Plastic Surgery - Eyelids
Blepharoplasty is surgical modification of the eyelid. Excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.
Blepharoplasty is often done as an elective surgery for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin. Asian blepharoplasty or double eyelid surgery is a special type of blepharoplasty that creates a crease in the upper eyelid. This "supratarsal fold" is common in many races but absent in about half of Asians. Surgery can artificially create this crease and make a 'single-lidded' patient appear 'double-lidded'. It is the most popular form of cosmetic surgery among those of east and southeast Asian background.
Blepharoplasty is sometimes needed for functional reasons. When an advanced amount of upper eyelid skin is present, the skin may protrude over the eyelashes and causes a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision.
The fat (yellow tissue) and skin (linear tissue) removed from a quadruple blepharoplasty. Lower-lid fat was removed using the transconjunctival technique.
Blepharoplasty is usually performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids. Incisions may be made from the inside surface of the lower eyelid (transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed. External skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously.This allows for a faster recovery process.
The operation typically takes one to three hours to complete. Initial swelling and bruising resolve in one to two weeks but at least several months are needed until the final result becomes stable. Blepharoplasty's effects are best appreciated by comparing before and after photos of surgical patients.
The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect the cosmetic and functional outcomes.
Factors which are known to cause complications include:
dry eyes - which may become exacerbated by disrupting the natural tear film
laxity (looseness) of the lower lid margin (edge) - which predisposes to lower lid malposition
prominence of the eye in relation to the malar (cheek) complex - which predisposes to lower lid malposition
The recovery process after a blepharoplasty may take up to a few weeks. Patients will receive instruction for during the home care and most of the time they receive painkillers that ease the pain caused by the incisions.
The first two days after the operation has been performed, the patient receives an ointment treatment to keep the incisions lubricated. Doctors recommend keeping iced eye pads on the eyes to reduce bruising and swelling. Eye drops may also be prescribed as they may help in pain management and in preventing infections. Patients are recommended to keep their heads higher than the body while sleeping as this will accelerate the recovery process.
Different medications can help in moderating bruises and swelling resulted after surgery and also to accelerate the patient's recovery. One of them is Wobenzym, an agent that helps in moderating swelling. Wobenzym should be administrated the second or third days after surgery and three times a day. The patient's condition will improve without this medication as well as it is only an additional treatment. Auriderm is another medication that has quite a similar effect as Wobenzym. Auriderm must be applied 10 days before the blepharoplasty and twice a day. There are however many products like these that could accelerate one's recovery and they must be discussed with one's surgeon.
The third day after surgery, the patients are advised to keep lukewarm eye pads for comfort and wearing dark glasses for at least one week is also recommended to prevent irritation that may be caused by the wind and sun exposure.
The stitches are usually removed two days after the operation. The patient's eyelids will be discolored and swollen for about seven to ten days, and feel "tight" or "stiff" for a while. Patients should lubricate their eyes by exercising closing their eyes or looking at the ceiling.
During the first few weeks after a blepharoplasty, patients normally experience excessive tearing, light sensitivity and sometimes double or even blurred vision. The whites of the patient's eyes can turn red or have red splotches. These symptoms usually disappear on themselves within two or three weeks after the operation.
Wearing contact lenses is prohibited until the incisions are completely cured. Patients who need them will be advised by their doctor when it is safe to wear them again.
Patients who undergo a blepharoplasty may watch TV and are able to read after two or three days after surgery. Patients may go to work in a week or ten days after the operation. The scars may however still be visible, but one can use makeup to cover them.
As a part of blepharoplasty recovery, the patient must avoid bending at the waist for about five days and strenuous activity (especially activities that raise one's blood pressure, such as lifting and rigorous sports) for about ten days to two or three weeks.
Surgery will leave scars, but they are usually well hidden and normally fade in time. Blepharoplasty may leave patients with bruises or swelling on their faces, and sometimes patients become depressed because of this. These are some of the side effects of surgery, which are completely normal and which disappear in few weeks, after a complete healing.