Blepharoplasty Surgery Details

Blepharoplasty or Eyelift Surgery is a plastic surgical procedure that is used for correcting defects, deformities, and disfigurations of the eyelids, and more recently, it has been used for achieving aesthetic modification of the periorbital region of the face.

Surgery involves removal or repositioning of excess tissue as well as reinforcement of surrounding muscles and tendons to reshape the upper eyelid, lower eyelid or both. The operation typically takes one to three hours to complete, depending on the technique and extent of surgery done.

What are the Types of Blepharoplasty?

Based on desired results, blepharoplasty can be done either for functional or cosmetic purposes.

Anatomically, blepharoplasty can be done on either the UPPER or LOWER eyelids, or BOTH eyelids.

  1. Upper eyelid Blepharoplasty ("eye lift"): Reduces excess skin and fat in the upper eyelids.
  2. Lower Eyelid Blepharoplasty: Lower eyelid blepharoplasty is almost always done for cosmetic reasons - to improve puffy lower eyelid "bags" or to reduce wrinkling of skin.
  3. Combined Upper and Lower Blepharoplasty: Involves removal of excess skin and fat in both the upper as well as lower eyelids with smoothing of the muscle and other tissues.

The blepharoplasty surgical details

Stepwise description of Blepharoplasty

  1. Marking Incision Sites: This is perhaps the most important part of the procedure as it dictates the outcome of the procedure. Meticulous marking of incision sites is done prior to the surgery.
  2. Local Anaesthesia: Once marking is done, blepharoplasty is done under local or modified local anaesthesia and patient co-operation is absolutely essential for a symmetrical surgical outcome.  Local anaesthesia is injected for each eyelid.
  3. Incision Design: The design of the blepharoplasty incision depends on the patient’s eyelid, facial and eyebrow contours. The incision should be made along the eyelid creases or traverse transconjunctivally to ensure that the incision sites are not obvious or in plain sight.

    Blepharoplasty is usually performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids. Incisions may possibly be made from the inside surface of the lower eyelid (transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed. External skin resurfacing with a chemical peel or carbon dioxide laser may possibly be performed simultaneously. This allows for a faster recovery process.

  4. Skin Excision: The initially incision is at the eyelid crease and cuts through the skin and orbicularis oculi muscle but avoiding the levator muscle just below the skin. The second incision is along the curvilinear superior aspect where deep incision is possible. The third incision is the lateral extent of the eyelid, from the lateral canthus towards the lateral eyebrow.
  5. Orbital Septum Excision: A strip of septum is removed across the entire upper eyelid to gain access to the underlying fat pads.
  6. Fat Removal and Redistribution: Excess fat is meticulously removed or redistributed to obtain a smooth and younger-looking surface in the upper eyelid, above the cheek and under the eyes. Muscle laxity is also corrected by sutures that make it taut. Fat can also be redistributed or dermal fillers applied to hollow areas for a plump, healthy looking face to correct sunken eyes.
  7. Achieving Haemostasis: It is very important to stop bleeding during a blepharoplasty as it can lead to retroorbital haematoma and loss of vision. The most common site of bleeding is the Orbicularis oculi muscle which is extremely vascular.
  8. Closing the Incision Sites: Blepharoplasty incision sites are closed using interrupted absorbable or non-absorbable sutures perpendicular to the lateral canthus. Scarring is negligible with meticulous wound closure and timely suture removal at 7 to 8 days following

Surgery Step-by-Step Animation

 

 

 

Recovery after eyelid surgery

 

The operation typically takes one to three hours to complete. Initial swelling and bruising resolve in one to two weeks but at least several months are needed until the final result becomes stable. Blepharoplasty's effects are best appreciated by comparing before and after photos of surgical patients.

Expectations after surgery

The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect the cosmetic and functional outcomes. Factors which are known to cause complications include:

 

Below is a surgical video demonstrating an actual upper eyelid blepharoplasty