What is Blepharoplasty?
The problem: You look in the mirror and your eyes look different. They look smaller. They may look puffier and swollen. There may be extra skin hanging down or bunching up under your eyes when you smile. You may look tired or drowsy, just not like your usual self. Maybe eyelid surgery can help.
The anatomy: The eyelid skin is the thinnest skin in the body. Because of this it is more susceptible to age and sun damage, loss of elasticity and stretching. In the upper eyelids, it is mainly the skin that gets stretched out, sometimes the muscle and rarely does the internal fat hold out. If there is fat bulging this is usually at the side closest to the bridge of the nose. Often upper eyelid excess is complicated by sagging and dropping down over the brow (see brow lift). When the sagging of the brow is severe enough this has to be addressed along with the extra skin in the eyelid. In the lower lids the most common problem is sagging or herniation of the fat pads. This causes the “bags”. The skull is very hard and the eye is very soft. There are small fat pads around the eyeball in side the sockets that protected and act as shock absorbers. And as people age these fat pads can bulge out. This process is made worse by allergies, sinus disease, thyroid or kidney problems. Because the eyelids skin is so thin and susceptible, damage and stretching can occur at any age. Eyelid surgery is often the first cosmetic surgery done on a person, well before any kind of face lifting but perhaps after non-invasive skin tightening Thermage. Some people may even benefit from eyelid surgery as early as their twenties.
The solution: Blepharoplasty
Blepharoplasty is plastic surgery to remove extra skin muscle and fat from the eyelids when these structures have stretched out or bulge out changing normal contours. As mentioned above this can be associated with medical problems or eventually just be a sign of general wear and tear. In the upper eyelid a crescent, or half Moon of skin is removed right in the crease of the eyelid. This creates a defined crease and opens up the eye. Sometimes some muscle is removed as well. Occasionally fat is removed near the bridge of the Nose. In the lower lid an incision is made in the crease underneath the eyelashes. The skin is lifted up. The muscle layer is opened. The extra fat is removed. The skin is tightened by removing the excess. Sometimes a suture is placed from the lower eyelid to tighten the lower lid if it is extremely loose. This is called a canthopexy. This procedure can be done alone or with a brow lifts or a facelift. When done alone it is usually done with local anesthesia and sedation. When it is done with several other operations, is often done under a general anesthetic for comfort and safety. The blepharoplasty usually takes one to two hours and is an outpatient procedure. There is minimal pain and discomfort involved. Sometimes there is bruising and swelling. A week at home to recover is sufficient. Patients can then go back to work after the sutures are removed at one week. The sutures placed are dissolving sutures and they usually dissolve by seven days. The ones that have not dissolved are then removed.