By Gunnar Bergqvist, MD
Blepharoplasty is a type of surgery that is done to remove extra skin muscle and soft tissue fat around the eyes.
As we mature, we normally develop changes in the soft tissue consistency and thus we can get bags under her eyes and heavy droopy extra skin of the upper eyelid. There are also several different structures that can change including muscles that open, close eyes, and help raise the eyelid.
Dermatochalasis is the presence of loose and redundant skin of the eyelids. This can result in a less than aesthetic appearance but can also impede your vision. Upper eyelid blepharoplasty can be done both for cosmetic purposes as well as for medical reasons to give you a better visual field.
Laxity of the lower eyelid can result in the sagging of the eyelid more show the white portion of your eyes and also chronic irritation and dryness and tearing. This is called ectropion and is also reason for lower eyelid surgery whereby the lower eyelid needs tightening. This is considered in many cases of medical procedure rather than cosmetic.
Eyelid surgery has been described in Roman literature; however, the term blepharoplasty was coined by coined by Karl Ferdinand von Grafe in 1818. At that time the surgery was primarily performed related to cancer of the eyelids. The procedure has changed over the years and has improved in technique. We are more aware of other structures around the eyelids including the eyebrow the cheeks, etc., and how they correlate to the eyelids.
Plastic surgeons often do cosmetic eyelid surgeries, and perform corrective eyelid surgeries related to improvement of visual field, as well as reconstruction after resection related to cancers or trauma. Surgery of the eyelid can often be done in an office setting under local anesthesia or in a surgery center setting as an outpatient. Recovery from this procedure is different for each individual, however, normal recovery ranges from about a week to several weeks for the initial bruising and swelling, which drastically reduces after 1 week. In some patients may have persistent swelling that may go on for several weeks. This is a very common and successful procedure among the older population of both men and women with great success and little to no downtime.
The upper eyelid surgery the incision is normally placed within a natural crease in the eyelid away from the eyelid margin as to hide this and make it look natural.
There are multiple different incisions for the lower eyelid currently the newer techniques involve the pinch technique whereby small amounts of skin are removed from the eyelid itself.
If a patient has several different fat pockets around her eyes this can be reduced, and can also be repositioned to help cover up some of the contour deformities, particularly of the lower eyelid that have been due to maturing.
It is important to recognize the correlation between other structures around the eye if you have a droopy eyelid that does not have extra eyelid skin, however the eyelid itself hangs down over your pupil. This is often related to the function of muscles that raise her eyelid. Surgery for this can involve re-suspending the eyelid as well as tightening up the muscles around the eye. An example of this may be from a condition such as Bell’s policy, which is a neurological problem resulting in inability to close the eye. A Plastic surgeon can put a small weight in your eye which has to be adjusted appropriately to allow for eye closure.
The brow is a structure that often has to be lifted and tightened at same time as the eyelid. There are many different options of doing so, which can be done in an office setting under local anesthesia.
Having a consultation finding out what options and surgeries are best for you is recommended for you to get the best outcome not just from a cosmetic aspect but also from a functional point of view.
The pictures shown are before/after post ops; unevenness due to swelling. This gets better in a few weeks.
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