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What is blepharoplasty? | Why should blepharoplasty be done? | Contraindications | Pre-surgery | Post-surgery | Risks | Insurance

What is blepharoplasty?

Blepharoplasty is eyelid surgery where excess fat along with skin and muscle are removed from the upper and lower eyelids. It is the second most common aesthetic procedure people have performed. As people age, their eyelid skin stretches, their skin becomes less elastic, and their muscles weaken and stretch, causing droopy eyelids. Heredity, skin abuse, and overexposure to the sun cause this condition to occur more rapidly. In many people, fat accumulates around the eyes in one of five pockets. As we age, the skin and subcutaneous tissue become weak and let the fat pads sag forward causing "bags."

Some people get droopy eyelids at a much younger age than normal because they have puffy eyelids caused by allergies or water retention. Excess skin of the upper eyelids can interfere with vision. It can also make a person's eyelashes turn in and irritate the eye.

Blepharoplasty is often the first cosmetic surgery a person has and is a very popular surgery with men. It brightens the face and restores a person's youthful appearance. However, it won't remove crow's feet or other wrinkles, nor will it eliminate dark circles under the eyes or lift sagging eyebrows. If there is excessive skin on the upper eyelids that droops down and blocks a person's peripheral vision, he or she will be able to see better after surgery.

Why should blepharoplasty be done?

Extra skin in the eyelids can make it hard for a person to keep his or her eyes open. It can give people a sleepy, disinterested appearance and make them look tired, or even angry. Droopy eyelids can also interfere with vision. People with droopy eyelids may constantly raise their eyebrows to try to get greater field of vision. This makes them work their eyebrow and forehead muscles hard, which can cause brow aches and fatigue. Blepharoplasty can improve vision.

Contraindications

There are certain medical conditions that increase the risk for blepharoplasty surgery. These include thyroid diseases such as hypothyroidism and Graves' disease, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes.

Blepharoplasty can present a problem for people who have insufficient tears to keep their eyes lubricated, and for people who suffer from a detached retina or glaucoma.

Pre-surgery

During the initial consultation, the doctor will take a complete medical history. Patients should be prepared to describe any allergies they have. In addition, they will be asked what vitamins, medications (prescription or over-the-counter), and other drugs they take.

The doctor will photograph the patient and test his or her vision and rate of tear production. These tests are required by insurance companies to determine if blepharoplasty is medically necessary.

Other topics that will be discussed include goals and expectations of surgery, how many lids will be done, how much fat and skin will be removed, surgical techniques, and anesthesia.

The patient will be given instructions concerning eating and drinking habits, smoking, and the medications and vitamins they take. These instructions should be followed carefully in the days and weeks before surgery.

Procedure

Blepharoplasty is performed on an outpatient basis. Generally a local anesthetic is used along with sedation to relax the patient. The surgery takes from one to three hours depending on the number of lids being done.

Incisions are made in the creases of skin so they aren't very noticeable. In the upper lid, the incision is made in the crease of the eyelid. In the lower lid, the incision is made just below the lash line. The surgeon will separate the skin from underlying fatty tissue and muscle. Then he will remove excess fat and trim sagging skin and muscle. The surgeon may also operate on muscles that control the eyelids to make them function properly. Finally, he will close the incision with fine sutures.

If fat, but not skin, is to be removed from below the lower eyelids, the surgeon may perform a transconjunctial blepharoplasty. The incision is made on the inside of lower eyelid. There is no visible scar. This procedure is usually performed on younger patients with thicker, more elastic skin.

Post surgery

After surgery, patients can expect swelling and discomfort for a few days. They may also experience bruising or black eyes that can last from two to four weeks.

The patient will be told to keep his or her head elevated for several days. Quiet rest with an elevated head relieves soreness and discomfort.

Patients can apply cold compresses to their face to reduce swelling and bruising. Some patients experience temporary blurred vision and excessive tearing. These symptoms are usually the result of the ointments applied after surgery. In addition, some patients have a temporary problem closing their eyelids. Scars will be thin red lines that disappear over time.

Patients won't be able to wear contacts for at least two weeks, and even then the lenses may be uncomfortable. Usually the patient can go back to work in about ten days. However, patients will be sensitive to sunlight, wind, and other irritants for several weeks and will need to wear sunglasses and a special sun block.

Patients should keep their activities to a minimum for three to five days. In addition, they should avoid strenuous activities for three weeks, especially anything that could raise blood pressure such as bending, lifting, or rigorous sports. Finally, they should avoid alcohol, which can cause fluid retention.

Results

Results of blepharoplasty are generally good. The final outcome depends on the extent of the reconstructive work, the patient's skin structure, and the healing process.

Risks

Risks associated with blepharoplasty surgery are usually minor. As with most surgery, there is always a chance of infection or a reaction to the anesthesia.

Minor complications include double or blurred vision for a few days, temporary swelling at corner of the eyelids, or a slight asymmetry in healing. Other possible complications include hemorrhaging, infection, and occasionally blindness.

Rare complications include difficulty in closing the eyes when sleeping or development of ectropic eyelids, which is the pulling down of the lower eyelids. If this occurs, the patient will need corrective surgery.

Insurance

Insurance coverage depends on the type of insurance and level of coverage the patient has. In general, insurance doesn't usually cover cosmetic surgery. However, if droopy eyelids are interfering with the field of vision, it may be considered medically necessary and will be paid for by insurance.