Blepharoplasty
(eyelid reduction)
Indications
With age skin and underlying muscle of the eyelids loosen.
This may result in skin folds forming in the upper eyelids
and deep skin wrinkles in the lower eyelids. Slackening
of the muscle allows fat, which is normally found in the
eye-socket, to project forwards and produce eyelid bags.
Blepharoplasty removes excess skin, muscle and fat to produce
a more youthful looking eye. In most instances the operation
is cosmetic; however in some people the skin is so loose
that it hangs over the eyelashes and obstructs vision.
The operation may remove skin only; skin and muscle; skin,
muscle and fat or just fat.
Anaesthetic
- General or local anaesthetic
Technique
For upper eyelid blepharoplasty a cut is made in the main
fold of the eyelid; the cut is carried into the crow’s
feet area. For lower lid surgery the cut is made just below
the eyelashes; again it is carried out into the crow’s
feet. Sufficient skin and muscle is removed to correct any
excess. Protruding fat can be removed through the same incision.
If there is fat excess in the lower lids, without excess
skin, then it can be removed via an incision on the inside
of the lower lid (transconjunctival blepharoplasty).
The skin can be cut with a scalpel, laser or special electrode
- the operations are essentially the same.
The skin cuts are stitched up; most surgeons use stitches
that need to be removed.
Blepharoplasty operations can be combined with operations
to lift the brow (brow-lift) and with facelifts. Laser resurfacing
can be combined with transconjunctival blepharoplasty to
treat fine wrinkles and to provide some skin tightening.
Length
of Operation - Bilateral upper eyelid blepharoplasty
takes about 40 minutes to one hour; bilateral lower lids
a similar amount of time. Combining upper and lower lids
about one and a half hours.
Time
in Hospital - Day-case or overnight stay.
Postoperative
Discomfort/Limitations
Expect some discomfort; significant pain is unusual. Swelling
settles over several days; cold compresses may help.Stitches
are removed after 3 - 5 days. At first closing the eyes
appears tight and the lids may gape 2-3mm this settles over
a few days. If the eyes do not close at night then eye-ointment
should be used at bed-time. Bruising is common and takes
1-2 weeks to settle - it can be hidden with dark glasses
or make-up. Watery eyes, due to swelling around tear-ducts,
may take a few weeks to settle. Scars become red before
fading over a period of weeks and months; in most people
scars are excellent, almost invisible.
Blepharoplasty does not remove cheek bags (festoons), fine
wrinkle lines nor crow’s feet. Dark eye-lids are not
improved by blepharoplasty. It is important for the surgeon
to assess the position of the eyebrow before performing
blepharoplasty - a descended brow contributes to upper eyelid
deformities. If the brow is descended then a brow lift should
be considered instead of, or in addition to, upper lid surgery.
Blepharoplasty
may be inappropriate in patients with thyroid eye disease,
water retention due to kidney & heart disease; patients
with facial weakness, patients with eyelid or eye disease/injury;
patients with dry eyes and in patients on aspirin and non-steroidal
anti-inflammatory drugs. If there is any concern about eye-disease,
visual problems or dry-eyes the opinion of an ophthalmologis
should be sought.
Time
off Work - one to two weeks.
Risks
and Complications
There is a long list of potential complications after blepharoplasty;
fortunately most are extremely rare. The following list
covers some of the more common problems, most are unusual
if the operation is performed appropriately.
Bleeding; infection; dry-eyes; conjunctival swelling; turning
inwards or outwards of lower eyelid; inability to close
the lids; excessive fat removal; unsatisfactory scars; difficulty
with contact lens wearing. Blindness is a potential risk;
particularly when fat has been removed; it is very rare
(0.04%). Bleeding and swelling in the eye-socket is the
usual cause - early surgical decompression, administration
of diuretics (water “tablets”) and immediate
ophthalmology consultation are essential.
