Blepharoplasty describes removing excess eyelid skin and/or muscle or repositioning eyelid soft tissues to restore a more refreshed, alert and rested appearance. Often upper eyelid skin drooping is at least partly accounted for by a drooping eyebrow. Lifting the eyebrows returns them to a more youthful position and decreases the appearance of tiredness or droopiness of the upper eyelid. An eyelid crease incision made during blepharoplasty or an endoscopic approach with small incisions hidden by the hairline may be used to elevate the eyebrows. Simply removing upper eyelid skin without repositioning the eyebrow may worsen the problem by pulling the brow further down.
The lower eyelids are often affected by bulging of the soft tissues, causing a lumpy appearance and altered contour. Lower eyelid blepharoplasty often involves repositioning the soft tissues with minimal removal of excess skin. Lower eyelid skin tone can often be improved with noninvasive treatments.
The cheek area, often referred to as the midface, can also sag or droop as the attachments to the facial bones lengthen with time. Tightening these connections lifts the cheek and restores a more youthful contour.
Blepharoplasty can be performed using a skin incision or an incision through the mucous membrane of the eyelid (the conjunctiva). If a skin incision is planned, precise measurements and skin markings are made prior to beginning the procedure. No surgical markings are needed for an incision made through the conjunctiva. Local anesthetic is then injected and the surgical site is washed with a sterile cleanser. A plastic contact lens may be placed on the eye for protection during surgery. Once the surgical site is anesthetized, the initial incision is made.
Upper Eyelid Blepharoplasty
In upper eyelid blepharoplasty, soft tissue removal is performed using a heated cautery needle or scissors depending on the tissue type and the surgeon’s preference. Pinpoint bleeding is controlled using cautery or a chemical clotting agent. Most surgeons recommend sutures (stitches) to close the operative site. In many cases the sutures used will dissolve over time, though occasionally removal is needed.
Lower Eyelid Blepharoplasty
Lower eyelid blepharoplasty often uses an incision made through the conjunctiva. The protruding, fatty tissue of the lower lid is removed or sculpted. Once tissue is removed or repositioned, stitches may be placed to close the operative site. If redundant skin is present, a thin strip just below the eyelashes may be excised.
At the completion of surgery, antibiotic ointment is typically applied over any incisions. Ice pack compresses are recommended for the first two days to limit swelling. Warm compresses are used thereafter to aid in resolution of bruising. Discomfort is usually minimal and controlled by over the counter medicines such as acetaminophen. Brief follow up postoperative appointments are generally made a week and two months after surgery, though additional visits may be requested if needed.