Eyelid surgery, or blepharoplasty, is an operation that corrects drooping eyelids as well as the bags and bulges. These conditions develop as a result of laxity of the eyelid skin and protrusion of fat around the eyes. It is not limited to older patients, as many individuals inherit a predisposition toward development of fat pouches at an early age.
Surgical correction is appropriate for all age groups. In some cases, the condition will be caused by other medical problems such as allergy or thyroid disorders. In these patients, the proper treatment may be medical rather than surgical.
WHEN SHOULD SURGERY BE DONE?
The age range for eyelid surgery is wide because of the various factors that predispose to the condition. Younger patients who have surgery usually have it because of an inherited condition in which the fat deposits push against muscle wall of the eye resulting in early bulging. Older patients generally seek surgery because of sagging of the eyelid skin as well as the bulging of fat. Often these patients choose to have eyelid surgery when they elect to have a facelift. In some cases, patients seek surgery because their drooping eyelids interfere with their vision.
Although more women elect to have eyelid surgery, the operation is equally suitable for both sexes.
HOW IS THE OPERATION DONE?
Dr. Tobin begins the operation by making hidden incisions in the upper and lower eyelids with the surgical laser. Use of the laser has had a profound effect upon blepharoplasty surgery. It allows the surgery to be carried out in a bloodless fashion with greater precision. Post operative bruising and swelling is diminished. The location of the incisions, coupled with the excellent healing ability of the eyelid skin, almost always results in scars that are difficult, if not impossible, to see with the passage of time. Through these incisions excess skin, fat or muscle is removed depending on the individual problem. The use of the surgical laser has helped to minimize postoperative swelling and bruising. Following completion of the surgery, the incisions in the upper eyelid are closed with very fine absorbable suture.
In certain cases, where the lower eyelid is very lax, additional work may be required to tighten the lid to prevent postoperative drooping.
TRANSCONJUNCTIVAL BLEPHAROPLASTY
When the problem in the lower lid is primarily the bulging of fat, without excess skin, the lower lid blepharoplasty is conveniently carried out through a laser incision made inside the lower eyelid, thus eliminating all visible scarring. This procedure, called the transconjunctival blepharoplasty, has gained popularity because it minimizes the risk of pulling on the lower lid, a complication discussed below. Most of our lower lid blepharoplasties are now performed with this technique. The transconjunctival approach is often combined with laser resurfacing of the lower eyelid skin. This helps to decrease the fine lines in the lower eyelid skin. (Deeper expressive lines in these areas are treated with Botox®, which is discussed elsewhere in this booklet.)
POSTOPERATIVE COURSE
Patients can apply iced compresses during the day of surgery to minimize swelling. No other dressings are required. Sutures are absorbable and require no removal. Make-up can be worn within three days of surgery except where the laser has been applied to the skin. Most patients can return to near normal activity within a very few days of their surgery. Bruising, coupled with some swelling, often persists for several days beyond that time, but is easily camouflaged by make-up or sunglasses. When laser resurfacing is combined with the blepharoplasty, the skin beneath the eye will be raw for several days and pink for even longer (see chapter on skin resurfacing).
Discomfort is usually relatively mild after blepharoplasty although, this will vary. Most patients require little or no pain medication. Some minor irritation of the eyes is common and may occur for several days after the operation. Close adherence to your postoperative instructions will greatly diminish the discomfort, swelling and bruising that you will have after your surgery.
RISKS OF THE OPERATION
Complications can occur with any operation, and blepharoplasty is no exception. Serious complications are most unusual and those that occur can usually be corrected. Since there is variation in the scar contracture following this operation, wise and conscientious surgeons are always careful in removing lower eyelid skin. The transconjunctival approach minimizes the risk of a complication called ectropion – in which the lower lid is pulled down and outward. This risk is also minimized by very conservative removal of lower eyelid skin, when indicated. Additional risks include bleeding, postoperative dryness of the eye, visible scaring, and, in very rare cases, visual loss.
Patients who are subject to dryness of the eyes should notify us of this problem. Blepharoplasty can exacerbate this problem, and precautions should be taken to keep the eyes moist after surgery. On the other hand, there are cases where blepharoplasty helps to reduce dry eyes. When needed, drops or ointments can be used, and patients can cover the eyes with Saranwrap® at night.
RESULTS OF SURGERY
Most patients can anticipate a marked improvement in the appearance of the eyes. They have a fresher, more wide-open appearance. This is often coupled by a similar feeling of lightness in the eyelids. Bags and pouches are significantly reduced if not completely eliminated. Some patients actually experience an improvement in their eyesight or peripheral vision as a result of removal of skin that was hanging over the pupil and obstructing vision.
Lines and fine “crow’s feet” about the eyes are diminished but not eliminated by the operation when combined with laser resurfacing. Sometimes a second laser skin resurfacing treatment can be of great value.