Blepharoplasty (eyelift) is a procedure designed to improve the appearance of the upper and lower eyelids. The appearance of our eyes and our expressions can significantly influence how we are perceived in day-to-day interactions. As we age the appearance of our eyes changes in a characteristic fashion producing a more tired and older appearance. These changes motivate patients to seek ways to restore their natural appearance.
Youthful appearing eyelids are rich in color with smooth tight skin. The lower eyelids and cheeks blend subtly into a harmonious unit. The shape of the eyelid is firm and youthful. Upper eyelids can differ greatly with ethnicity and gender. Depending on ethnic and genetic origins, an eyelid crease may or may not be present. Ethnic differences of the eyelids require an individual approach to planning eyelid surgery. Ideally, the corners of the eyelids are sculpted; eyelid function produces comfortable closure at rest, obstruction-free peripheral vision, and adequate tear function; eyebrows and eyelashes are healthy and abundant.
As we age, these details slowly fade. An aging appearance may be influenced by genetics and lifestyle factors such as: stress, alcohol, tobacco, sun exposure, environmental allergies, and trauma, Aging results in volume loss, skin and tendon laxity and loss of elasticity. The skin becomes thickened and discolored and eyebrows and lashes may become frail and scarce. Lower lids may become rounded (i.e.: puppy-dog eyes) resulting in poor tear function with dry, red, irritated eyes.
Rejuvenating the eyelids involves correcting lower lid bags, improving dark circles and puffiness under the eyes, and reducing a tired and hollow appearance. In addition, surgery of the upper eyelids corrects excess loose skin, occasionally severe enough to partially block vision. Removing bulging fat and excess skin reduces the appearance of puffy upper eyelids and makes the patient appear more alert.
The Blepharoplasty Procedure
The blepharoplasty procedure begins with a cosmetic evaluation followed by an eye exam performed by an ophthalmologist or a licensed optometrist. After a consultation with Dr. Rachel, patients understand what has produced the changes in their appearance that cause them to be dissatisfied.
Upper Eyelid Blepharoplasty
Most patients seek upper eyelid blepharoplasty to correct excess skin of their upper eyelid. The skin may fold onto the eyelashes and even interfere with vision. This is a minimally invasive surgery in most cases and can be done using local anesthetic alone or under IV sedation. An incision is made in the natural crease of the upper eyelid followed by the removal of excess skin and fat. Occasionally the underlying muscle has stretched out of shape and needs to be trimmed. Wounds are closed with a very fine suture, which can be removed in 5-7 days. Patients return to work the next day if they choose.
Lower Eyelid Blepharoplasty
Most patients seek lower eyelid blepharoplasty to correct baggy protrusions of the lower eyelids. Some patients also have excess skin that needs to be removed. This is a minimally invasive surgery in most cases and can be done using local anesthetic alone or under IV sedation. The surgery can be performed from within the lower eyelid so there are no visible scars (a transconjunctival blepharoplasty), or from the outside where the incision is placed in the crease just below the eyelashes where a scar will be camouflaged (a subciliary blepharoplasty). Fat can be removed subtly with a laser and while patients avoid vigorous activities for a week, wounds usually heal in a matter of days.
Canthal plication is performed for patients who complain of drooping of the corners of the eyelids or whose eyelids are rounded at the corners. This simple procedure is also minimally invasive and involves a short incision at the corners of the eyelids.
Surgical correction is specifically designed to target the problem areas. The “bags” can be improved by partially removing the fatty deposits. This can be performed without any external incisions. Removal of the loose skin and muscle and tightening of the eyelids require a concealed incision below the eyelashes in the lower eyelid and in the lid crease in the upper eyelid. Healing of the skin is usually quick and the stitches will either dissolve or be removed within a week. Following surgery, eye drops or lubrication may be needed for dry eyes and patients may experience a transient blurriness of their vision. The resulting scar may be visible if the eyes are closed. Often, patients can appreciate the improvement immediately and some will notice a relief from the heaviness that the extra skin was causing.
Eyelid surgery can be accompanied by other facial rejuvenation procedures such as facelift and forehead lift. Sometimes eyebrows sag to the point of pushing the upper eyelid onto the eyelashes and an eyebrow lift is necessary to correct this problem. Additionally, wrinkled eyelid skin can be treated with chemical peels or laser surgery.
These procedures are performed in our surgery center under local or twilight anesthesia.