Blepharoplasty Procedure

Eyelid surgery (called blepharoplasty) is procedure to remove fat–usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and that could even be interfering with your vision.

eyelid-blepharoplastyEyelid surgery won’t remove crow’s feet, however, or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows.  Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift.

If you’re considering eyelid surgery (blepharoplasty), this information will give you a basic understanding of the procedure and when it can help, how it’s performed, and what results you can expect. It can’t answer all of your questions, since a lot depends on the individual patient and the surgeon.

Frequently Asked Questions (FAQs)

1. Am I a good candidate for this eyelid surgery?

Blepharoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with the surgeon.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

Few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves’ disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your opthamologist before you have surgery.

2. Are there risks involved?

When (upper or lower) eyelid surgery is performed by a qualified and highly experienced cosmetic surgeon, generally complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anaesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

Please find below associated risks and complications associated with the Blepharoplasty procedure.

(a) Insufficient skin removal

While blepharoplasty undercorrection is always preferable to overcorrection, an objectionable amount of undercorrection may call for a “touch-up” operation.

Be aware that what sometimes appears to be an undercorrection may, in fact, represent a basic and inherent limitation of blepharoplasty surgery in that particular patient. For instance, mild hooding of upper eyelid skin on the side closest the temple may be secondary to a mild downward droop of a patient’s eyebrow.

Likewise, skin excess in the medial canthus towards the nose may be more related more to a patient’s forehead droop than an under aggressive blepharoplasty.

Remember two things: (1) blepharoplasty is an operation on the eyelids alone and can accomplish only so much for the face, and (2) attempting to leave eyelid skin “bone tight” in either the upper or lower eyelids is courting disaster.

(b) Excessive skin removal

Excessive removal of upper eyelid skin may interfere with proper closure of the eyelids (“lagophthalmos“) during blinking or especially when sleeping. Extreme shortage may distort the eyelid margin and create a widening of the palpebral fissure (opening between the eyelids) that is both cosmetically and functionally objectionable (“eyelid retraction“).

Excessive removal of lower eyelid skin may cause the eyelid margin to pull away from the eye surface (“ectropion“). When mild, the main symptom may be overflow tearing due to the pulling away of the tear drain opening from the surface of the eye (“punctal eversion“).

If more severe, the entire lid may be pulled downward. Problems resulting from skin overcorrection are annoying at best and dangerous at worst; almost all such complications require surgical intervention.

(c) Insufficient fat removal

When insufficient fat removal creates a noticeable or asymmetric blemish, further removal may be indicated.

(d) Excessive fat removal

Fat removal from the upper eyelid may create a lid crease that appears too high and deep (“superior sulcus defect“). Fat removal in the lower eyelids may create a hollowed-out appearance (“inferior sulcus defect“). Hollowness may develop either immediately or years after surgery.

(e) Excessive muscle removal

Aggressive removal of orbicularis muscle from the upper eyelid may hollow the superior sulcus and in the lower eyelid may lead to weakened eyelid closure and support.

(f) Excessive internal scarring

Internal scarring (“fibrosis”) or shrinkage of the internal eyelid layers below the skin may cause distortion, limitation of movement, and retraction. Massage may help in mild cases, but surgery may be needed to improve appearance and function.

(g) Excessive external scarring

Visible scarring on the skin may be aggravated by poor healing in damaged or sensitive skin, suboptimal placement of incisions (too high in the upper eyelid; too low in the lower eyelid), delayed suture removal, prolonged fragility with laser incisions, failure to follow postoperative instructions, and other factors.

(h) Inappropriate crease

An upper crease placed too high tends to “feminize” the male eyelid. An overly high or arched upper crease in an Asian eyelid may “round the eye” and make it appear inconsistent with the rest of the face. Excessive upper skin removal and/or failure to fixate the crease during suture closure may allow the final scar to migrate higher and be visible.

(i) Rounding at the lateral commissure

Rounding of the acute angle where the outer upper and eyelids come together may be caused by excess skin and/or muscle resection or a result of canthoplasty – canthopexy. If subtle, the deformity is best ignored; if more noticeable, surgical revision may be undertaken.

(j) Drooping upper eyelid

Blepharoplasty may “unveil” a pre-existing but unrecognized drooping upper eyelid (that is, not a baggy lid but one that rides too low), a condition known as “ptosis“. Less commonly, injury to the levator muscle and tendon (aponeurosis) may cause ptosis to appear in a previously healthy levator system.

Mild ptosis after blepharoplasty is not rare and may persist for several weeks to months. If the condition does not resolve with time, exploratory surgery may be indicated.

(k) Swelling on the eyeball surface

Collection of post-surgical inflammatory fluid (edema) or temporary disruption of lymphatic drainage (chemosis) may cause swelling on the eye surface that is uncomforabe and cosmetically frustrating. It is not rare and has been reported in over 10% of patients undergoing skin-incision lower blepharoplasty.

Nearly all cases resolve within three weeks to three months. Chronic chemosis persisting six months or more may occur rarely and is of unknown cause. Lubrication, medicated eye drops, patching, and passing time are generally curative.

(l) Injury to the lacrimal system

If the main tear-producing gland is injured, prolonged swelling in the outer portion of upper eyelid may persist for several weeks. No additional surgery is required. Injury to the drainage canal (“canalicular laceration”) is rare but requires immediate repair by an oculoplastic surgeon.

(m) Double vision

If the muscles that move the eyeball are injured or scarring occurs in the fat surrounding the eye muscles, temporary or permanent double vision may result. The most vulnerable muscles are the superior and inferior oblique muscles and the inferior rectus muscle, all of which course within or near the fat of the eyelids.

Attempt at correction of any resulting double vision (“diplopia”) may require the services of an ophthalmologist specializing in eye muscle surgery (“strabismus surgery specialist”)

(n) Complications of anesthesia

While hardly unique to cosmetic eyelid surgery, complications may occur from the anesthesia alone, including severe allergic reactions, blood pressure fluctuations, and serious heart and breathing difficulties. Such problems are more common with the administration of intravenous and/or inhaled anesthetic agents than with local anesthesia using oral sedation.

(o) Unrealistic expectations

If you are expecting “perfection” from your surgery, you should be warned upfront that you are all but certain to be disappointed. It is important, therefore, to understand exactly what you should and should NOT anticipate from any given cosmetic eyelid surgery.

If your expectations are inappropriate or inflated because of your lack of preparation or your surgeon’s lack of explanation, no matter how wonderful the result may be from an objective point of view, you will not be satisfied. Put bluntly, perfection is never attained because no surgeon is perfect, no wound will heal perfectly, and most patients possess some anatomic limitations. If you can’t accept this concept, you should not undergo cosmetic surgery.

(p) Patient indecision

Some patients (generally, those inordinately afraid of being overcorrected) make a definite point of requesting a conservative approach (“I just want to look a little bit better”) only to be disappointed by the expected undercorrection. This is not the fault of the surgery or the surgeon. While more surgery can be undertaken, such patients should be fully prepared to pay for the second operation.

(q) Poor aesthetic choice

Not often mentioned in lists of blepharoplasty “complications” is the matter of inappropriate selection of procedure or poor aesthetic judgment on the part of the surgeon resulting in “technical” success but cosmetic “failure”. For instance, if what you really need is an upper eyelid blepharoplasty but what you have done instead is a forehead lift, even though you may not experience any true medical “complication”, you may still be very unhappy about the way you look.

As with unrealistic expectations noted above, the best (and only) approach is avoidance. Be sure that you and your surgeon understand and agree upon exactly what you are getting yourself into.

Late complications:

Most problems from surgery are apparent in the immediate post-operative period, but there are two notable exceptions:

(a) As aging progresses, some people (not the majority) naturally “absorb” a substantial amount of the fat from inside of their eye sockets. If fat removal or manipulation has been undertaken in such patients at an earlier age, the orbit may come to look hollow as the years pass. Predicting which patients will be most prone to this outcome is difficult. Thus, conservative or no removal and minimal manipulation of eyelid fat are prudent preventatives.

(b) A skin approach (transcutaneous approach) to the deeper structures of the lower eyelid undertaken for any reason (e.g., blepharoplasty, midface lift, fat transfer, etc.) may cause increased internal scarring during healing. Over years, the stress from such tightening may promote stretching of the eyelid support system and the eventual development of noticeable eyelid retraction (as noted earlier). The minimally-invasive transconjunctival approach to the lower eyelid is much less likely to lead to late problems.

3. What is the duration of the procedure?

Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you’re having all four eyelids done, the surgeon will probably work on the upper lids first, then the lower ones.

In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow’s feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

If you have a pocket of fat beneath your lower eyelids but don’t need to have any skin removed, your surgeon may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.

front-blepharoplasty

Patient has excess skin in the upper lids. Upper eyelid blepharoplasty was performed under local anaesthesia in room. Photos presented reflect the eyes pre surgery and 2 weeks following surgery.

Surgeon: Dr Jorge Lopez

4. What happens after the surgery?

After surgery, our surgeon will probably lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anaesthesia wears off, but you can control any discomfort with the pain medication prescribed post surgery. If you feel any severe pain, call your surgeon immediately.

The surgeon will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.)

You’ll be shown how to clean your eyes, which may be gummy for a week or so. Many doctors recommend eyedrops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

The surgeon will follow your progress very closely for the first week or two. The stitches will be removed two days to a week after surgery. Once they’re out, the swelling and discoloration around your eyes will gradually subside, and you’ll start to look and feel much better.

5. When do I get back to normal?

You should be able to read or watch television after two or three days. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing and doctor’s instructions, you’ll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

6. What will be my new look?

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line. On the other hand, the positive results of your eyelid surgery is a more alert and youthful look that will last for years. For many people, these results are permanent.

7. How much does eyelid surgery cost?

Surgeon’s Fee: Bilateral Upper Eyelid Surgery: Approximate: $4,400 ( excluding GST)(Medicare rebates may apply)

Surgeon’s Fee: Lower Eyelid Surgery: Approximate: $5,500 to $6,000 ( excluding GST)

Additional fees will include theatre bed fee, anaesthetist fee if the procedure is performed under general anaesthesia. If the procedure is performed in rooms under local anaesthesia, a minor operating facility fee of $550 will apply.

 

Please keep in mind not all patients are alike and some will require a slightly different operation than others. Rest assured, you will receive a specific price quotation during your consultation visit. Our staff are always happy to discuss these matters with you in more detail.

The Esteem Cosmetic Studio website provides general information about cosmetic surgery. General information is not a substitute for professional medical advice and treatment, and should not be accepted in place or in preference to a consultation with a surgeon.

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