Blepharoplasty is a cosmetic surgical procedure that aims to reshape and rejuvenate rejuvenate the unaesthetic appearance of bulging upper or lower eyelid. It can include removal and/or repositioning excess tissue, muscle and skin. It also reinforces the surrounding muscles and tendons.
With age, the fatty tissue surrounding the eye in the orbital cavity increases. It protrudes under the eyelids and is split in 3 herniations by ligaments.
Patients with a less severe amount of excess skin and those with more elastic skin may still wish to undergo similar transconjunctival procedure for cosmetic reasons, without removal of skin. Lower eyelid blepharoplasty is most commonly performed in elderly patients to improve puffy lower eyelid “bags” and reduce the wrinkling of skin.
The method selection and resulting cosmetic outcome of the procedure depends on multiple factors – the anatomy of the eyelid, patient’s age, skin quality, the bony tissues, and soft tissues which are adjacent to the location, where the blepharoplasty took place.
How is it performed?
There are two methdods for surgical blepharoplasty:
1. Through external incisions. Such location may be the creases of the upper lids or below the lashes of the lower lids.
2. From the inside of the eyelid, through the conjunctiva. This method is most often applied when the skin is still elastic and not dropping. The initial swelling and bruising might not be visible, but if present, it takes one to two weeks to disappear.
3. When there is only an upper eyelid sagging, in most cases we first do an eyebrow lift using Serdev Suture lifting technique. This is the most effective method, which eliminates the lateral sagging of the eye (as in the first image below). Thus, we postpone blepharoplasty with many years. Furthermore, if we first perform eyelid correction, it lowers the position of the eyebrows, which have already dropped at an elderly age. In case we first do a blepharoplasty, a subsequent brow lift often cannot be performed properly. This is because the excessive skin excision will not allow full closure of the eyelids, due to their initial shortening. In such cases, the eye gets dry and suffers.
There are factors known to cause complications after blepharoplasty. Failure to recognize their existance before surgery may result in undesired outcomes. Such factors are:
– Pre-existing dry eyes. Possible disruption of the natural tear film may worsen this condition after surgery;
– Laxity (looseness) of the lower lid margin (edge), which causes dryness and consequences for the eye health.
Upper blepharoplasty in Asian patients is termed Asian blepharoplasty or "double eyelid surgery". It is the most popular form of cosmetic surgery among those of East and Southeast Asian background, due to anatomical differences between the Asian and Caucasians. Asians are mostly born without a supratarsal eyelid crease and blepharoplasty can be used to artificially create a such crease above the eye. Another most common congenital lid condition in Asians is the epicantal fold - a semi-lunar fold of skin at medial canthus, which is operated using different techniqies of Z-plasty
Transconjunctival blepharoplasty can be applied when there is no excess skin and there is prerserved skin elasticity. It involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Since there is no external incision, excess skin can not be removed during the surgery, but skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. This allows for a faster recovery process.