Anatomy and Description of Blepharoplasty
What is Blepharoplasty?
Blepharoplasty refers to eyelid surgery.
It is a surgical procedure to remove excess skin and underlying fat from the upper eyelids, lower eyelids or both.
Blepharoplasty surgery is customised for every patient, depending on his or her particular needs. It can be performed alone involving upper, lower or both eyelids, or in conjunction with other surgical procedures of the brow or face.
Blepharoplasty can diminish excess skin and bagginess in the eyelid region but cannot stop the process of aging.
Blepharoplasty will not remove “crow’s feet” or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows or upper cheeks.
Upper eyelid surgery can help improve vision in older patients who have hooding of skin over the upper eyelids.
Eyelid surgery can add an upper eyelid crease to the Asian eyelid but it will not erase the racial or ethnic heritage.
Incisions in the upper eyelids
An incision is made in the natural skin fold of the upper eyelid. The skin fold of the upper eyelid helps to conceal the scar.
Excess skin and protruding fat are removed. The incision may be closed with a suture that dissolves or a skin suture that will have to be removed after a few days.
Incisions in the lower eyelids
There is a choice of two incisions in the lower eyelids. The incision used will depend on the individual surgeon and the underlying eyelid problem.
Your surgeon may either choose an external or internal incision and/or laser resurfacing.
An external (sub-ciliary) incision is made in the skin just beneath the lower eyelashes and follows the natural curve of the eye. Fat and excess skin is removed and the incision is closed with sutures.
An external approach to lower blepharoplasty allows the surgeon to remove excess skin of the lower eyelid if required.
Internal incision (transconjunctival)
A trans-conjunctival incision is made on the inside of the eyelid, to remove excess fatty deposits. This incision leaves no external scar. The muscle of the eyelid is not disturbed and the risk of lower eyelid retraction may be reduced.
If there is some skin laxity then laser resurfacing of the lower eyelid may be recommended by your surgeon.
At Cairns Plastic Surgery we use a FRAXEL laser which can be used to rejuvenate the lower eyelid by removing fine lines and tightening the skin.
Laser resurfacing will not remove large amounts of excess skin or bags in the lower lids. Laser resurfacing is commonly combined with the trans-conjunctival approach to the lower eyelid to tighten the skin of the lower eyelid.
The surgery is performed either as a day procedure, or can be an overnight stay in hospital. Surgery takes between 1 – 2 hours under a general anaesthetic or a local anaesthetic with sedation.
Ice packs are usually applied after the procedure to assist with the swelling, bruising and discomfort. Vision is blurred initially due to the eye ointment that is used to protect the cornea.
Recovery time varies. It may take up to 2 weeks or longer for bruising to subside. Make-up can be applied to conceal any residual bruising.
The eyes may feel tight, dry, watery and even sensitive to light for 4 weeks or more. During recovery, sunglasses may assist in avoiding the sun and glare, and to help disguise the surgery.
Alternative forms of management include not treating the skin laxness and bagginess in the eyelids by surgery.
Occasionally upper eyelid excess is directly related to brow droop and improvement of upper eyelid skin excess and laxity may be accomplished by a browlift or a forehead lift when indicated. Other forms of eyelid surgery may be needed if there are disorders affecting the function of the eyelid such as drooping eyelids from muscle problems (eyelid ptosis) or looseness between the eyelid and eyeball (ectropion).
Minor skin wrinkling may be improved through chemical skin peels, laser resurfacing and Botox injections.