Blepharoplasty

Definition

Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.

(Fig 2.6a; Fig 2.6b; Fig 2.6c.)
Blepharoplasty is one of the most common cosmetic surgical procedures. The illustration above depicts a procedure to eliminate dermochalasia, or baggy skin around the eyes.



Purpose

The primary use of blepharoplasty is for improving the cosmetic appearance of the eyes. In some older patients, 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.

Precautions

Before performing blepharoplasty, the surgeon will assess whether the patient is a good candidate for the treatment. A good 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.

Preparation

Prior to surgery, patients meet with their surgeon to discuss the procedure, clarify the results that can be achieved, and discuss the potential problems thatmight occur. Having realistic expectations is important in any cosmetic procedure. Patients 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. Patients are also told to stop smoking in the weeks before and after the procedure, and to refrain from alcohol and aspirin.



Description

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.

The surgeon will begin by deciding whether excess skin, fat deposits, ormuscle looseness are at fault. While the patient is sitting upright, the surgeon will mark on the skin where incisions will be made. Care will be taken to hide the incision lines in the natural skin folds above and below the eye. The patient then receives injections of a local anesthetic to numb the pain. Many surgeons also give the patient 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 pockets of fat that have collected in the lids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull it tighter. Then the incision is closed with stitches.

In some patients, fat deposits in the lower eyelid may be the only or primary problem. Such patients 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 to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.

Aftercare

An antibiotic ointment is applied to the line of stitches 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. Patients 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. Patients can generally return to their usual activities within a week to 10 days.

Risks

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, the patient may have difficulty closing his 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.

Normal results

Most patients 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.

Abnormal results

As noted, if too much excess skin is removed from the upper eyelid, the patient may be unable to close his 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. Called an ectropion, this too 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.