Eyelid surgery (blepharoplasty)

Candidates

Adults of all ages can benefit from blepharoplasty. Patients in their 20s or 30s might improve their inherited traits that can make them look older or tired. Patients with excess skin or puffy appearance on the upper eyelids, excess skin, bags and dark circles on the lower eyelids.

Objectives

The eyelid procedure can be designed according to the problem. If only the upper eyelids are affected there is no need to operate on the lower eyelids, and vice versa. If the problem is only caused by excess fat, with no skin excess, there is no need to remove skin. If excess skin is the problem, it might not be necessary to remove fat. Usually, however, with a patient in their forties of fifties, there is usually the need to correct the drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. Sometimes a forehead lift is recommended if the upper eyelid condition is accompanied by sagging of the eyebrows. A chemical peel may be necessary if there is dark pigmentation forming circles around the eyes. Crow's feet can be treated simultaneously through laser resurfacing.

Incisions and technique

We prefer to do blepharoplasty using an erbium laser. The technique will depend on the problem, the excess fat and skin in the eyelid areas, and the position of the eyebrows. In the upper eyelid, the incision is hidden within the natural fold and extends to the outer corner of the eye. Excess skin and fat are removed. The incision is performed with the laser and there is no bleeding. The lower eyelid fat pockets are removed through an incision placed inside the lower eyelid. There is no need for stitches. If there is a need to remove excess skin and muscle, another incision is hidden just below the lower lashes, easily camouflaged by natural creases. The laser may be used to tighten the lower eyelid skin.

Operating Time

1 to 3 hours. Anesthesia: Usually locally with sedation or general.

In/Out patient

Usually outpatient.

Recovery period

There is usually no pain, just temporary discomfort, swelling, bruising, itching of the eyes, tearing and sensitivity to light for a few days.

Recovery

Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks. Exercising about 3 weeks. Bruising and swelling may take several weeks to disappear, but usually with makeup or dark glasses the appearance is almost normal.

Risks

Hematoma (accumulation of blood under the skin that may require removal), infection and reactions to anesthesia. Temporary blurred or double vision. Bleeding, dry eyes, slight asymmetry in healing or scarring. There might be a temporary difficulty in closing eyes completely (rarely permanent). If there is a pulling down of the lower lids, it may require further surgery. Blindness is extremely rare.

Details

Besides the normal pre-operative exams you will be asked to do an eye test. The first evening after surgery, you should rest quietly with your head elevated. You should apply cold compresses to your eyelids to increase comfort. Stitches are usually removed after five to seven days.

Duration of Results

Several years. Sometimes permanent.

Therapy

Antibiotic, pain killer, and anti-swelling after surgery and some anti-scar prevention treatment is recommended.