Blepharoplasty (Eyelid Lifts)
In the past year, blepharoplasty has risen to among the top five plastic surgery procedures performed on both men and women in the United States. In fact, over 175,000 cases were performed in the United States alone. The operation addresses both problems of aging around the eyelids and younger patients who have dark circles or puffy eyelids, which are usually inherited.
Blepharoplasty overview by John E. Sherman, MD, FACS
There are several options of the procedure available. The choice depends on the age of the patient, the amount of fat in the upper and lower eyelids, and the general elasticity and tone of the lower eyelid.
The eyelid procedure is routinely performed on patients from their late adolescence through later years. Younger patients who request this operation often have inherited fat pockets which may appear as dark circles underneath the eyelids. The nature of each procedure varies widely depending on the age and needs of the individual patient.
After a preparation period, blepharoplasty is almost always performed under intravenous sedation anesthesia, supplemented with local anesthesia. Of course, as in all of our surgeries, the patient is continuously monitored by a board certified anesthesiologist. The patient is drowsy, pain-free, and unaware of the procedure that is being performed.
The operation may take anywhere from 30 minutes to one hour. This depends on whether a four lid blepharoplasty is performed, or if just the lower eyelids or upper eyelids are done. The patient is then transferred to the recovery room, and will be discharged from our clinic approximately one hour after surgery.
The procedure is usually performed under sedation anesthesia in the office setting. Our office is fully accredited, and anesthesia is administered by an experienced board certified anesthesiologist.
After discharge, the patient may return home or to the hotel under the care of a nurse, friend, or a family member. The main requirement is that ice compresses be maintained on the eyelids for several hours after surgery as this will reduce bruising.
This procedure is usually characterized by patients having minimal discomfort in the postoperative period. Pain medication is usually prescribed. However, the patient will look worse than he or she feels due to the bruising that usually accompanies blepharoplasty. Bruising is typically gone within 10 days of the procedure. Sutures, if present, are removed by the fourth or fifth day. Patients can go out and do normal activities on the first day, but usually wear sunglasses to disguise their bruising.
Swelling usually lasts up to three weeks, and the final eyelid result is obtained by two months. Scars are placed in inconspicuous areas that are most difficult to see on the upper lid. On the lower eyelid, if a transconjunctival blepharoplasty is not performed, the scar is placed right below the eyelashes, which is most difficult to see. On younger patients when a transconjunctival approach is used, incision is inside the eyelid, without any visible scar.
Dr. Sherman will discuss all potential complications, and the relative frequency (or infrequency) of their occurrences. This may include bleeding, dry eye, and swelling.
Variations of the Operation
The basic decision must be made as to the type of blepharoplasty that will benefit you most.
Dr. Sherman has routinely performed transconjunctival blepharoplasty operations over the past 30 years, and was featured in an article describing this procedure in Elle magazine. This procedure is ideal for the younger patients, in their early adolescence through their early forties who have inherited a family tendency for puffy upper and lower eyelids. It is perfect for the patient who has that puffiness in the upper and lower eyelids. In these younger patients, the fat may be removed without removing skin, because the skin has enough elasticity to contract. On the upper lids, a small amount of skin may be removed.
In a transconjunctival blepharoplasty the incision is made inside the eyelid, avoiding any type of scar. The periorbital fat is then carefully and conservatively teased out of the lower eyelid. Because of the elasticity in the younger patient, the skin drapes nicely, avoiding the need for skin adjustment. If a small amount of skin must be tightened, a laser or peel may be performed simultaneously.
The operation for transconjunctival lower lid blepharoplasty takes roughly 30 minutes. If upper eyelids are added, the procedure may take up to one hour. Most of our patients are back to work within a week, without the use and need for any suturing.
Laser Resurfacing of the Eyelids
This procedure has the advantage of resurfacing the eyelids to provide a younger fresher look, and to minimize the finer wrinkling that is often present with aging and/or sun damage. This procedure is also performed as an outpatient.
Lower Eyelid Resuspension or Canthopexy
Occasionally the lower eyelid may need to be repositioned. This is due to aging and poor tone. The patient often notices that too much sclera (white of the eye) shows below the iris (the colored part of the eye). This procedure restores the natural shape and the tension of the lower eyelid; it is usually performed in conjunction with the lower eyelid blepharoplasty and upper eyelid blepharoplasty on older patients if needed.