Eyelid surgery, also known as blepharoplasty, is a way to treat the tired appearance of the eyes that occurs with aging. A properly performed eyelid lift is oftentimes not noticed as its effect is to make the patient look less tired and more like their original self. As a plastic surgeon, the best results are when patients appear rested and refreshed compared to their preoperative photographs.
Eyelid surgery usually is directed to both upper and lower lid issues that occur with aging. These problems include excess skin of the upper and/or lower lid, excess bulging fat of the upper and lower eyelid, loss of fat around the eye, laxity of the supportive ligaments of the lower lid, and sagging of the brow contributing to excess skin of the upper lid. Blepharoplasty, as performed by a skilled surgeon, will improve both the appearance and function of the eye.
Blepharoplasty of the upper lid is performed by excising a segment of skin and muscle and removing any excess fat present. In some instances, a brow lift is performed to elevate a brow that has sagged low on the forehead before removing skin from the upper eyelid.
Blepharoplasty of the lower lid can be performed by removing both skin and fat from the lower lid through an incision just below the eyelashes. Alternatively, if no skin needs to be removed, a transconjunctival approach through the inside of the lower lid is a more direct route to treat excess fat. Excess fat in the lower lid can be conservatively trimmed or in the case of a deep tear through deformity, repositioned to fill in this contour deformity.
Surgical procedures that are often required and performed with blepharoplasty are listed below:
- Brow lift – elevates the brow to the proper position on the bony skeleton
- Canthopexy – reinforces the ligament of the lower eyelid
- Canthoplasty – shortens the length and improves the position of the ligament of the lower eyelid
- Fat grafting to the cheek – builds up the volume of the cheek and adds support to the lower eyelid.
- Fat grafting to the brow and temple – builds up the volume around the upper eyelid to decrease the sagging of the excess skin around the upper eyelid.
The male patient below shows many of the typical changes associated with aging of the upper and lower eyelids.
Candidates for blepharoplasty have skin excess and/or fat excess present that may create a tired or fatigued appearance. Eyesight and tear function are assessed to determine if “dry-eye” symptoms are present and are accounted for in the preoperative preparation and postoperative treatment.