Blepharoplasty is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes.
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, or muscle 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.
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?
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.
Purpose
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.
Demographics
Approximately 100,000 blepharoplasty procedures are performed each year in the United States. The procedure is more common among women than men.
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 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
With age, the skin sags beneath the eye (B). To repair the area, the surgeon pinches the excess (C), then marks areas for removal (D). The incisions are closed with very fine stitches (E). (Illustration by GGS Inc.)
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 muscle tissue tighter. Then the incision is closed with stitches.
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.
Diagnosis/Preparation
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.
Aftercare
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.
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, 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.
Normal Results
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.
Alternatives
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.
Engler, Alan M. BodySculpture: Plastic Surgery of the Body for Men and Women. 2nd ed. Hudson Pub, 2000.
Irwin, Brandith, and Mark McPherson. Your Best Face: Looking Your Best without Plastic Surgery. Carlsbad, CA: Hay House, Inc, 2002.
Man, Daniel, and L. C. Faye. New Art of Man: Faces of PlasticSurgery: Your Guide to the Latest Cosmetic Surgery Procedures. 3rd ed. New York: BeautyArt Press, 2003.
Papel, I. D., and S. S. Park. Facial Plastic and ReconstructiveSurgery. 2nd ed. New York: Thieme Medical Publishers, 2000.
Periodicals
Byrd, H. S., and J. D. Burt. "Achieving Aesthetic Balance in the Brow, Eyelids, and Midface." Plastic and Reconstructive Surgery 110 (2002): 926–939.
Cather, J. C., and A. Menter. "Update on Botulinum Toxin for Facial Aesthetics." Dermatology Clinics of North America 20 (2002): 749–761.
Oliva, M. S., A. J. Ahmadi, R. Mudumbai, J. L. Hargiss, and B. S. Sires. "Transient Impaired Vision, External Ophthalmoplegia, and Internal Ophthalmoplegia after Blepharoplasty under Local Anesthesia." American Journal of Ophthalmology 135 (2003): 410–412.
Yaremchuk, M. J. "Restoring Palpebral Fissure Shape after Previous Lower Blepharoplasty." Plastic and Reconstructive Surgery 111 (2003): 441–450.
Organizations
American Academy of Facial Plastic and Reconstructive Surgery. 310 S. Henry Street, Alexandria, VA 22314. Telephone: (703) 299-9291, Fax: (703) 299-8898. http://www.facial-plastic-surgery.org.
American Board of Plastic Surgery. Seven Penn Center, Suite 400, 1635 Market Street, Philadelphia, PA 19103-2204. (215) 587-9322. http://www.abplsurg.org.
American College of Surgeons. 633 North Saint Claire Street, Chicago, IL, 60611. (312) 202-5000. http://www.facs.org.
American Society for Aesthetic Plastic Surgery. 11081 Winners Circle, Los Alamitos, CA 90720. (800) 364-2147 or (562) 799-2356. http://www.surgery.org.
American Society for Dermatologic Surgery. 930 N. Meacham Road, P.O. Box 4014, Schaumburg, IL 60168-4014. (847) 330-9830. http://www.asds-net.org.
American Society of Plastic and Reconstructive Surgeons. 44 E. Algonquin Rd., Arlington Heights, IL 60005. (847) 228-9900. http://www.plasticsurgery.org.
American Society of Plastic Surgeons. 444 E. Algonquin Rd., Arlington Heights, IL 60005. (888) 475-2784. http://www.plasticsurgery.org.
"Eyelid Surgery (Blepharoplasty)." Department of Otolaryngology/Head and Neck Surgery at Columbia University and New York Presbyterian Hospital. 2002 [cited April 2003]. http://www.entcolumbia.org/bleph.htm.
Galli, Suzanne K. Doud, and Phillip J. Miller. "Blepharoplasty, Transconjunctival Approach." emedicine. September 11, 2001 [cited April 2003]. http://www.emedicine.com/ent/topic95.htm.
The incisions made during an upper eyelid blepharoplasty procedure.
Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons.
When an advanced amount of upper eyelid skin is present, the skin may protrude over the eyelashes and causes a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.
Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete.
The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect the cosmetic and functional outcomes. Factors which are known to cause complications include:
dry eyes - which may become exacerbated by disrupting the natural tear film
laxity (looseness) of the lower lid margin (edge) - which predisposes to lower lid malposition
prominence of the eye in relation to the malar (cheek) complex - which predisposes to lower lid malposition
The fat (yellow tissue) and skin removed from a quadruple blepharoplasty. Lower-lid fat was removed using the transconjunctival technique.
The manner in which blepharoplasty surgery can alter a person's appearance is best appreciated by comparing before and after photos of surgical patients.
An upper blepharoplasy in someone who is east Asian is termed Asian blepharoplasty or double eyelid surgery.[1] It is the most popular form of cosmetic surgery among those of east and southeast Asian background[citation needed]. Due to anatomic differences between the Asian and occidental eyelid, about half of this population are born without a supratarsal eyelid crease and are called single-lidded. Surgery can be used to artificially create a crease above the eye.
Transconjunctival blepharoplasty involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Because 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. [2] This allows for a faster recovery process.
Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.
The roots of the present cosmetic advancements began around 3000 years ago with the ancient Egyptians. Documents “written on papyrus text detail how surgeons, even in that primitive age performed reconstructions on lips, noses, and ears using skin grafts cut from folds from the forehead or cheek”. [3] As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Celsus, a first century Roman, described making an excision in the skin to relax the eyelids in his book De Medicine.[4] Knowledge of blood circulation and tissue health were discovered and spread throughout the ancient world allowing techniques to improve. However, during the middle ages, plastic surgery was prohibited because it was viewed as something that was spiritual and unethical. This ban was also due to poor hygiene. During the Renaissance, intellectuals rediscovered texts from ancient Greece and Rome illustrating surgical procedures and techniques.[citation needed]
As the 19th century approached developments were being made that would eventually be the foundation to modern cosmetic surgery. The First World War was the first major event that really relied on the dedication of surgeons and advancements in cosmetic surgery. This gave doctors a chance to practice and perfect reconstructive surgical procedures. It also prepared medical personnel for the tragedies of World War II and other subsequent catastrophes. As with any medical advancements, the development of surgical techniques goes through a period of trial and error as reconstructive surgery did during World War I. Each improvement eventually becomes the root of future advancements allowing physicians to combine procedures such as a basic lid fat resection and chemical peels ensuring a speedy recovery.
Non-surgical alternatives
Non-surgical alternatives have shown improvement with patients exhibiting early indications of facial aging. Lasers, chemical peels, botulinum toxin, and dermal fillers are all used in some degree to treat periorbital tissue. Although effective, these treatments are not technically "blepharoplasty" and yet some practitioners refer to any treatment involving the eyes as such; often precededby "laser", "non-surgical" or "lunch-time". Botulinum toxin, it should be noted, is used to relax the muscles in the forehead and between the eyes, therefore not addressing most of the issues a patient seeking a blepharoplasty would want fixed.[citation needed]
In so called "non-surgical blepharoplasty" topical applications of acids and/or the use of lasers are used to tighten and decrease skin volume in the upper and lower eye lids. Injectable dermal fillers are also used to temporarily increase volume in the trough area between the lower eyelid and the cheek. These techniques are effective yet have not replaced surgical treatments, and should not be confused with blepharoplasty, which treats not only the superficial skin tissue, but also underlying connective and muscle tissues.
^ McCurdy JA Jr. "Upper blepharoplasty in the Asian patient: the 'double eyelid' operation." Facial Plast Surg Clin North Am. 2005 Feb;13(1):47-64. Review. PMID 15519927.
