Eyelid Surgery - Blepharoplasty

Aging is a complex dynamic process in the face that produces numerous structural changes.  The Plastic surgeon needs to understand and address these changes in each patient in order to produce a natural appearing youthful result tailored to each individual.

In the region of the eye, or what is termed the orbit, structural changes occur in the bone, fat, muscles, ligaments and skin.  In the youthful eye, the eyelid opening is long with graceful arcs. As we age, the eyelid opening becomes foreshortened and rounder, the eye sits farther back in the orbit, the lids may droop, fat may bulge, and the skin becomes redundant.  Each patient is different and each eyelid must be evaluated for what needs to be done to restore a youthful appearance.

Blepharoplasty is a global term meaning surgery of the eyelid.  Blepharoplasty can be performed on the upper eyelid alone, the lower eyelid alone, or on both eyelids together.  In the past blepharoplasty may have meant removing excess skin and fat leaving an operated appearance.  However, the modern blepahroplasty is designed to restore the youthful beauty of the eyelid.

Upper Eyelid Blepharoplasty:

The upper eyelid that may show signs of aging by a variety of means.  There may be shortening and rounding of the eyelid margin, excess skin may have developed, there may be bulging of the upper eyelid fat pads, and there may be redundancy of superficial eyelid muscle or sagging of the eyelid position.  Aging changes may also be associated with lowering of the eyebrows or in many patients, eyebrow lowering may cause the aging changes they see in the eyelids.  It is important to identify the problems if a youthful, natural, pleasing result is to be achieved.

The aging of the upper eyelid may even interfere with the peripheral vision. If this can be demonstrated medically, third party payers may even cover portions of the expenses for the procedure.

Upper eyelid blepharoplasty is performed either under intravenous sedation or local anesthetic depending upon the individual procedure necessary.  A curvilinear incision in the normal upper eyelid crease gives the surgeon access to the anatomical structures relevant to the procedure.  Some may be tightened, some may be repositioned, and others may be reduced in size or volume.  The excess skin is then tailored and the skin is closed with tiny sutures. Youthfulness of the lid is restored and a natural, graceful sweep to the eyelid is created. This procedure may be performed alone or it may be combined with other facial rejuvenation procedures to improve the youthfulness of the entire face.

Lower Eyelid Blepharoplasty:

The lower eyelid may show similar characteristic aging changes as the upper eyelid. There may be shortening and rounding of the eyelid margin, excess skin may have developed, there may be bulging of the lower eyelid fat pads, and there may be redundancy of superficial eyelid muscle or sagging of the eyelid position.  Many patients complain that these changes make them look sad or tired. 

Lower eyelid blepharoplasty is usually performed under intravenous sedation. Some patients may only need a hidden incision inside the eyelid while in others an incision just below the eyelashes is made. The procedure will improve the look of the lower eyelid by removing excess skin, tightening the muscle surrounding the lid, repositioning the outer part of the lid, and / or removing or repositioning excess fat. In many cases, the procedure can be performed in combination with a laser resurfacing to help eliminate wrinkles.

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