Blepharoplasty is eyelid surgery used to restore or enhance the natural appearance and function of the eyelids. It is typically performed to lift droopy or sagging lids caused by changes related to age. The most common reason for blepharoplasty is to remove excess skin that hangs over the eyelashes and pushes the upper eyelids down, causing decreased peripheral vision and a feeling of heaviness in the eyelids. Blepharoplasty is typically performed to improve these symptoms and is usually covered by insurance. It can also be performed on the lower lids to decrease wrinkles and bags under the eyes. Both upper and lower lid blepharoplasty can also be performed for purely cosmetic reasons.
Ideal candidates for blepharoplasty are those who experience symptoms of decreased peripheral vision from sagging eyelids, feel heaviness in their lids that makes it difficult to keep the lids open, or whose brows become tired throughout the day due to using the forehead muscles to hold the eyelids open. As with any surgery, those in generally good health heal better and are the best candidates. Patients with ocular conditions such as dry eyes, glaucoma, corneal problems, or past retinal detachment may still be good candidates and should be evaluated by an oculoplastic surgery specialist if they desire blepharoplasty. Systemic issues such as diabetes, heart and lung disease, or smoking may affect the healing process and should be discussed prior to scheduling surgery.
Blepharoplasty is an outpatient procedure that is typically performed with local anesthetic with or without IV or oral sedation. General anesthesia (being put completely asleep with placement of a breathing tube) is not necessary. When IV sedation is used the procedure takes place in the operating room, however, some cases can be performed in the office with oral sedation or just local anesthetic. Either way, patients are kept comfortable throughout the procedure, which typically takes 30-45 minutes to complete both upper lids and approximately 1 hour for both lower lids.
Patients can expect some bruising and swelling to last 7-10 days following blepharoplasty. This can be minimized by use of ice packs and sleeping with the head elevated for the first few days after the procedure. Patients are asked to refrain from heavy lifting, bending with the head below the waist, and strenuous activity for the first 7 days, with gradual return to full activity by 2 weeks after surgery. During the first week, patients may shower or bathe but should keep the eyelids clean and dry, with the exception of any ointments or creams that may be prescribed at the time of surgery. Most patients feel well enough to drive and return to light-duty work a few days following the procedure.
Keeping yourself in good general health is the most important way to prepare for surgery. After discussion with your surgeon, may blood thinners such as aspirin, Eliquis, Plavix, Pradaxa, and Warfarin are stopped or held for several days prior to the procedure. This is typically done in conjunction with primary care providers or other physicians who prescribed these medications. When the procedure is performed with IV sedation patients are usually asked to fast beginning at midnight the night before surgery.
As with any surgical procedure, there are some risks for blepharoplasty. Thankfully, these risks are minimal and rarely occur. Any time there is a skin incision there is risk of infection and bleeding. We control these risks with sterile surgical technique, intra-operative cautery, and antibiotics. Other risks include dry eye from over-aggressive surgery or some residual sagging skin following the procedure. These risk are minimized by meticulous measurements and eyelid marking prior to surgery. Due to normal differences in anatomy there is a possibility for slight asymmetry of the lids following complete healing.
The most obvious benefit for most patients is improvement of peripheral vision and more light entering the eye. This is particularly helpful for those who already have difficulty in low-light settings. The heaviness of the lids is also typically relieved with blepharoplasty. There are cosmetic benefits as well, giving the face a more rejuvenated look.
It is uncommon to experience pain during the procedure, but there is typically some discomfort for the first few days after its completion. Pain pills are usually prescribed for the first few days after surgery, but patients often only need a few doses before switching to over-the-counter medications. Ice packs will also help decrease discomfort.
Yes, however, because the skin on the eyelids is very thin, it typically heals with minimal scarring. Incisions in the upper eyelids are placed in the eyelid crease and tucked into the natural smile lines of the face to decrease visibility of scars, especially when the eyes are opened. Incisions in the lower lids are usually placed just below the eyelashes. These also heal very well.
Asian eyelids do not have a crease, or a very low crease, compared to Western lids. Asian blepharoplasty seeks to preserve this look. If desired, a Western-style eyelid crease can be created during surgery.