Blepharoplasty: surgical eye area rejuvenation

Blepharoplasty, or eyelid surgery, is performed to modify the shape of the upper and lower eyelids, often by removing excess skin or fat. Sometimes this is needed to improve peripheral vision obstructed by skin hanging over the eyelashes. In most cases, blepharoplasty serves a cosmetic purpose, helping to improve appearance of the eyes, repair droopy eyelids, puffy bags under the eyes and straighten out wrinkles. The benefits include a younger, less tired look. However, this procedure does not remove dark circles under the eyes or wrinkles and crow's feet around the eyes.

How blepharoplasty is done

Two types of blepharoplasty exist: transconjunctival (involving incision from the inside of the eyelid) and transcutaneous (with incision going through the outer skin).

Transconjunctival approach is most commonly used to remove from under the eyes fatty tissue that forms bulging puffy "bags". No skin is removed in this case. The surgeon pulls away the lower eyelid from the eyeball, makes an incision from the inside of the eyelid with a scalpel or laser, and removes or rearranges the fat. The incision may be closed with one or more dissolving sutures, although this is not always necessary. Transconjunctival blepharoplasty usually works well in people with thicker, more elastic skin, which is usually found in younger people.

Surgeons perform transcutaneous blepharoplasty by cutting through the eyelids from the outside, usually in the creases of the upper lids and under the lashes of lower eyelids, where scars would be less prominent. When sagging and/or drooping is significant, the incisions may extend out towards the temples where they would be camouflaged by crow's feet. Then the surgeon would separate skin from muscle and fatty tissue, removing excess fat and trimming loose skin and muscle. Unlike transconjunctival blepharoplasty, the transcutaneous kind requires sutures to cover the incision.

Some authorities on reconstructive surgery prefer transconjunctival blepharoplasty because it is less invasive and heals faster than the transcutaneous approach. It also allows the surgeon to inspect the result of the procedure by returning the eyelids to the regular position and make adjustments accordingly. Although transconjunctival blepharoplasty itself does not remove excess skin, it can be combined with skin excisions to achieve that.

Surgeons can perform blepharoplasty of both kinds with laser as well as scalpel. Laser surgery offers the benefits of smaller incisions and cauterization of blood vessels, which reduces bleeding during the procedure.

The surgery usually lasts between one and three hours, under either local or general anesthesia. The patient can generally return home on the day of the surgery.

Precautions before and after surgery

Blepharoplasty is performed in the immediate vicinity of the eyes, which can make it a riskier procedure than some other types of cosmetic and reconstructive surgery. Patients should avoid taking inflammatory medications (including over-the-counter drugs like ibuprofen and aspirin), some supplements and herbs for about two weeks before the surgery because they increase the risk of bleeding (more details in the Risks and complications section below). Surgeons would also advise to stop smoking one or several days before the procedure. Consuming alcohol shortly before surgery is also inadvisable as it may increase bruising. Patients should limit exposure to sunlight for about one week before surgery to prevent discoloration.

A complete physical examination before the surgery should include an inspection of the eyes to identify immediately any possible, although unlikely, impairment of the eyesight after blepharoplasty. The surgeon should inspect the quality and amount of skin in the eyelids and folds to find the best approach to the procedure.

After surgery, patients should take antibiotics for several days to prevent infection and apply antibiotic ointment to the stitch line. They should use ice-cold compresses continuously on the first day following the surgery, gradually decreasing the number and frequency of compresses on the following days. Stitches (if any) should be removed several days after surgery. Patients should refrain from alcohol and some medications (including aspirin) for approximately a week. Discoloration around the eyes and some swelling is normal after blepharoplasty, and patients should avoid strenuous activity at this time. In most cases, people can go back to their usual activities seven to ten days after blepharoplasty.

Benefits

Blepharoplasty can improve peripheral eyesight, smooth the bags or puffiness under the eyes or correct puffy upper eyelids. This can help people look younger and more alert. The effects of blepharoplasty can last for several years at least.

Risks and complications

Blepharoplasty is a relatively minor cosmetic procedure, and severe or long-lasting complications are rare, although possible.

When done properly by a competent, experienced surgeon, blepharoplasty is usually successful and does not harm the patient; however, as with any surgery, there is always some risk. Problems with eyelid surgery can be aesthetic or medical.

If too much skin is removed from lower or upper eyelid, the patient may lose the ability to close their eyes (this condition is called an ectropion, or exposure of eyelid lining), which may require an additional, corrective surgery. Most aesthetic defects are generally removed by repeating the procedure.

Medical complications include dry or watery eyes, collection of fat under the eye, eye redness or slower heart rate (a reaction to local anesthetic). Most complications of blepharoplasty are temporary and light, but occasionally more serious problems develop. Blood clot behind the eyeball, a rare complication, can be very painful, and orbital hemorrhage may result in loss of eyesight.

Because of these risks, blepharoplasty is not suitable for people with dry-eye syndrome, hypertension, heart disease, thyroid disorders or diabetes. Ophthalmologic conditions including glaucoma or a detached retina can also increase the risk.

Conclusion

For people with moderate or severe under eye bags, droopy eyelids and puffiness, blepharoplasty is likely to be the only option offering marked improvement. It can also improve peripheral vision. However, it may be associated with certain risks and not be appropriate for some people. Before proceeding with blepharoplasty, be sure to discuss it with your general physician and your ophthalmologist. Also, make sure that the surgeon performing the procedure has your complete medical history and is in contact with your other doctors. This should help you avoid most complications. As one possible rule of thumb, blepharoplasty is appropriate for people over 35; however, if droopy eyelids restrict your vision, you may be a candidate at any age older than eighteen.

If blepharoplasty is not suitable for you, skin tightening procedures radiofrequency lift) or topical agents (e.g. DMAE) might be worth considering although a dramatic improvement is unlikely.