Everything you wanted to know about eyelid surgery
One of the oldest plastic surgery procedures and one of the most common areas for facial rejuvenation surgery is the eyes. Eyelid surgery is referred to as Blepharoplasty surgery. Bleph- refers to the eyelid and -plasty refers to surgically altering an area. Blepharoplasty refers to surgical procedures performed to change the eyelids. It can be done for cosmetic, medical, and reconstructive reasons. The upper and lower eyelids can be operated on but in some instances only one eyelid, only the upper eyelids, or only the lower eyelids may be treated. Blepharoplasty surgery is performed in patients of all ages and is one of the more common procedures performed on men.
The appearance of the eyes sets the tone for the face. While the eyes may be the windows to the soul, the eyelids form a frame in which that window is set. The frame will often set the tone for the entire face. With sad, tired eyes the individual will never look their best even after a full nights rest. Many times the primary complaint patients present with is, "I always look tired", or "people always tell me I look tired". Excessive eyelid skin will cause the upper lids to droop casting a shadow over the eyeball. This gives the appearance of tired, half-open eyes. Another common complaint is swollen or puffy eyes. Patients complain of looking like, "I have a cold or allergies". They will complain about their eyes looking tired and swollen. Men are especially concerned about this because they often feel they look older and less energetic than their younger colleagues. Bulging fat in the lower eyelids will cast shadows on the cheeks giving eyes a puffy or swollen appearance. This shadow also gives the appearance of tired listless eyes.
Am I a candidate?
Cosmetic surgery addresses these issues directly. Surgery of the upper eyelids requires three things, removal of extra skin, removal of extra muscle, and removal of extra fat. The upper eyelid has a small crease about 3/8ths of an inch above the eyelashes. This is known as the tarsal crease. In the Western eye this marks the location where the eyelid muscles attach to the eyelid to open and close the eye. In the Asian eye the muscle attaches to the eyelid just above the eyelashes. Measuring from the middle of the eyebrow to the eyelashes, the upper eyelid in an adult needs to have approximately one inch of skin between these two points. In patients with too much skin there is often more than twice as much skin as there needs to be. In the most severe cases this skin will actually block the patients vision. When that happens, blepharoplasty surgery may become medically indicated. The muscle of the upper eyelid will often duplicate the skin pattern. When there is redundant skin there is redundant muscle as well. Fat in the upper eyelid may also push forward giving the upper eyelid a full, bulging appearance. Correcting these three features are critical to giving the upper eyelid a more youthful, fresh, and energetic appearance.
Cosmetic surgery of the lower eyelid addresses these same issues. The anatomy of the lower eyelid requires a different surgical approach to achieve good results. Unlike the upper eyelid, the appearance of too much skin in the lower eyelid is caused by fat pushing forward making it look like there is too much skin. When the fat is removed and the skin is allowed to return to its original position, often only minimal amounts of skin are removed. The removal of an excessive amount of skin will cause the lower lid to droop giving the eye a pink, hound dog look. Lower eyelids will also sag due to weakness in the outer connection between the eyelids and the eye socket. This area is known as the lateral canthus. When this area is weak or when lower lid surgery requires extra tension to be applied to this area, surgery to tighten the canthus is required. This is known as a lateral canthopexy. As with any cosmetic surgical procedure, each procedure should be designed to meet the individual needs of the specific patient. No one procedure fits all patients.
The Surgery
The surgery is straight forward but very delicate. The upper eyelid requires removal of skin, muscle and fat. The lower eyelid requires removal of fat, tightening of the muscle and removal of only a minimal amount of skin, if any. The procedures may be done under local anesthetic, local anesthetic with intravenous (iv) sedation, or general anesthesia. The choice of anesthetic is determined by the procedure to be done and the needs of the patient. There should be a 2-3mm gap when the eyelids are closed at the end of the procedure. This will go away as the surgical swelling dissipates over the next few days. The procedure will take from one hour to two and 1/2 hours depending on the complexity of the procedure performed.
The Recovery Process
Recovery from the surgery is usually rapid. There will be swelling and bruising for the first several days. Sutures can usually be removed from three to five days after surgery. Tapes are applied to the skin at the end of the procedure and will remain in place until the sutures are removed. Bruising will be present but usually fades during the first week to the point where it can be hidden with makeup. Most patients can return to public activities in one week to ten days. The surgery will continue to change over the next six to eight weeks and patients need to be cautious during these periods as their blink or lid reflex will not be as fast as normal. This can result in damage to the eye due to wind or dust. This can be easily prevented by wearing glasses when out doors or in a dusty environment. Recovery is usually rapid and the results will last for years.
What are the Risks?
All surgical procedures carry the possibility of risk and uncertainty. Side effects and possible risks of eyelid surgery include infection, bleeding, scarring, swelling, bruising, burning sensation in the eye, excessive tearing, light sensitivity, dryness/burning/itchy eyes, blurred or double vision, asymmetry, droopy eyelid, difficulty closing the eye, and blindness. It is important to discuss your medical history during your initial consultation. A thorough discussion with your physician of risks and benefits as well as your expectations will be completed prior to your surgery.
Blepharoplasty surgery is a simple and effective way to remove one of the most common signs of aging. When performed by an experienced board certified or a qualified board eligible plastic surgeon, this procedure can provide the patient with a quick yet elegant way to reverse one of the most visible signs of aging.
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