Blepharoplasty
Blepharoplasty
Definition
Purpose
Demographics
Description
Diagnosis/Preparation
Aftercare
Risks
Normal results
Morbidity and mortality rates
Alternatives
Definition
Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.
Purpose
The primary use of blepharoplasty is for improving the cosmetic appearance of the eyes. In some older persons, however, sagging and excess skin surrounding the eyes can be so extensive that it limits the range of vision. In those cases, blepharoplasty serves a more functional purpose.
Demographics
Approximately 100,000 blepharoplasty procedures are performed each year in the United States. The procedure is more common among women than men.
Description
Blepharoplasty can be performed on the upper or lower eyelid. It can involve the removal of excess skin and fat deposits and the tightening of selected muscles surrounding the eyelids. The goal is to provide a more youthful appearance and/or to improve eyesight.
The surgeon begins by deciding whether excess skin, fat deposits, or muscle looseness are at fault. While a person is sitting upright, the surgeon marks where incisions will be made on the skin. Care is taken to hide the incision lines in the natural skin folds above and below the eye. The surgeon then injects a local anesthetic to numb the pain. Many surgeons also administer a sedative intravenously during the procedure.
After a small, crescent-shaped section of eyelid skin is removed, the surgeon works to tease out small pockets of fat that have collected in the lids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull muscle tissue tighter. Then the incision is closed with stitches .
In some persons, fat deposits in the lower eyelid may be the only or primary problem. Such people may be good candidates for transconjunctival blepharoplasty. In this procedure the surgeon makes no incision on the surface of the eyelid, but instead enters from behind, through the inner surface of the lid, to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.
KEY TERMS
Ectropion— A complication of blepharoplasty, in which the lower lid is pulled downward, exposing the inner surface.
Intravenous sedation— A method of injecting a fluid sedative into the blood through the vein.
Retrobulbar hematoma— A rare complication of blepharoplasty, in which a pocket of blood forms behind the eyeball.
Transconjuctival blepharoplasty— A type of blepharoplasty in which the surgeon makes no incision on the surface of the eyelid, but, instead, enters from behind to tease out the fat deposits.
Diagnosis/Preparation
Before performing blepharoplasty, the surgeon assesses whether a person is a good candidate for the treatment. A thorough medical history is important. The surgeon requires knowledge of any history of thyroid disease, hypertension, or eye problems, which may increase the risk of complications.
Prior to surgery, surgeons and their candidates meet to discuss the procedure, clarify the results that can be achieved, and discuss potential problems that might occur. Having realistic expectations is important in any cosmetic procedure. Candidates learn, for example, that although blepharoplasty can improve the appearance of the eyelid, other procedures, such as a chemical peel, may be necessary to reduce the appearance of wrinkles around the eye. Some surgeons prescribe vitamin C and vitamin K for 10 days prior to surgery in the belief that this helps the healing process. Candidates are also told to stop smoking in the weeks before and after the procedure, and to refrain from using alcohol or aspirin.
Aftercare
An antibiotic ointment is applied to the line of stitches each day for several days after surgery. Patients also take an antibiotic several times a day to prevent infection. Ice-cold compresses are applied to the eyes continuously for the first day following surgery, and several times a day for the next week or so, to reduce swelling. Some swelling and discoloration around the eyes is expected with the procedure. Persons should avoid aspirin or alcoholic beverages for one week and should limit their activities, including bending, straining, and lifting. The stitches are removed a
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Blepharoplasty procedures are performed by surgeons with specialized training in plastic and reconstructive surgery. They are most commonly performed in outpatient facilities or in private professional offices. The procedure may also be performed in a hospital.
In 2003, the average price of blepharoplasty for both upper lids was approximately $4,000. For both lower lids, the cost may be slightly higher. The cost for both upper and lower blepharoplasty was approximately $6,000. These prices usually include anesthesia and surgeon fees. Medications and lab work, as well as any revisionary work, are not included.
few days after surgery. People can generally return to their usual activities within a week to 10 days.
Risks
As with any surgical procedure, blepharoplasty can lead to infection and scarring. Good care of the wound following surgery can minimize these risks. In cases where too much skin is removed from the eyelids, people may experience difficulty closing their eyes. Dry eye syndrome may develop, requiring the use of artificial tears to lubricate the eye. In a rare complication, called retrobulbar hematoma, a pocket of blood forms behind the eyeball.
Normal results
Most people can expect good results from blepharoplasty, with the removal of excess eyelid skin and fat producing a more youthful appearance. Some swelling and discoloration is expected immediately following the procedure, but this clears in time. Small scars will be left where the surgeon has made incisions; but these generally lighten in appearance over several months, and, if placed correctly, will not be readily noticeable.
Morbidity and mortality rates
If too much excess skin is removed from the upper eyelid, persons may be unable to close their eyes completely. Another surgery to correct the defect may be required. Similarly, too much skin can be removed
QUESTIONS TO ASK THE DOCTOR
- What will be my resulting appearance?
- Is the surgeon board certified in plastic and reconstructive surgery?
- How many blepharoplasty procedures has the surgeon performed?
- What is the surgeon’s complication rate?
from the lower eyelid, allowing too much of the white of the eye (the sclera) to show. In extreme cases, the lower lid may be pulled down too far, revealing the underlying tissue. This is called an ectropion and also may require a second, corrective surgery. The eye’s ability to make tears may also be compromised, leading to dry eye syndrome. Dry eye syndrome can be dangerous; in rare cases it leads to damage to the cornea of the eye and vision loss.
Alternatives
Some of the alternatives to blepharoplasty include losing some excess body fat through diet and exercise, accepting one’s body and appearance as it is, or using makeup to de-emphasize the area.
Resources
BOOKS
Engler, Alan M. BodySculpture: Plastic Surgery of the Body for Men and Women, 2nd ed. Hudson Pub, 2000.
Irwin, Brandith and Mark McPherson. Your Best Face: Looking Your Best without Plastic Surgery. Carlsbad, CA: Hay House, Inc, 2002.
Man, Daniel, and L. C. Faye. New Art of Man: Faces of Plastic Surgery: Your Guide to the Latest Cosmetic Surgery Procedures, 3rd ed. New York: Beauty Art Press, 2003.
Papel, I. D., and S. S. Park. Facial Plastic and Reconstructive Surgery, 2nd ed. New York: Thieme Medical Publishers, 2000.
PERIODICALS
Byrd, H. S. and J. D. Burt. “Achieving Aesthetic Balance in the Brow, Eyelids, and Midface.” Plastic and Reconstructive Surgery 110 (2002): 926–939.
Cather, J. C., and A. Menter. “Update on Botulinum Toxin for Facial Aesthetics.” Dermatology Clinics of North America 20 (2002): 749–761.
Oliva, M. S., A. J. Ahmadi, R. Mudumbai, J. L. Hargiss, and B. S. Sires. “Transient Impaired Vision, External Ophthalmoplegia, and Internal Ophthalmoplegia after Blepharoplasty under Local Anesthesia.” American Journal of Ophthalmology 135 (2003): 410–412.
Yaremchuk, M. J. “Restoring Palpebral Fissure Shape after Previous Lower Blepharoplasty.” Plastic and Reconstructive Surgery 111(2003): 441–450.
ORGANIZATIONS
American Academy of Facial Plastic and Reconstructive Surgery. 310 S. Henry Street, Alexandria, VA 22314. (703) 299-9291. Fax: (703) 299-8898. http://www.facialplasticsurgery.org.
American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. http://www.abplsurg.org.
American College of Plastic and Reconstructive Surgery. http://www.breast-implant.org.
American College of Surgeons. 633 North Saint Claire Street, Chicago, IL, 60611. (312) 202-5000. http://www.facs.org.
American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. http://www.surgery.org.
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.
American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. http://www.plasticsurgery.org.
OTHER
“Blepharoplasty.” American Society of Ophthalmic Plastic and Reconstructive Surgery. [cited April 2003]. http://www.asoprs.org/blepharoplasty.html.
“Blepharoplasy.” Facial Plastic Surgery Network. [cited March 2003]. http://www.facialplasticsurgery.net/blepharoplasty.htm.
“Eyelid Surgery (Blepharoplasty).” Department of Otolaryngology/Head and Neck Surgery at Columbia University and New York Presbyterian Hospital. 2002 [cited April 2003]. http://www.entcolumbia.org/bleph.htm.
Galli, Suzanne K. Doud, and Phillip J. Miller. “Blepharoplasty, Transconjunctival Approach.” emedicine. September 11, 2001 [cited April 2003]. http://www.emedicine.com/ent/topic95.htm.
L. Fleming Fallon, Jr., MD, DrPH
Blepharoplasty
Blepharoplasty
Definition
Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.
Purpose
The primary use of blepharoplasty is for improving the cosmetic appearance of the eyes. In some older persons, however, sagging and excess skin surrounding the eyes can be so extensive that it limits the range of vision. In those cases, blepharoplasty serves a more functional purpose.
Demographics
Approximately 100,000 blepharoplasty procedures are performed each year in the United States. The procedure is more common among women than men.
Description
Blepharoplasty can be performed on the upper or lower eyelid. It can involve the removal of excess skin and fat deposits and the tightening of selected muscles surrounding the eyelids. The goal is to provide a more youthful appearance and/or improve eyesight.
The surgeon will begin by deciding whether excess skin, fat deposits, or muscle looseness are at fault. While a person is sitting upright, the surgeon will mark where incisions will be made on the skin. Care will be taken to hide the incision lines in the natural skin folds above and below the eye. The surgeon will then inject a local anesthetic to numb the pain. Many surgeons also administer a sedative intravenously during the procedure.
After a small, crescent-shaped section of eyelid skin is removed, the surgeon will work to tease out small pockets of fat that have collected in the lids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull muscle tissue tighter. Then the incision is closed with stitches.
In some persons, fat deposits in the lower eyelid may be the only or primary problem. Such people may be good candidates for transconjunctival blepharoplasty. In this procedure the surgeon makes no incision on the surface of the eyelid, but instead enters from behind, through the inner surface of the lid, to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.
Diagnosis/Preparation
Before performing blepharoplasty, the surgeon will assess whether a person is a good candidate for the treatment. A thorough medical history is important. The surgeon will want to know about any history of thyroid disease, hypertension, or eye problems, which may increase the risk of complications.
Prior to surgery, surgeons and their candidates meet to discuss the procedure, clarify the results that can be achieved, and discuss potential problems that might occur. Having realistic expectations is important in any cosmetic procedure. People will learn, for example, that although blepharoplasty can improve the appearance of the eyelid, other procedures, such as a chemical peel, will be necessary to reduce the appearance of wrinkles around the eye. Some surgeons prescribe vitamin C and vitamin K for 10 days prior to surgery in the belief that this helps the healing process. Candidates are also told to stop smoking in the weeks before and after the procedure, and to refrain from using alcohol or aspirin .
Aftercare
An antibiotic ointment is applied to the line of stitches each day for several days after surgery. Patients also take an antibiotic several times a day to prevent infection. Ice-cold compresses are applied to the eyes continuously for the first day following surgery, and several times a day for the next week or so, to reduce swelling. Some swelling and discoloration around the eyes is expected with the procedure. Persons should avoid aspirin or alcoholic beverages for one week and should limit their activities, including bending, straining, and lifting. The stitches are removed a few days after surgery. People can generally return to their usual activities within a week to 10 days.
Risks
As with any surgical procedure, blepharoplasty can lead to infection and scarring. Good care of the wound following surgery can minimize these risks. In cases where too much skin is removed from the eyelids, people may experience difficulty closing their eyes. Dry eye syndrome may develop, requiring the use of artificial tears to lubricate the eye. In a rare complication, called retrobulbar hematoma, a pocket of blood forms behind the eyeball.
Normal results
Most people can expect good results from blepharoplasty, with the removal of excess eyelid skin and fat producing a more youthful appearance. Some swelling and discoloration is expected immediately following the procedure, but this clears in time. Small scars will be left where the surgeon has made incisions; but these generally lighten in appearance over several months, and, if placed correctly, will not be readily noticeable.
Morbidity and mortality rates
If too much excess skin is removed from the upper eyelid, persons may be unable to close their eyes completely. Another surgery to correct the defect may be required. Similarly, too much skin can be removed from the lower eyelid, allowing too much of the white of the eye (the sclera) to show. In extreme cases, the lower lid may be pulled down too far, revealing the underlying tissue. This is called an ectropion and may require a second, corrective surgery. The eye's ability to make tears may also be compromised, leading to dry eye syndrome. Dry eye syndrome is potentially dangerous; in rare cases it leads to damage to the cornea of the eye and vision loss.
Alternatives
Some of the alternatives to blepharoplasty include losing some excess body fat, exercise , accepting one's body and appearance as it is, or using makeup to downplay or emphasize facial features.
See also Face lift; Liposuction.
Resources
books
Engler, Alan M. BodySculpture: Plastic Surgery of the Body for Men and Women. 2nd ed. Hudson Pub, 2000.
Irwin, Brandith, and Mark McPherson. Your Best Face: Looking Your Best without Plastic Surgery. Carlsbad, CA: Hay House, Inc, 2002.
Man, Daniel, and L. C. Faye. New Art of Man: Faces of Plastic Surgery: Your Guide to the Latest Cosmetic Surgery Procedures. 3rd ed. New York: BeautyArt Press, 2003.
Papel, I. D., and S. S. Park. Facial Plastic and Reconstructive Surgery. 2nd ed. New York: Thieme Medical Publishers, 2000.
periodicals
Byrd, H. S., and J. D. Burt. "Achieving Aesthetic Balance in the Brow, Eyelids, and Midface." Plastic and Reconstructive Surgery 110 (2002): 926–939.
Cather, J. C., and A. Menter. "Update on Botulinum Toxin for Facial Aesthetics." Dermatology Clinics of North America 20 (2002): 749–761.
Oliva, M. S., A. J. Ahmadi, R. Mudumbai, J. L. Hargiss, and B. S. Sires. "Transient Impaired Vision, External Ophthalmoplegia, and Internal Ophthalmoplegia after Blepharoplasty under Local Anesthesia." American Journal of Ophthalmology 135 (2003): 410–412.
Yaremchuk, M. J. "Restoring Palpebral Fissure Shape after Previous Lower Blepharoplasty." Plastic and Reconstructive Surgery 111 (2003): 441–450.
organizations
American Academy of Facial Plastic and Reconstructive Surgery. 310 S. Henry Street, Alexandria, VA 22314. Telephone: (703) 299-9291, Fax: (703) 299-8898. <http://www.facial-plastic-surgery.org>.
American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. <http://www.abplsurg.org>.
American College of Plastic and Reconstructive Surgery. <http://www.breast-implant.org>.
American College of Surgeons. 633 North Saint Claire Street, Chicago, IL, 60611. (312) 202-5000. <http://www.facs.org>.
American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. <http://www.surgery.org>.
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. <http://www.asds-net.org>.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. <http://www.plasticsurgery.org>.
American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. <http://www.plasticsurgery.org>.
other
"Blepharoplasty." American Society of Ophthalmic Plastic and Reconstructive Surgery. [cited April 2003]. <http://www.asoprs.org/blepharoplasty.html>.
"Blepharoplasy." Facial Plastic Surgery Network. [cited March 2003]. <http://www.facialplasticsurgery.net/blepharoplasty.htm>.
"Eyelid Surgery (Blepharoplasty)." Department of Otolaryngology/Head and Neck Surgery at Columbia University and New York Presbyterian Hospital. 2002 [cited April 2003]. <http://www.entcolumbia.org/bleph.htm>.
Galli, Suzanne K. Doud, and Phillip J. Miller. "Blepharoplasty, Transconjunctival Approach." emedicine. September 11, 2001 [cited April 2003]. <http://www.emedicine.com/ent/topic95.htm>.
L. Fleming Fallon, Jr., MD, DrPH
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Blepharoplasty procedures are performed by surgeons with specialized training in plastic and reconstructive surgery. They are most commonly performed in outpatient facilities or in private professional offices. The procedure may also be performed in a hospital.
In 2003, the average price of blepharoplasty for both upper lids was approximately $4,000. For both lower lids, the cost may be slightly higher. The cost for both upper and lower blepharoplasty was approximately $6,000. These prices usually include anesthesia and surgeon fees. Medications and lab work, as well as any revisionary work, are not included.
QUESTIONS TO ASK THE DOCTOR
- What will be the resulting appearance?
- Is the surgeon board certified in plastic and reconstructive surgery?
- How many blepharoplasty procedures has the surgeon performed?
- What is the surgeon's complication rate?
Blepharoplasty
Blepharoplasty
Definition
Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.
Purpose
The primary use of blepharoplasty is for improving the cosmetic appearance of the eyes. In some older patients, however, sagging and excess skin surrounding the eyes can be so extensive that it limits the range of vision. In those cases, blepharoplasty serves a more functional purpose.
Precautions
Before performing blepharoplasty, the surgeon will assess whether the patient is a good candidate for the treatment. A good medical history is important. The surgeon will want to know about any history of thyroid disease, hypertension, or eye problems, which may increase the risk of complications.
Description
Blepharoplasty can be performed on the upper or lower eyelid; it can involve the removal of excess skin and fat deposits and the tightening of selected muscles surrounding the eyelids. The goal is to provide a more youthful appearance.
The surgeon will begin by deciding whether excess skin, fat deposits, or muscle looseness are at fault. While the patient is sitting upright, the surgeon will mark on the skin where incisions will be made. Care will be taken to hide the incision lines in the natural skin folds above and below the eye. The patient then receives injections of a local anesthetic to numb the pain. Many surgeons also give the patient a sedative intravenously during the procedure.
After a small, crescent-shaped section of eyelid skin is removed, the surgeon will work to tease out small pockets of fat that have collected in the lids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull it tighter. Then the incision is closed with stitches.
In some patients, fat deposits in the lower eyelid may be the only or primary problem. Such patients may be good candidates for transconjunctival blepharoplasty. In this procedure the surgeon makes no incision on the surface of the eyelid, but instead enters from behind to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.
KEY TERMS
Ectropion— A complication of blepharoplasty, in which the lower lid is pulled downward, exposing the surface below.
Intravenous sedation— A method of injecting a fluid sedative into the blood through the vein
Retrobulbar hematoma— A rare complication of blepharoplasty, in which a pocket of blood forms behind the eyeball.
Transconjuctival blepharoplasty— A type of blepharoplasty in which the surgeon makes no incision on the surface of the eyelid, but, instead, enters from behind to tease out the fat deposits.
Preparation
Prior to surgery, patients meet with their surgeon to discuss the procedure, clarify the results that can be achieved, and discuss the potential problems that might occur. Having realistic expectations is important in any cosmetic procedure. Patients will learn, for example, that although blepharoplasty can improve the appearance of the eyelid, other procedures, such as a chemical peel, will be necessary to reduce the appearance of wrinkles around the eye. Some surgeons prescribe vitamin C and vitamin K for 10 days prior to surgery in the belief that this helps the healing process. Patients are also told to stop smoking in the weeks before and after the procedure, and to refrain from alcohol and aspirin.
Aftercare
An antibiotic ointment is applied to the line of stitches for several days after surgery. Patients also take an antibiotic several times a day to prevent infection. Ice-cold compresses are applied to the eyes continuously for the first day following surgery, and several times a day for the next week or so, to reduce swelling. Some swelling and discoloration around the eyes is expected with the procedure. Patients should avoid aspirin or alcoholic beverages for one week and should limit their activities, including bending, straining, and lifting. The stitches are removed a few days after surgery. Patients can generally return to their usual activities within a week to 10 days.
Risks
As with any surgical procedure, blepharoplasty can lead to infection and scarring. Good care of the wound following surgery can minimize these risks. In cases where too much skin is removed from the eyelids, the patient may have difficulty closing his eyes. Dry eye syndrome may develop, requiring the use of artificial tears to lubricate the eye. In a rare complication, called retrobulbar hematoma, a pocket of blood forms behind the eyeball.
Normal results
Most patients can expect good results from blepharoplasty, with the removal of excess eyelid skin and fat producing a more youthful appearance. Some swelling and discoloration is expected immediately following the procedure, but this clears in time. Small scars will be left where the surgeon has made incisions; but these generally lighten in appearance over several months, and, if placed correctly, will not be readily noticeable.
Abnormal results
As noted, if too much excess skin is removed from the upper eyelid, the patient may be unable to close his eyes completely; another surgery to correct the defect may be required. Similarly, too much skin can be removed from the lower eyelid, allowing too much of the white of the eye (the sclera) to show. In extreme cases, the lower lid may be pulled down too far, revealing the underlying tissue. Called an ectropion, this, too, may require a second, corrective surgery. The eye's ability to make tears may also be compromised, leading to dry eye syndrome. Dry eye syndrome is potentially dangerous; in rare cases it leads to damage to the cornea of the eye and vision loss.
Resources
ORGANIZATIONS
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. 〈http://www.asdsnet.org〉.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. 〈http://www.plasticsurgery.org〉.
Blepharoplasty
Blepharoplasty
Definition
Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.
Purpose
The primary use of blepharoplasty is for improving the cosmetic appearance of the eyes. In some older patients, however, sagging and excess skin surrounding the eyes can be so extensive that it limits the range of vision. In those cases, blepharoplasty serves a more functional purpose.
Precautions
Before performing blepharoplasty, the surgeon will assess whether the patient is a good candidate for the treatment. A good medical history is important. The surgeon will want to know about any history of thyroid disease, hypertension , or eye problems, which may increase the risk of complications.
Description
Blepharoplasty can be performed on the upper or lower eyelid; it can involve the removal of excess skin and fat deposits and the tightening of selected muscles surrounding the eyelids. The goal is to provide a more youthful appearance.
The surgeon will begin by deciding whether excess skin, fat deposits, or muscle looseness are at fault. While the patient is sitting upright, the surgeon will mark on the skin where incisions will be made. Care will be taken to hide the incision lines in the natural skin folds above and below the eye. The patient then receives injections of a local anesthetic to numb the pain . Many surgeons also give the patient a sedative intravenously during the procedure.
After a small, crescent-shaped section of eyelid skin is removed, the surgeon will work to tease out small pockets of fat that have collected in the lids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull it tighter. Then the incision is closed with stitches.
In some patients, fat deposits in the lower eyelid may be the only or primary problem. Such patients may be good candidates for transconjunctival blepharoplasty. In this procedure the surgeon makes no incision on the surface of the eyelid, but instead enters from behind to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.
Preparation
Prior to surgery, patients meet with their surgeon to discuss the procedure, clarify the results that can be achieved, and discuss the potential problems that might occur. Having realistic expectations is
important in any cosmetic procedure. Patients will learn, for example, that although blepharoplasty can improve the appearance of the eyelid, other procedures, such as a chemical peel, will be necessary to reduce the appearance of wrinkles around the eye. Some surgeons prescribe vitamin C and vitamin K for 10 days prior to surgery in the belief that this helps the healing process. Patients are also told to stop smoking in the weeks before and after the procedure, and to refrain from alcohol and aspirin .
Aftercare
An antibiotic ointment is applied to the line of stitches for several days after surgery. Patients also take an antibiotic several times a day to prevent infection. Ice-cold compresses are applied to the eyes continuously for the first day following surgery, and several times a day for the next week or so, to reduce swelling. Some swelling and discoloration around the eyes is expected with the procedure. Patients should avoid aspirin or alcoholic beverages for one week and should limit their activities, including bending, straining, and lifting. The stitches are removed a few days after surgery. Patients can generally return to their usual activities within a week to 10 days.
Risks
As with any surgical procedure, blepharoplasty can lead to infection and scarring. Good care of the wound following surgery can minimize these risks. In cases where too much skin is removed from the eyelids, the patient may have difficulty closing his eyes. Dry eye syndrome may develop, requiring the use of artificial tears to lubricate the eye. In a rare complication, called retrobulbar hematoma, a pocket of blood forms behind the eyeball.
Results
Most patients can expect good results from blepharoplasty, with the removal of excess eyelid skin and fat producing a more youthful appearance. Some swelling and discoloration is expected immediately following the procedure, but this clears in time. Small scars will be left where the surgeon has made incisions; but these generally lighten in appearance over several months, and, if placed correctly, will not be readily noticeable.
As noted, if too much excess skin is removed from the upper eyelid, the patient may be unable to close his eyes completely; another surgery to correct the defect may be required. Similarly, too much skin can be removed from the lower eyelid, allowing too much of the white of the eye (the sclera) to show. In extreme cases, the lower lid may be pulled down too far, revealing the underlying tissue. Called an ectropion, this, too, may require a second, corrective surgery. The eye's ability to make tears may also be compromised, leading to dry eye syndrome. Dry eye syndrome is potentially dangerous; in rare cases it leads to damage to the cornea of the eye and vision loss.
Resources
ORGANIZATIONS
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.
Richard H. Camer