Blepharoplasty – Eyelid Surgery

Indications for eyelid surgery are droopy or baggy eyelids, excess hooded skin, weak, loose muscle, and bulgy fat pockets. These are usually caused by ageing but sometimes may be hereditary and appear prematurely.

The indications for Blepharoplasty include:

• Puffiness in the upper eyelids caused by excess fatty deposits
• Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision
• Excess skin and fine wrinkles of the lower eyelid
• Bags under the eyes
• Droopiness of the lower eyelids

The above symptoms may result in both cosmetic and functional concerns, which can be addressed with Blepharoplasty or Eyelid Surgery.

Cosmetic eyelid surgery refers to the procedure, when it is not medically necessary and is performed solely to improve the aesthetic appearance of the eyes. Whereas a functional eyelid surgery, refers to the procedure, when it is performed for medical reasons. In most cases, a functional eyelid surgery is performed to remove loose skin from the upper eyelid if it droops low enough to impair one’s vision for driving or other visual activities. Other problems addressed with functional eyelid surgery are:

• Baggy upper or lower eyelids causing difficulty wearing glasses or contact lenses Excess folds of eyelid skin rubbing together causing Irritation Forehead discomfort from overused muscles that strain to lift sagging skin in the eyelid area.

Functional Eyelid Surgery is normally covered by insurance whereas Cosmetic Eyelid Surgery is not.

Prior to making a decision about surgery, it is important to determine the underlying issues causing the concerns you have with your eyes. Sometimes it may be due to a medical condition or it might not even be your eyelids causing the problem, thus requiring another type of treatment. For example, the sagging of eyebrows can sometimes be the root of droopy upper lids, rather than the lids themselves and this should be addressed with a lateral brow lift and not an eyelid surgery. A thorough consultation and assessment is necessary to determine your suitability for surgery and to also discuss all the implications of the procedure including the possible risks and complications.

Before you see Mr Rezai, it is important to consider exactly what you are trying to achieve from your surgery. In particular, you should understand that the surgeon will only be removing the skin and/or fat from the area around the eyes – the blepharoplasty operation does not affect wrinkles, creases and folds that are distant and distinct from the eye socket itself.

Advances in eyelid surgery has allowed patients to have the surgery with little to no visible scars at all. By making incisions in the natural creases of the upper and lower eyelids, surgeons are able to keep most scars from being visible to others. Depending on the severity of the condition of the eyes, different techniques are used in Eyelid surgery.

Upper Blepheroplasty / Eyelid Surgery

In the upper eyelids, excess skin and fat can create a heavy looking eyelid, aged appearance, puffiness, and sometimes it can even block one’s vision. An upper eyelid surgery uses incisions on the skin to allow for removal of excess skin and fat and sometimes tightening of the eyelid to correct droopiness or sagging. A thin suture is then used to bring the skin together allowing for the creation of an eyelid crease.

Lower Blepharoplasty / Eye Bag Removal

Lower eyelid surgery can involve skin incisions directly below the lash line or an incision on the inside of the lower eyelid, known as a transconjunctival approach. The transconjunctival technique is usually performed on patients with small bags under their eyes (i.e. no excess skin). The fat can be removed through an incision in the interior of the lower lid, while keeping the patient from having any visible scar.

Asian Blepharoplasty / Double Eyelid Surgery

There are a number of anatomic differences between Asian and Caucasian eyelids. In the Asian upper eyelids, the skin and subcutaneous fat tend to be thicker with an overhanging upper eyelid skin pushing down on the eyelashes. The goal with an Asian Blepharoplasty is to create a crease in the upper eyelid. It is often used to create a more Caucasian look in the patient.

• The operation may be performed under local anaesthetic alone, local anaesthetic with sedation, or general anaesthetic
• Either the upper or lower lids, or both, may be treated during the same operation
• Incisions are made in the natural lines of the eyelids allowing for both skin excision and fat removal
• If only fat removal is required, then the surgeon may opt to remove the fat through an incision hidden on the inside of the lower eyelid (transconjunctival blepharoplasty)
• It takes about 45 to 90 minutes, depending on technique and extent of surgery
• Many times, patients are discharged from the hospital the same day, however some may need to stay overnight at hospital.

Immediately after Blepharoplasty, patients may experience, discomfort, mild pain, swelling, bruising, and possibly vision changes. As a result of both swelling and skin excision, closing of the eyes might feel a little tight for a while. This generally settles down as the swelling subsides. The pain and blurriness usually subside within a few days and depending on the extent of surgery, most patients return to work and normal activity within couple of weeks. Any sutures are removed after three to five days. To begin with, the scars will appear pink. However, as with all scars, they will fade over a period of time. In many patients, they are virtually invisible. However, it’s important to remember that no surgical scar ever totally disappears.

Mr Rezai and his team will provide you with detailed post-surgery instructions to expedite your recovery. Should you develop any doubts or concerns following your treatment, however, they would encourage you to contact them straight away.

Cosmetic surgery is amongst the very safest of surgical procedures. However, all patients must understand that no surgical procedure is absolutely free from risk. Mr Rezai will discuss these with you at your consultation. For further information please refer to Risks and Complications of Blepharoplasty.

For the majority of patients, the result of eyelid surgery is long lasting and many times permanent, however, it will not stop ageing and of course, the younger a patient undergoes surgery, the more likely it is that a further eye surgery may be needed further down the line.

The person’s heredity along with external factors and lifestyle, play a big role in how the person ages. Avoiding sun exposure, reducing stress, limiting one’s smoking and drinking will help to maintain the youthful look of the eyes for longer.