Eyelid Lift

Blepharoplasty - A surgical procedure that corrects baggy eyelids by removing excess skin and fat from the upper and lower eyelids and tightens up lax muscles around the eyes.

The eyes play an important role in communication. They reflect emotions such as anger, fear, coyness, and happiness. Literary characters are frequently described in terms of their eyes. Yet, it is only the tissue around the eyes that is responsible for their dynamic expressions. The eyes themselves relay no message.

The skin around the eyes changes with age. It loses elasticity, becoming loose and redundant; the muscles around the eyes become slack; and excess fat in the pockets above and below the eyes become prominent. Cyclical edema or water in the tissue occurs with menstruation and certain sleep patterns.

The aging of the eyelids is largely determined by a genetic predisposition to the noted changes and by the amount of sun exposure received over time. The eyelids are also affected by gravity and muscle pull, such as habitual squinting. Allergies, cardiac problems, as well as thyroid and renal disorders can also be responsible for eyelid changes.

A surgical procedure called a blepharoplasty or eyelid plasty is commonly used to correct baggy eyelids. It is effective in removing excess skin and fat over the upper and lower eyelids and tightening up lax muscles around the eyes.

Who is a candidate for eyelid surgery?
Careful evaluation and medical examination is critical in ensuring a satisfactory result. A good candidate for eyelid surgery is a person with baggy eyelids due to excess fat, redundant skin, lax muscles around the eyes, and someone who has reasonable expectations.

Blepharoplasties will not be performed in the case of abnormal tear production, protruding eyes due to thyroid disease, or abnormalities of the muscles around the eye.

Bags, which form at the junction of the lower eyelids and upper part of the cheeks, are medically referred to as malar bags. These bags are due to chronic swelling, not muscle weakness or excessive fat accumulation and will not be improved by a blepharoplasty. Malar bags may be excised directly during eyelid surgery, but may be better treated by laser resurfacing.
What takes place in a blepharoplasty? The following are steps taken to improve the upper eyelid.

1. A surgical plan is drawn on the eyelids.
2. A local anesthetic is administered. In most cases an intravenous sedation is used to relax the patient in conjunction with the local anesthetic.
3. An incision is made, and the excess skin is removed which exposes the underlying muscle.
4. A strip of muscle 5 to 8 millimeters (1/8 to 1/4 inches) wide is removed to create a deeper eyelid crease.
5. Removal of the muscle exposes 2 fat pads. Excess fat is carefully removed.
6. The incision is closed with absorbable sutures, or if absorbable sutures are not used, the stitches are removed in 3 to 5 days.

Does the surgery hurt?
There is no pain during surgery. There may be some post surgical pain, which can be easily managed with painkillers.

What will the eyes look like after surgery?
Some swelling and bruising will occur immediately after surgery. It usually takes 10-14 days for swelling and bruising to disappear.

Eyelid surgery makes the eyes look brighter and wider. The puffiness from the excess fat will be gone as well as the redundant skin and bagginess.

Will there be a scar?
The incision for an upper lid blepharoplasty is placed in the crease of the eyelid so the scar will be inconspicuous when healed. Most eyelid scars fade rapidly after surgery and are quite faint in 6 weeks to 3 months. They may, however, take as long as 6 months to a year to fade; depending on how quickly the patient heals.

No visible scar occurs with a lower lid transconjunctival blepharoplasty because the incision is inside the eyelid. There is a scar just under the eyelashes of the lower lid when the external technique is used.

When may makeup, glasses, and contact lenses be worn?
Makeup could be used to camouflage bruising 4 days after the surgery. Makeup should not be applied to the scar until 10 days after the surgery and false eyelashes should not be used for 3 weeks.

Can blepharoplasty be combined with other surgery?
Eyelid surgery is often performed in combination with other cosmetic procedures, such as laser resurfacing, facelifts, facial liposuction, and brow lifts.

How long do the effects of a blepharoplasty last?
The surgery does not stop the aging process, soft tissue around the eyes will continue to develop the signs of aging. It is, however, unlikely that a second full blepharoplasty will be needed. Usually, secondary procedures, such as lid tightening or laser resurfacing, are sufficient to correct minor imperfections around the eyes in the future.

What complications might occur after blepharoplasty?
Scarring - Scars normally fade to fine white lines and are only a problem in patients who are hereditarily predisposed to develop thick, raised scars. Even if a person is prone to scarring, it may nonetheless resolve itself over time.

Puffiness - Occasionally, lid puffiness is prolonged due to a problem with the lymphatic vessels in the eyelids which, when functioning normally, reduce tissue fluid. This problem usually resolves itself over time.

Scleral Show - A problem that may occur with an external lower lid blepharoplasty is scleral show, where the whites of the eyes are exposed under the iris. This can occur even in the most carefully executed surgery. Scleral show can usually be resolved by upwardly massaging the lower lid on a regular basis over a period of time.

Lack of Symmetry - If one eyelid looks different from the other after surgery, it is usually due to a difference in the amount of scarring and swelling in each lid. In most cases, this is resolved over time, as the scar heals and the swelling subsides.

Eyelid Lag - An inability to close the eyelids completely is a temporary complication, which resolves as the swelling settles and the scar fades.

Numbness - Numbness around the eyes may occur, but this is usually temporary and slowly resolves over a few months.

Hematoma - Extremely rare, excessive bleeding may put pressure on the eye, which could result in altered vision or blindness.

Who performs blepharoplasties?
Plastic surgeons, dermatologists, and ophthalmologist specializing in esthetic facial surgery may perform blepharoplasties.