EYELID LIFT (UPPER/LOWER BLEPHAROPLASTY)
"A beautiful eye is one that is well framed by the brow, and the contours of the skin around it. It is well rested, attentive and defies its true age"
Your eyes are a focal point on your face and give others clues about your age, mood, and whether or not you are tired or well rested. When beginning the process of facial rejuvenation, many people choose eyelid surgery as a starting point. One of the main reasons may be that the eyelids often show the effects of aging, gravity, sun exposure and smoking before the rest of the face or neck.
Protruding fatty tissue from your eye sockets that causes bulging above or below the eye can be an inherited trait that shows up early in life, but can also be the result of aging that occurs in men and women. Generalized sun exposure over the years will have a direct effect on the weakening of your elastic fibers that keep eyelid skin taut.
At first, bags or sagging may be most noticeable when you are particularly tired. Eventually the signs become visible all of the time. Eyelid skin and muscle thin and stretch with time. Bulging fat pockets result when fat pads that cushion the eyes begin to fall forward, pull away from the bone of the lower eyelids and sag.
"There are many factors that contribute to the changes in the delicate tissues of the eyelids."
Aging upper eyelids may cause a hood to form over the eyelashes where your upper lids have become heavier and fuller. Blepharoplasty can get rid of droopy or hooded eyelids, and eliminate the protruding fat bags above and below your eyes. In some cases, cosmetic eyelid surgery may be combined with surgery to correct a functional problem such as weakness of upper eyelid muscles called “ptosis” (pronounced toe-sis) that can decrease the range of upward vision.
The goals of eyelid rejuvenation techniques are to remove excess skin, reduce fat deposits or reposition them, to tighten lax eyelid muscles, and to re-establish a natural crease in the upper lids. A decade ago, we removed more skin, fat and muscle. Today, we preserve the fat whenever possible to avoid creating an operated look or causing hollows.
Eyelid surgery does not directly correct the dark circles under the eyes, but can eliminate the dark shadowing effect caused by bulging fat pockets and loose and redundant skin. Surgery of the eyelids will also not lift sagging eyebrows. This requires a brow or forehead lift that can be performed in tandem with eyelid surgery. Botulinum toxin injections, peels and laser therapies can reduce fine lines and wrinkles near the eye.
Cosmetic eyelid surgery may need to be revised in the future if there is very loose or thin skin, but the rejuvenation effect of blepharoplasty generally lasts ten years or more and often times does not need to be repeated. Since the eyes are a central feature of the face, rejuvenating them is critical to achieving a more youthful appearance.
In blepharoplasty, excess fat, skin, and, if needed, muscle are removed from your upper and/or lower eyelids. The procedure is performed on an outpatient basis under local anesthesia with intravenous sedation or under general anesthesia, especially when it is combined with another surgical procedure. First, eye drops may be used to anesthetize your eyes, and then an ointment may be placed in your eyes to protect the globes during the surgery. We use very fine electrocautery throughout eyelid surgery to minimize bleeding.
The most common methods of performing lower blepharoplasty are the external approach –also called a skin-muscle flap – and the transconjunctival approach. For the external approach, the incision begins at a point near the inner tear duct of the lower eyelid, approximately 2 to 3 mm below the eyelash line, and typically extends into the crow's feet area where lines already exist so that the scar will be less noticeable. We lift the skin and muscle to remove a small amount of fat. Excess skin and muscle are then trimmed from the lower lid.
If you have a pocket of fat beneath your lower eyelids but do not have any loose skin, we may recommend a transconjunctival blepharoplasty. It is usually performed on younger people with fatty lower eyelids and taut skin. The transconjunctival method utilizes an incision hidden inside the lower eyelid which leaves no visible external scars. Through this incision, the surgeon exposes and trims the excess fat. The incision is closed with dissolving sutures or, more commonly, it is left to heal on its own. A lower eyelid tightening procedure may also be performed at the same time during either surgical approach, but if significant skin and muscle laxity are present the skin muscle flap (external) approach is advisable.
Another aspect of lower eyelid surgery addresses the “tear troughs” or deep grooves that can result when there is an obvious demarcation at the junction of the lower eyelid area and the cheek. The main methods for improving the tear trough area are fat removal, fat injections or fat transposition to move around the existing fatty deposits to create a smoother look.
Upper blepharoplasty involves making an elliptical incision across the eyelid crease, in the natural skin fold. We draw a line to identify the lower edge of the skin to be excised, which will eventually become the scar that remains. The loose and redundant skin of your upper eyelid is then marked out. Excess skin and fatty tissue are removed along with a thin strip of muscle to give your eyelid crease more definition. We close the incision with a single layer of fine sutures. When correctly planned, the scar is well hidden within the natural fold of your upper eyelids.
Thin surgical tape will be applied to your stitch line after the surgery. An ointment to prevent dryness may be applied but it is not necessary for your eyes to be covered. Your eyelids will feel tight and sore as the anesthesia wears off and you may feel a slight burning sensation along the suture lines. Although you will be able to read, use a computer and watch television the next day, these activities should be limited because they tend to dry the eyes and your eyes will tire easily. Some swelling and bruising is to be expected for several weeks, depending on the extent of your procedure. Head elevation with extra pillows above the level of the heart is important when you are lying down to help minimize swelling and applying cold compresses or ice packs for the first 48 hours will also help to reduce your swelling.
The stitches are removed three to five days after the procedure. For seven to ten days, the eye area will need to be cleaned and your eyes may feel sticky and itchy. In some cases, we recommend using artificial tears for lubrication that will help the gritty or scratchy feeling in the first few days after surgery.
You should not wear contact lenses for one to two weeks and you may feel uncomfortable for a while when you resume wearing them. You should avoid excessive blinking, which leads to increased swelling, if possible. We recommend wearing sunglasses in the first few weeks after surgery since your eyes will be sensitive to sun, wind and other irritants. For the first two weeks, it is important to avoid any activity that increases blood flow to the eyes or surrounding area including bending, lifting, crying and exercise or sports. Although your scars can remain slightly pink for six months after surgery, they should eventually fade to a thin, barely visible white line. Eyelid scars generally heal very well because of the thinness of the skin.
Certain medical conditions including dry eyes or lack of sufficient tears, thyroid problems such as hypothyroidism and Graves' disease, hypertension, cardiovascular disease, and diabetes may increase the risks associated with eyelid surgery Depending on your medical history and exam findings, your surgeon may require an examination by an ophthalmologist before surgery, to perform glaucoma testing and measure tear production. A dry eye condition or blepharitis can inhibit healing and possibly result in injury or infection of the cornea. Your plastic surgeon or ophthalmologist may recommend against surgery if your dry eye condition is very severe, or may suggest a more conservative surgical approach.
Other than expected bruising and swelling after blepharoplasty, minor adverse effects may include temporary double or blurred vision, burning, stinging, gritty sensation in the eye, excessive tearing and a slight asymmetry. Severe complications may include decreased sensation in the eyelid, dry eyes, difficulty closing your eyes completely, or an ectropion where the lower lid is pulled down. A more serious but extremely rare complication is bleeding behind the eye, called retrobulbar hematoma that can be successfully treated once it is recognized.
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