Blepharoplasty - Eyelid Surgery by Jan Stanek at Surgical Aesthetics

Whether a face looks fresh and young is partly determined by eyelids.  If they become saggy, wrinkled and puffy, the overall impression is that of a tired and aged person. Ageing also makes eyes look smaller.  Blepharoplasty is the name for an operation that reshapes eyelids, by removing redundant skin, some wrinkles and puffiness.  It also returns to the upper eyelid its natural fold, which may have been obscured by redundant skin.

The surgery is usually carried out under general anaesthesia, although it may be done under local anaesthesia and sedation.  There is no need to stay in hospital overnight, and the majority of patients leave hospital the same day.  It is a painless operation but rest is required for several days and bruising will persist for 10 to 14 days.

For upper eyelids the surgeon makes an incision in the natural crease or, if it is absent or asymmetrical, he will make a new one, and excise any excess skin and fat that may have accumulated.  The scar is usually barely perceptible when mature.

In the lower eyelids there are two options.  In the standard lower blepharoplasty skin is incised a few millimetres below the eyelashes and is either lifted alone or together with the underlying muscle, and the excess fat is then removed through the same incision.  Finally, the skin is re-draped, and any excess removed.  It is often not understood that standard blepharoplasty cannot remove fine lines, especially crow’s feet.  This can lead to dissatisfaction in the presence of an otherwise good result.

To deal with the problem of eyelid wrinkles, laser and chemical peeling have assumed a greater role in eyelid surgery.  In the transconjunctival approach, fat can be removed through an incision inside the eyelid without causing visible scarring and loose skin and wrinkles are treated with laser resurfacing or chemical peeling.  In selected patients, this combination appears to yield better results than previously possible with conventional surgery.  The only problem with this technique is that the lasered skin takes 8-10 days to heal, and the redness may take 6-8 weeks or longer to settle.  The final result however, can be superior because the laser removes lines that are outside the scope of conventional surgery, such as crow’s feet, and there is no scarring at all. It is recommended that Botulinum injections are used post-operatively to immobilise the muscle causing crow’s feet for a year or so.

Eyelid Surgery: Possible Complications

Eyelid surgery is very safe, but complications may occur as in other surgical procedures.  However, all are very uncommon.

  1. Infection: This is very unusual even in the form of conjunctivitis, because the eye is protected with an antibiotic cream.

  2. Bleeding: Patients who have high blood pressure may be prone to this complication, if not under control. If severe, it may necessitate taking the patient back to the operating theatre to stop the bleeding.

  3. Scar: Although eyelid scars are the best one can have, some may not be satisfactory, and may need to be revised at a later stage. Laser eyelid surgery leads to no visible scars, and for those who worry about scar visibility, this may be a better option. It is extremely unusual for scars to become hypertrophic or keloid.

  4. Ectropion (drooping eyelid): This is usually caused by the removal of too much skin. In some cases, particularly if the eyelids are slack, it may be a temporary complication, which usually corrects itself, but it may require taping during the early stages of healing, injection of steroids or even further surgery.

  5. Dry eye: Some patients develop this problem, either temporarily or permanently, which is due to reduced lubrication of the eyeball by tears. It presents itself with a gritty feeling, crusting of the eyes in the morning, and sensitivity to light. Treatment with artificial tears usually corrects the problem. Long term contact lens users maybe more prone to it and those who have incipient dryness.

  6. Blindness: This frightful complication has been reported, and is caused by bleeding behind the eyeball, where it compresses the artery to the retina. Proper and expert management of this complication should lead to complete recovery.

  7. Asymmetry: All eyelids are asymmetrical and it is impossible to make them completely symmetrical.

  8. Persistent swelling: Some patients are prone to prolonged swelling which may take a long time to resolve. In rare cases this swelling may persist indefinitely

  9. Thread veins: It has been noticed that blood vessels in the lower lids become more visible in the first 3 months after surgery. Some of them may even be permanently enlarged. If this is a problem, it can be treated by laser but thread veins tend to recur and appear as a natural process of aging

It is essential to have a consultation with a surgeon who can discuss the pros and cons of the surgery in order to decide whether to continue with the surgery or not.

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