Blepharoplasty

UPPER LID BLEPHAROPLASTY

The eyes, commonly referred to as “the window to the soul,” are one of the most important aspects of your appearance, and one of the first areas to show aging. This can occur as early as your late twenties to early thirties. If the eyes project a lack of energy due to overhanging skin and puffiness, you may appear older. Conversely, if the eyes are more open and relatively uncreased, you will probably seem more rested and youthful.

Commonly referred to as an eyelift, blepharoplasty is actually one of the most frequently performed plastic surgery procedures for the face. There are two types of blepharoplasty, upper lid and lower lid (explained in a separate article), each corresponding to the anatomic region where it is used.

Upper lid blepharoplasty involves the improvement of two characteristics of the aging upper eyelid area. The first is correction of excess skin of the upper eyelid, a condition referred to as “hooding of the upper lid.” The second condition that can be corrected is the puffiness that is seen in the inner corner and middle of the eyelid as a result of the herniation (pushing forward) of fat located in these areas above the eye. Upper lid blepharoplasty is commonly performed with lower lid blepharoplasty and/or other procedures such as a face lift, brow lift, or laser resurfacing. It will not correct crow’s feet, eliminate dark circles under your eyes, or lift sagging eyebrows.

About the Procedure

Upper lid blepharoplasty can be performed under general anesthesia, or under twilight anesthesia. The choice of anesthesia depends on many factors including whether any other procedures will be performed at the same time, the age and health of the individual, and the preference of the patient and surgeon.

In the operating room excess, overhanging skin that is causing hooding is removed, along with any bulging fat. A more defined eyelid crease can also be achieved. This results in a refreshed, open appearance to the eyes.

Typically, the surgeon places the incision in the natural crease of the upper lid. The incisions usually extend out into a laugh line at the outer corners of the eyes. After removing excess skin and fat, the incisions are closed with fine sutures. Scarring is minimal and concealed by placing the incision in the existing eyelid creases.

Hooding and puffiness of the upper eyelid can occur as early as one’s twenties. For this reason, there is no fixed time to perform this procedure. When signs of aging are first noticed, they can be addressed and the results enjoyed for many years.

Recovery and Healing

Swelling and discoloration vary from person to person. It is usually present during the first seven to ten days following surgery, but is easily covered up with sunglasses or makeup. For the first few weeks you may experience dryness, tearing, or sensitivity to light, but this is only temporary.

Your stitches will be removed two days to a week after surgery. The swelling and discoloration around your eyes will gradually subside, and you’ll start to look and feel much better day by day.
At first the incisions may appear red and somewhat bumpy, but this will resolve in time and the resulting scar should become flat and inconspicuous. Though you can be up and about almost immediately, you should limit your activities, and especially avoid bending over and lifting heavy objects or anything that increases blood flow to the eyes such as crying.

Risks

As a rule, discomfort is minor and usually lasts for only 24-48 hours. A mild pain medication can be taken as needed. As with any surgical procedure, there is always a possibility of infection, or reaction to the anesthesia. A few patients may have difficulty completely closing their eyes when they sleep; in rare cases this condition may be permanent. However, if this does occur, a naturally protective mechanism called the Bell’s Phenomenon causes the eye to roll up behind the lid when the lid closes. This protects the eye and usually prevents any problem from developing.

LOWER LID BLEPHAROPLASTY

If there are bags and puffiness in the area underneath the eye, you may appear older and as though you need a good night’s sleep, even if you have just had one. Conversely, when your eyes are more open and have no puffiness, you will probably seem more rested and youthful even after a night on the town.
Lower lid blepharoplasty is a procedure performed to improve the appearance of the lower eyelids, which is the anatomic area that extends from the lower lid eyelashes to the bony rim of the eye socket. Lower lid blepharoplasty is one of the least traumatic procedures for someone to undergo, but one that can create a most dramatic effect.

About the Procedure

Lower lid blepharoplasty can be performed under general anesthesia or twilight anesthesia. The choice of anesthesia depends on multiple factors -including whether other procedures will be performed at the same time, the age and health of the individual, and the patient’s preference.
There are two different surgical approaches to remove the fat. The more common technique utilizes an inconspicuous incision that runs just beneath the lash line. An alternative is to enter the fat pockets through an incision made in the inner lining of the lower eyelid. If excess skin needs to be removed, this can only be accomplished through an external approach. The procedure is long lasting and usually never has to be repeated.

Recovery and Healing

The skin of the eyelids is very thin and even slight bruising is clearly evident, though it can be covered by makeup. Healing is very rapid, so much so that sutures are removed in five to seven days to prevent over-healing and the formation of little bumps called melia. Your doctor will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling. Many physicians also prescribe eye drops as a precautionary measure to help with possible dryness. This may occur and be present until the eyelid’s lubricating ability returns to normal.
During the week after surgery, you will be able to assume a light schedule. However, there should be no strenuous activity and no heavy lifting whatsoever. This includes lifting small children! All bending should be at the knees, not at the waist.

Risks

As a rule, discomfort is minimal. A mild pain medication can be taken as needed. As with any surgical procedure, there is always the possibility of infection, or reaction to the anesthesia. Blepharoplasty complications are very rare, but could include a pulling down of the lower lid or visual impairment.