Eyelid Surgery (Blepharoplasty)

Blepharoplasty

Eyelid surgery or “blepharoplasty” is a method of restoring a more youthful appearance to the eyes. The eyes themselves are seen as the most expressive feature of the face and often function to transmit our inner feelings. Blepharoplasty procedures correct wrinkles, puffy bags, and heaviness of the lids leaving patients with more open eyes and a youthful, and energized look.

The process of natural aging causes changes in the eyes that can make a person look tired or worn-out. Heavily wrinkled eye skin may simply be a result of natural aging or it may run in your family. In cases were there is a familial tendency to heavy baggy eyes, these changes may occur in you long before your piers leaving you very uncomfortable at the discordance between your inner feeling and outward appearance.

These procedures are not designed to treat a dropped position of the eyebrow or wrinkles in the forehead or between the eyebrows. These changes are best treated by a brow (or forehead) lift. The use of Botox┬« for wrinkles between the eyebrows may also be very helpful. Elimination of crow’s feet at the sides of the eye may be best treated by Botox┬« or by a non-mechanical skin resurfacing method (laser or chemical peel). Dark pigment below the eyes can be treated with laser, chemical peels or bleaching agents. Rejuvenation procedures in these areas are addressed in detail in other sections.

It is possible to combine blepharoplasty surgery with brow lifts and/or facelift procedures but they are not part of the same surgical procedure, and are not described in this section.

AGE-RELATED EYE CHANGES

Please inform your surgeon if you are under the care of an optometrist or an ophthalmologist. Patients with corrective lenses, contacts, dry eyes should always identify themselves to the surgeon as this may change your candidacy for or approach to surgery.

PREPARATION

Patients with dry eyes should identify this point to their surgeon. Eyelid tone and its ability to recoil against the eye may be a cause of dry eye. If this is the case, your surgeon may decide to Your surgeon will likely ask you to avoid make-up and alcohol consumption for 48 hours prior to surgery.

THE PROCEDURE

Blepharoplasty surgery is usually a one to two hour outpatient procedure performed under local anesthesia (with our without sedation) or under general anesthesia when in combination with other procedures.

Blepharoplasty involves removing fat, muscle and skin from the upper lids, lower lids or both. Your surgeon marks your eyelid creases and incisions are made in the natural creases of your upper lids or just below the eyelash line in the lower lids. Soft curved arches incisions then extend into the lateral crow’s feet of the outer eye. The surgical area is anesthetized and small strips of skin and muscle are removed to allow access to the deeper fat compartments. Selective removal of only excess fat allow of a rejuvenated and avoid a hollowed out eye appearance. Fat may also be redistributed to reduce the appearance of puffiness and bags while avoiding a hollowed-out look to the eye. In the lower lids, skin is separated from the underling structures; redundant skin and muscle are identified and removed. If the lower eyelid is very loose and easily falls away from the eye, your surgeon may perform a tightening (or Canthopexy) procedure to correct the laxity in the eyelid. Incisions are then closed with very fine sutures that often require removal in 3-5 days.

In some cases of isolated puffy lower lids, no skin removal may be required and a ‘transconjunctival’ blepharoplasty may be performed. This technique uses incisions hidden on the inside of the lower eyelid to remove problematic fat. As this modified procedure does not leave visible scars, it is often requested but may not be appropriate in your case, as it cannot remove the skin excess that may be required to reach your aesthetic goal.

In almost every case, the eyelid incisions fade over months to the point of near imperceptibility.

THE RECOVERY

Recovery after cosmetic surgery is a big concern to all patients. The standard convalescence following blepharoplasty surgery is approximately 2-3 weeks. At that time most patients resume all normal activity.

Pain after the operation is usually quite minimal. Most patients require only over-the-counter medications or are comfortable without pain medication within days of the procedure. Discuss all medications you are on or plan to take with your surgeon. You should only take medications prescribed by your surgeon. Swelling and some bruising around the eyes are common during the first 4-7 days after the operation. The use of cool cloths or gel pack compresses immediately after the operation can reduce some of the initial swelling but should be discussed with your surgeon. Sleeping in a semi-inclined position (with 2-3 pillows) will reduce the collection of fluid around the eyes and reduce swelling. Initial swelling may partly shut the eyes or limit your ability to move your eyelids properly. If you are unable to shut your eyes completely in the first few days after the procedure, lubricating drops or nighttime ointments may be recommended to avoid irritation of the eye and other associated problems. In some cases watering of the eye during the first 2-3 weeks can be seen. Exercise, stress, alcohol and head-down positions will increase swelling and bruising around the eyes. Remember that this is a normal part of recovery and often disappears within the first 2 weeks of the procedure. Make-up may be used to hide these changes during the early recovery phase.

As with any surgical procedure, patients should plan to rest for the first few days.

COMPLICATIONS

A discussion of potential complications is essential with every discussion about a surgical procedure. It is important to know that although complications from blepharoplasty surgery are possible they are not common. Some possible complications associated with a blepharoplasty are listed into both early and late complications:

EARLY

LATE

  • Bleeding
  • Hematoma (blood collection)
  • Infection
  • Double vision (temporary)
  • Inability to close lids (temporary)
  • Visual loss (extremely rare)
  • Dry eye
  • Asymmetry (between sides)
  • Excessive tearing
  • Hollowed look (over resection)
  • Hyperpigmented scars (lower lid)

High blood pressure, diabetes, or thyroid problems my increase your risk of complications during these procedures. For a more detailed discussion on expected results, recovery, and specific complications, please see your individual surgeon.

COST

Upper eyelid correction (Blepharoplasty) may be covered under the Canadian Health Care Plan if your upper eyelid skin significantly obstructs your vision. Please see your doctor or ophthalmologist to see if this is the case. A certified letter of the degree of visual obstruction is required by provincial Medical Services Plans prior to their approval for coverage of this procedure. The final decision on coverage will be made by your plastic surgeon as all plastic surgeons do not performed health care plan covered procedures. In many cases, surgery on the eyelids is not covered and the final cost for such procedures will be at the discretion of the plastic surgeon performing the procedure. The average cost of this procedure, published by the Canadian Society of Aesthetic (Cosmetic) Plastic Surgery (CASPS) is $5000 (for both upper and lower lids).

IS THIS REALLY FOR ME?

Blepharoplasty surgery is one of the most successful cosmetic surgical procedures with a very high patient satisfaction rate. In isolation or combined with a brow lift, this procedure opens the eye shadow space and has one of the greatest rejuvenating effects of all facial plastic surgical procedures. Remember, that the initial rejuvenation changes are not permanent as the surgery reverses but does not stop the aging process.

DISCLAIMER

This website does not cover all of the medical knowledge related to eye lid surgery (Blepharoplasty) nor does it deal with all possible risks and complications of surgery on the eyelids and associated structures. Although it is designed to provide the patient with greater depth of information in some areas, it is not intended to substitute for the in depth discussion between patient and surgeon that must occur prior to any surgical procedure. For a more detailed discussion on expected results, recovery, and specific complications, please see your plastic surgeon.