The eye region is the first part of the face to show signs of aging. The skin around the eyes loses its elasticity, and the muscles become loose. Folds of excess skin develop on the upper eyelids which become hollow and creases under the lower lids deepen. As the muscles become weaker the fat, which cushions the eyes in their sockets, protrudes forward to give the appearance of bagginess. Some people have an inherited tendency for bags to develop during early adulthood before other signs of aging appear. In extreme cases enlarged puffy bags of skin in the lower lids, known as festoons, can develop. All of these changes can make the face look tired, sad and older than it actually is. In some instances, excess drooping eyelid skin can even impair vision. The patient tries to counter this by lifting the eyebrows which can lead to chronic headaches. Ageing process on the skin is apparent earlier in the eyelids than elsewhere. In thirties, tiny wrinkles on the eyelids and creases radiating from the corner of the eye (crow’s feet) develop.
Blepharoplasty is a surgical procedure designed to rejuvenate sagging, puffy or tired looking eyes and restore youthful volume and smooth contours. To avoid unnatural hollow look a modern eyelid surgery, reverses the aging structural changes of the eye region. We reposition the fat, retain and resuspend the muscles, and remove excess drooping skin. After properly planned and meticulously executed blepharoplasty, the eyes should not look unusual, surprised or different but rather bright, youthful and rested. Correction of the eyelids may be performed for aesthetic reasons or to improve sight by lifting the eyelids out of field of vision. To reduce tiny wrinkles under the eyes and in the crow’s feet region blepharoplasty can be combined with skin resurfacing. Injections of botulinum toxin may be necessary to maintain reduction of crow’s feet after the procedure.
Both upper and lower eyelid surgery can be carried out under local anesthesia as an outpatient procedure. However if, the patient prefers it can also be done under sedation or general anesthesia. The incision is made in the natural crease of the upper eyelid and just below the lashes in the lower lids. The skin is lifted from the underlying structures, and redundant fat or muscle is repositioned or removed. If necessary the fat compartments of the lower eyelid are repositioned over the orbital rim, to correct the hollowness under the eyes. The edge of the lower eyelid can be stretched by placing a stitch in the corner of the eye (cantopexy). This prevents the eyelid from dropping after surgery. Excess skin is trimmed without tension and incisions are sutured neatly. If only fat is being removed from the lower eyelids, it can be done from the inside of the lower eyelid avoiding an external excision (transconjunctival blepharoplasty).
The pain after the procedure is minimal and healing very rapid. The sutures are removed after 4-5 days. Also, there is some bruising patients are able to return to normal activity within one week. The closure of the eyes in the first few days after surgery appears tighter until the swelling disappears. To reduce swelling it is best to keep the head elevated for a few days and apply cold compresses. Blepharoplasty incisions tend to heal very well with good scars, which are barely noticeable after a few months.
Complications are infrequent and usually minor. A blood can collect under the skin after the operation (haematoma). It usually disappears spontaneously in a couple of weeks, but if large it may need to be drained. Sometimes tiny white cysts can appear along the stitch line and can be removed with a needle. Bacterial infection with redness, swelling and tenderness is very rare and treated with antibiotics. Overcorrection or uneven appearance may be corrected by another operation. Sagging of the lower eyelid (ectropion) can be prevented with meticulous surgical planning.
Correction of the eyelids can be done as a separate procedure or in combination with any other procedure for facial rejuvenation. Frequently patients come for an upper eyelid surgery unaware that their heavy eyelids are due to excess skin on the forehead and brow or forehead lift is the proper procedure to address their problems. Complimentary Non-Surgical Procedures are very commonly added to a blepharoplasty to increase its effect. Soft tissue fillers may be used in combination with blepharoplasty but not instead of it. Fillers are good to temporarily camouflage the crease between the lower eyelid and cheek region, but they do not correct the lower eyelid puffiness or redundant or wrinkled skin. This crease disappears when lower eyelid fat pockets are repositioned.