good scars, which are barely noticeable after a few months.

What are the risks?

Complications are infrequent and usually minor. Blood can collect under the skin after the operation (hematoma). It usually disappears spontaneously in a couple of weeks, but if large it may need to be drained. Sometimes tiny white cysts can appear along the stitch line and can be removed with a needle. Bacterial infection with redness, swelling and tenderness is very rare and treated with antibiotics. Undercorrection or uneven appearance may be corrected by a minor touch up operation. Sagging of the lower eyelid (ectropion) can be prevented with meticulous surgical planning.

Can blepharoplasty be combined with other procedures?

Correction of the eyelids can be done as a separate procedure or in combination with any other procedure for facial rejuvenation. Frequently patients come for an upper eyelid surgery unaware that their heavy eyelids are due to excess skin on the forehead and brow or forehead lift is the proper procedure to address their problems. Complimentary Non-Surgical Procedures are very commonly added to a blepharoplasty to increase its effect. Soft tissue fillers may be used in combination with blepharoplasty but not instead of it. Fillers are good to temporarily camouflage the crease between the lower eyelid and cheek region, but they do not correct the lower eyelid puffiness or redundant and wrinkled skin. This crease disappears when lower eyelid fat pockets are repositioned.

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