Eyelid Surgery (Blepharoplasty)

Author: Dr Bryce J Cowan BSc MSc MD PhD FRCS(C)
(Reconstructive & Cosmetic Plastic Surgeon, The Skin Care Centre, Vancouver)

Blepharoplasty

Eyelid surgery, called blepharoplasty, is a method of restoring a youthful appearance to the eyes. The eyes are often seen as the most expressive feature of the face, and often function to transmit emotions to others. This procedure corrects wrinkles, puffy bags, and heaviness of the eyelids, leaving patients with an energized look, with eyes open wider.

The process of natural aging causes changes in the eyes over time, which can make a person look tired and worn. Heavily wrinkled eye skin can also be a genetic trait in a family as well as a natural result of aging processes. If baggy eyes is a familial trait, these changes can take place much earlier than normal, which can be disturbing for the patient.

These procedures are not designed to treat a dropped position of the eyebrow or wrinkles in the forehead. These changes are best treated by a brow lift, or for treating wrinkles between the eyebrows, the use of Botox® may be appropriate. Botox® can also treat crow's feet at the sides of the eye, as well as lasers or chemical peels. Dark pigment below the eyes can be treated with laser, chemical peels, or bleaching agents. Rejuvenation procedures in these areas are addressed in detail in other sections.

It is possible to combine blepharoplasty surgery with brow lifts and/or facelift procedures but they are not part of the same surgical procedure, and are not described in this section.

AGE-RELATED EYE CHANGES

Please inform your surgeon if you are under the care of an optometrist or an ophthalmologist. Patients with corrective lenses, contacts, dry eyes should always identify themselves to the surgeon as this may change your candidacy for or approach to surgery.

PREPARATION

Patients with dry eyes should identify this point to their surgeon. Eyelid tone and its ability to recoil against the eye may be a cause of dry eye. If this is the case, your surgeon may decide to Your surgeon will likely ask you to avoid make-up and alcohol consumption for 48 hours prior to surgery.

THE PROCEDURE

Blepharoplasty surgery is usually a one to two hour outpatient procedure performed under local anesthesia (with our without sedation) or under general anesthesia when in combination with other procedures.

Eyelid surgery involves removing excess fat, muscle, and skin from the upper lids, lower lids or both. The surgeon marks the eyelid creases, and creates incisions in the natural creases of the upper eyelids or below the eyelash line in the lower lids. Soft curved arch incisions are made into the lateral crow's feet of the outer eye. The surgical area is anesthetized and small strips of skin and muscle are removed to allow access to the deeper fat compartments. Selective removal of only excess fat allow of a rejuvenated and avoid a hollowed out eye appearance. Fat may also be redistributed to reduce the appearance of puffiness and bags while avoiding a hollowed-out look to the eye. In the lower lids, skin is separated from the underling structures; redundant skin and muscle are identified and removed. If the lower eyelid is very loose and easily falls away from the eye, your surgeon may perform a tightening (or Canthopexy) procedure to correct the laxity in the eyelid. Incisions are then closed with very fine sutures that often require removal in 3-5 days.

In certain cases of isolated puffy lower lids, no skin removal may be required and a 'transconjunctival' blepharoplasty may be performed. This technique uses incisions that are hidden on the inside of the lower eyelid to remove the excess fat. As this modified procedure does not leave visible scars, it is often requested. Keep in mind, however, that this procedure has its limitations, specifically, it cannot remove the excess skin which may be required, depending on your goals.

In almost every case, the eyelid incisions fade over months to the point of near imperceptibility.

THE RECOVERY

Recovery time is, rightly, a large concern for many. The standard expected recovery time following eyelid surgery is approximately 2 to 3 weeks. At that time, most patients should resume normal activity.

Pain after the operation is usually quite minimal. Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure. Discuss all medications you are on or plan to take with your surgeon. You should only take medications prescribed by your surgeon. Swelling and some bruising around the eyes are common during the first 4-7 days after the operation. The use of cool cloths or gel pack compresses immediately after the operation can reduce some of the initial swelling but should be discussed with your surgeon. Sleeping in a semi-inclined position (with 2-3 pillows) will reduce the collection of fluid around the eyes and reduce swelling. Initial swelling may partly shut the eyes or limit your ability to move your eyelids properly. If you are unable to shut your eyes completely in the first few days after the procedure, lubricating drops or nighttime ointments may be recommended to avoid irritation of the eye and other associated problems. In some cases watering of the eye during the first 2-3 weeks can be seen. Exercise, stress, alcohol and head-down positions will increase swelling and bruising around the eyes. Remember that this is a normal part of recovery and often disappears within the first 2 weeks of the procedure. Make-up may be used to hide these changes during the early recovery phase.

As with any surgical procedure, patients should plan to rest for the first few days.

COMPLICATIONS

Although complications with blepharoplasty are uncommon, it is a possibility. Discussing potential complications with your surgeon is imperative. Listed below, divided into early and late complications, are a list of the most common complications with the procedure:

EARLY	LATE
Bleeding Hematoma (blood collection) Infection Double vision (temporary) Inability to close lids (temporary) Visual loss (extremely rare)	Dry eye Asymmetry (between sides) Excessive tearing Hollowed look (over resection) Hyperpigmented scars (lower lid)

Please be aware that high blood pressure, diabetes, or thyroid problems may increase your risk of complications during these procedures. For a more detailed discussion on expected results, recovery, and possible complications, please see your surgeon.

COST

Upper eyelid correction may be covered under the Canadian Health Care Plan, provided that the upper eyelid significantly obstructs vision. If this is the case, visit a doctor or an ophthalmologist. A certified letter stating the degree of obstruction is required by the provincial Medical Services Plans prior to approval of this coverage. The final decision on coverage will be made by the plastic surgeon.

In many cases, eyelid surgery will be deemed elective, and will not be covered by the health care plan. The average cost of this procedure, as published by the Canadian Society of Aesthetic Plastic Surgery is $5000 for both the upper and lower lids.

IS THIS REALLY FOR ME?

Blepharoplasty surgery is one of the most successful cosmetic surgical procedures with a very high patient satisfaction rate. In isolation or combined with a brow lift, this procedure opens the eye shadow space and has one of the greatest rejuvenating effects of all facial plastic surgical procedures. Remember, that the initial rejuvenation changes are not permanent as the surgery reverses but does not stop the aging process.

DISCLAIMER

This website does not cover all of the medical knowledge related to eye lid surgery (Blepharoplasty) nor does it deal with all possible risks and complications of surgery on the eyelids and associated structures. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical procedure. For a more detailed discussion on expected results, recovery, and specific complications, please see your plastic surgeon.