What is Blepharoplasty?
Blepharoplasty, commonly known as the Eyelid Lift, is a
surgical procedure that aims to restore that youthful
appearance to the eyes. It involves the removal of the
excess skin, fat or wrinkles around the eyes to give them a
more alert, fresher and youthful look.
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Effects of Blepharoplasty
Blepharoplasty results are dramatic and long-lasting. There
will be lesser chances of having puffy fat pockets and
excess skin around the eyes as you grow old.
In
order to maintain these results, you may need to have a
secondary procedure done in the future. Getting a
Blepharoplasty will help make a more youthful and alert
impression to the people you are with day in and day out.
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Candidates for Blepharoplasty
It is
a fact that the eyes are the most prominent feature on a
person's face. Loss of moisture in the skin, sun damage,
smoking, "wear and tear" from blinking and rubbing,
stretching from swelling or obesity, age-related loss of
elasticity, and heredity all contribute to changes in the
eyelid skin, muscle, fat, and support system producing
wrinkles, lines and "bags" around the eyes. As your eyes
convey a world of emotion, you normally would not want to
include tiredness or sleepiness to other people's impression
of you.
Men
and women who are good candidates for Blepharoplasty have
any of the following:
•
Excess skin covering the natural fold of the upper eyelids.
• Loose skin hanging down from the upper eyelids, especially
along the sides.
• A tired and puffy appearance of the upper eyelids.
• Excess skin, fine lines and wrinkles of the lower eyelids.
• Drooping lower eyelids revealing excessive "white" of the
eyes.
• Dark circles or bags under the eyes.
Blepharoplasty can usually solve these problems, but some
patients may need to consider additional treatment to
further correct other problem areas.
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Your
Consultation
During
the initial consultation, BHMG’s Board Certified Surgeon
will ask for a complete medical history and will conduct a
careful examination to evaluate your overall health. After
that, the doctor will ask you to describe your concerns with
regards to your eyelids. A careful and thorough evaluation
of your health will be done before the evaluation of your
eyes to check for any other conditions that may bring
complications to the upcoming procedure. Examples of these
conditions are visual impairment or inadequate tear
production, thyroid diseases, allergy and glaucoma. During
the consultation, the doctor will also advise you of other
appropriate procedures to be able to achieve the best
results.
Blepharoplasty can be an isolated procedure, and also can be
done in conjunction with other facial cosmetic procedures,
or in addition to other procedures (such as liposuction and
breast surgery) done elsewhere on the body.
There
may be circumstances where you will be asked to have a
complete evaluation by your personal physician or
ophthalmologist prior to surgery. Referrals may be given if
needed.
You
will be provided with pre- and post-operative instructions
and all necessary prescription medications before the date
of your surgery. You will also be given a list of vitamins
and homeopathic medications that helps in promoting faster
recovery and healing. Another thing you will be given is a
list of anti-inflammatory and aspirin-containing
medications, which should be avoided for at least 3 weeks
before and after surgery.
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The Blepharoplasty
Procedure
Blepharoplasty is done on an outpatient basis in a surgical
center. Blepharoplasty can be performed under intravenous
sedation, known as 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 only.
Prior
to surgery, the doctor will carefully mark the location of
the incisions to be made. You can be assured that every
effort will be done to assure that the incisions are placed
in the most inconspicuous locations to maximize cosmetic
healing and preserve natural eyelid shape and mechanical
function. The amounts of skin and fat to be removed from
each eyelid will be measured precisely to assure symmetry.
Pinpoint electrocautery will be used for the fat removal and
dissection to insure an almost bloodless operation. In
effect, this will minimize bleeding, as well as subsequent
bruising and swelling, leading to a speedier recovery. All
incisions are then carefully closed with ultra-fine sutures.
For
the lower eyelids, excess fat is removed either through the
traditional skin-muscle flap technique or through the lining
tissue of the lower eyelid, or more commonly known as the
trans-conjunctival technique. In certain cases, the
arcus marginalis release technique is used where the
lower eyelid fat is preserved and used to fill the hollow,
dark circle or prominent lower border of the bony orbit.
The excess lower eyelid skin can then be directly trimmed or
resurfaced and tightened using chemical or laser resurfacing
techniques.
Blepharoplasty takes from 1 to 2 hours as an isolated
procedure.
Below
are the different types of Blepharoplasty procedures:
The
Traditional Blepharoplasty
The
incision is made in the crease of the upper lid towards the
corners of the eyes. After healing, this incision would not
be noticeable when the eyes are open. Then, on the lower
lid, the incision is made just below the lash line towards
the corner of the eye. This incision will be hidden by
lashes when healed.
The
Trans-Conjunctival Blepharoplasty
This
is a newer technique for lower eyelid Blepharoplasty that
involves an incision inside the lining of the lower lid.
Fat can be removed through this incision. In order to
attend to excess skin, a “pinch” of skin can be taken, or
the lower eyelid skin can be tightened using chemical
peeling or laser resurfacing, without the actual removal of
skin. The upper eyelids are treated using traditional
techniques only if required.
Lateral Canthopexy or Canthoplasty
This
procedure is performed in conjunction with a traditional
lower Blepharoplasty. It is normally reserved for patients
with excessive laxity of the lower eyelid. Canthopexy is
sometimes needed 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.
This may make the eye appear somewhat narrower or less
rounded.
Laser
Eyelid Resurfacing or Chemical Peel
This
is a non-surgical alternative procedure that may delay the
need for a surgical Blepharoplasty. Laser or chemical peel
resurfacing causes a significant tightening of the skin
around the eyes, but will not affect the fat around the
eyes. It could also help improve dark pigmentation
accumulating around the eyelid region. Laser or chemical
peel resurfacing can be carried out alone or in conjunction
with traditional or trans-conjunctival Blepharoplasty
techniques.
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Recovery
An
hour after surgery, you will be cared for in the recovery
room where nurses will apply cold compresses to the surgical
area to minimize swelling. You can be discharged soon after
you wake up, fresh and alert from the procedure.
Please
make sure someone is able to assist and drive you home and
be available to care for you continuously for the first 24
hours. The area around the eyes may remain puffy and
slightly discolored for a few days following the surgical
procedure.
Here
are some recommendations for a smooth recovery:
• Keep
your head elevated at all times for the first several days
after surgery.
•
Continue to use cold compresses to minimize swelling and
bruising, which should begin to subside on the second or
third day after the procedure.
•
There should be minimal or no pain at all after the surgery,
although pain medications will be given for use only if
needed.
On
some occasions, you may experience a dry and scratchy
sensation on the eyes, with excessive tearing and
sensitivity to bright light. This condition does not
usually come about, and the use of eye drops during the day
and eye ointment at night will help lessen its occurrence.
Also, some blurring of vision or transient double vision is
normal after this procedure, and you may notice the eyes to
be easily tired while reading or watching television.
In 4
to 7 days, the stitches will be carefully removed. The
swelling and bruising may persist for up to 10 days. Women
can start wearing makeup to help conceal it after about 5
days, or after healing of the skin is complete, if you have
had laser or chemical peel resurfacing of the eyelid skin.
From a
week to 10 days, you may anticipate to resume normal work
and social activity. Wait for 10 days to wear your contact
lenses. In 10 to 14 days, you may do some exercise or other
strenuous activities. From within 6 months to a year, your
incisions will start to fade.
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Risks
It is
rare for complications to happen after a Blepharoplasty
procedure. It may be highly unlikely, but some of these
complications include:
•
Dryness or irritation of the eyes.
•
Bleeding and swelling.
•
Delayed wound healing or infection.
•
Drooping of the upper or lower eyelid, asymmetry, and double
vision.
In the
event of the following, it is usually advised to have
additional surgery to correct these problems.
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Frequently Asked
Questions
Q:
Will this surgical procedure improve my peripheral vision?
A:
If excessive upper eyelid skin and a drooping lateral brow
is the reason for the impairment of your vision,
Blepharoplasty alone will not improve your peripheral
vision, a combination of the Brow Lift and Upper
Blepharoplasty will be required.
Q: Is
the Blepharoplasty going to be painful?
A:
usually, there is minimal discomfort for the patient after
this surgical procedure. Some patients might feel a
scratchy sensation in the eyes because of the dryness or
possible irritation of the cornea during surgery. This is
usually controlled by the use of eye drops during the day or
ointment during the night. If there is any other pain
observed, do not hesitate to ask for a consultation.
Q: Is
it normal for my eyes to be unable to close completely after
this procedure?
A:
Your
eyelids may not close properly or completely during the
first few days after the Blepharoplasty due to swelling and
tightness.
A few
instructions to share:
• Wear
dark sunglasses when going outside to protect the eyes
against excessive brightness and wind exposure.
•
Sleep with your head elevated on two pillows.
•
Massage your eyelids as instructed, and use iced compresses
to speed up the resolution of your eye's swelling.
Q:
When can I wear makeup after the procedure?
A:
Women can start wearing makeup after the stitches are
removed. Although, if you have had laser or chemical peel
resurfacing of the eyelid skin, please make sure the skin is
completely healed before using makeup.
Q:
When can I wear contact lenses?
A:
Patients sometimes develop a condition called “Chemosis”
after the procedure which is a transient,
gelatinous-appearing swelling of the lining layer over the
white portion of the eyes. The swelling usually resolves
within the first 10 days after surgery. After 10 days,
patients may resume the use of contact lenses.
Q: How
soon after the procedure can I shower or bathe?
A:
Soap
and water will not harm your sutures so you may shower,
bathe, or gently wash your face and eyelid area immediately
after your Blepharoplasty. Afterwards, apply a thin layer
of ophthalmic ointment to your external suture lines to
soften dried blood on the suture lines, if there are any.
In the occasion that the eyelids and eyelashes become sort
of stuck together, just gently wash with soap and water or
use a warm compress around the area.
Q:
When can I start doing my normal activities after
Blepharoplasty?
A:
You may gradually resume your usual physical activities
approximately 1 week after Blepharoplasty if you have normal
blood pressure. If medications control your blood pressure,
make certain that your baseline blood pressure is within the
normal range before doing exercises. Patients are reminded
that they should avoid strenuous activities or any actions
that may require bending where the head will be below the
heart level. This tends to increase pressure in the small
veins around the eyes that may lead to delayed bleeding
complications.
Q: Can
Upper or Lower Blepharoplasty change the shape of my eyes?
A:
In certain cases, Blepharoplasty can change the shape of the
eyes, making it rounder or more open. Also, it is not
unusual for the two eyes to appear kind of different from
one another right after the procedure. As the healing
progresses and the swelling goes down, you will be able to
adjust to your improved appearance.
Q:
Will Blepharoplasty resolve my “Crow’s Feet”?
A:
No, it
will not.
Q:
Will my Blepharoplasty be covered by insurance?
A:
Insurance generally does not cover Blepharoplasty unless an
Optometrist or Ophthalmologist documents an impairment of
lateral (peripheral) vision. Oftentimes, patients do not
meet insurance criteria for their operation to be covered by
it.
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