Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.
The primary use of blepharoplasty is for improving the cosmetic appearance of the eyes. In some older persons, however, sagging and excess skin surrounding the eyes can be so extensive that it limits the range of vision. In those cases, blepharoplasty serves a more functional purpose.
Approximately 100,000 blepharoplasty procedures are performed each year in the United States. The procedure is more common among women than men.
Blepharoplasty can be performed on the upper or lower eyelid. It can involve the removal of excess skin and fat deposits and the tightening of selected muscles surrounding the eyelids. The goal is to provide a more youthful appearance and/or improve eyesight.
The surgeon will begin by deciding whether excess skin, fat deposits, or muscle looseness are at fault. While a person is sitting upright, the surgeon will mark where incisions will be made on the skin. Care will be taken to hide the incision lines in the natural skin folds above and below the eye. The surgeon will then inject a local anesthetic to numb the pain. Many surgeons also administer a sedative intravenously during the procedure.
After a small, crescent-shaped section of eyelid skin is removed, the surgeon will work to tease out small
In some persons, fat deposits in the lower eyelid may be the only or primary problem. Such people may be good candidates for transconjunctival blepharoplasty. In this procedure the surgeon makes no incision on the surface of the eyelid, but instead enters from behind, through the inner surface of the lid, to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.
Before performing blepharoplasty, the surgeon will assess whether a person is a good candidate for the treatment. A thorough medical history is important. The surgeon will want to know about any history of thyroid disease, hypertension, or eye problems, which may increase the risk of complications.
Prior to surgery, surgeons and their candidates meet to discuss the procedure, clarify the results that can be achieved, and discuss potential problems that might occur. Having realistic expectations is important in any cosmetic procedure. People will learn, for example, that although blepharoplasty can improve the appearance of the eyelid, other procedures, such as a chemical peel, will be necessary to reduce the appearance of wrinkles around the eye. Some surgeons prescribe vitamin C and vitamin K for 10 days prior to surgery in the belief that this helps the healing process. Candidates are also told to stop smoking in the weeks before and after the procedure, and to refrain from using alcohol or aspirin .
An antibiotic ointment is applied to the line of stitches each day for several days after surgery. Patients also take an antibiotic several times a day to prevent infection. Ice-cold compresses are applied to the eyes continuously for the first day following surgery, and several times a day for the next week or so, to reduce swelling. Some swelling and discoloration around the eyes is expected with the procedure. Persons should avoid aspirin or alcoholic beverages for one week and should limit their activities, including bending, straining, and lifting. The stitches are removed a few days after surgery. People can generally return to their usual activities within a week to 10 days.
As with any surgical procedure, blepharoplasty can lead to infection and scarring. Good care of the wound following surgery can minimize these risks. In cases where too much skin is removed from the eyelids, people may experience difficulty closing their eyes. Dry eye syndrome may develop, requiring the use of artificial tears to lubricate the eye. In a rare complication, called retrobulbar hematoma, a pocket of blood forms behind the eyeball.
Most people can expect good results from blepharoplasty, with the removal of excess eyelid skin and fat producing a more youthful appearance. Some swelling and discoloration is expected immediately following the procedure, but this clears in time. Small scars will be left where the surgeon has made incisions; but these generally lighten in appearance over several months, and, if placed correctly, will not be readily noticeable.
Morbidity and mortality rates
If too much excess skin is removed from the upper eyelid, persons may be unable to close their eyes completely. Another surgery to correct the defect may be required. Similarly, too much skin can be removed from the lower eyelid, allowing too much of the white of the eye (the sclera) to show. In extreme cases, the lower lid may be pulled down too far, revealing the underlying tissue. This is called an ectropion and may require a second, corrective surgery. The eye's ability to make tears may also be compromised, leading to dry eye syndrome. Dry eye syndrome is potentially dangerous; in rare cases it leads to damage to the cornea of the eye and vision loss.
Some of the alternatives to blepharoplasty include losing some excess body fat, exercise , accepting one's body and appearance as it is, or using makeup to downplay or emphasize facial features.
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L. Fleming Fallon, Jr., MD, DrPH
WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?
Blepharoplasty procedures are performed by surgeons with specialized training in plastic and reconstructive surgery. They are most commonly performed in outpatient facilities or in private professional offices. The procedure may also be performed in a hospital.
In 2003, the average price of blepharoplasty for both upper lids was approximately $4,000. For both lower lids, the cost may be slightly higher. The cost for both upper and lower blepharoplasty was approximately $6,000. These prices usually include anesthesia and surgeon fees. Medications and lab work, as well as any revisionary work, are not included.
QUESTIONS TO ASK THE DOCTOR
- What will be the resulting appearance?
- Is the surgeon board certified in plastic and reconstructive surgery?
- How many blepharoplasty procedures has the surgeon performed?
- What is the surgeon's complication rate?