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Blepharoplasty – Eyelid Surgery

Blepharoplasty, also known as eyelid surgery, is a cosmetic procedure that involves the removal of excess skin and fat from the upper and lower eyelids.[1] This surgery can improve the appearance of the eyes and give a more refreshed and youthful look.[2]

The procedure is commonly performed on individuals who have drooping or sagging eyelids, which can be caused by aging, genetics, or other factors. Blepharoplasty can also be beneficial for individuals who have excess skin or fatty deposits on their eyelids, which can cause them to appear puffy or tired.

How is Blepharoplasty Eyelid Surgery Done?

The surgery is typically performed on an outpatient basis, with the use of local anesthesia and sedation. During the cosmetic surgery, the surgeon will make small incisions in the natural creases of the eyelids, in order to minimize the appearance of scars. Through these incisions, the excess skin and fat will be removed, and the remaining tissue will be tightened to create a smoother and more defined appearance.

Before undergoing blepharoplasty, individuals should discuss with a qualified plastic surgeon. During the consultation, the surgeon will assess the patient’s medical history and conduct a physical examination to determine if they are a good candidate for the procedure. The surgeon will also discuss the potential risks and benefits of the surgery, as well as the expected recovery time and any potential complications. Find a eyelid surgeon near me

Preoperative Patient Evaluation for Blepharoplasty

Medical and Ophthalmologic History

The preoperative patient evaluation for blepharoplasty should begin with a comprehensive medical and ophthalmologic history. This should include a review of the patient’s chronic systemic diseases and medications. It is also essential to obtain a detailed ophthalmologic history, including the patient’s vision, corrective lenses, history of trauma, glaucoma, allergic reactions, excess tearing, and dry eyes.

Corneal refractory surgery is a contraindication to cosmetic surgery of the periorbital region. Therefore, no cosmetic surgery should be performed for at least six months following this procedure. If a patient has a history of dry eye, the Schirmer’s test should be considered.

Assessment of the Periorbital Area

In addition to a complete eye examination, the evaluation of the periorbital area should take into account the quality and quantity of the patient’s skin, underlying three-dimensional soft-tissue contours, and bony skeletal support.

Assessment of the Upper Eyelid

Upper eyelid dermatochalasis is a condition characterized by the loss of elasticity and support in the skin. This can lead to the formation of a fold of excess upper eyelid skin, which can impair the function of the eye, including supero-lateral visual field obstruction.

During the preoperative evaluation, it is crucial to assess the pre-septal and eyebrow fat pads to redefine the superior sulcus. An evaluation of the patient’s old photographs can also aid the surgeon in restoring a more youthful appearance. It is also essential to note any upper eyelid ptosis, as it can be corrected simultaneously.

The actual blepharoplasty procedure is typically performed under local anesthesia, with the patient awake but sedated. The surgeon will make incisions along the natural creases of the eyelids, and will carefully remove excess skin and fat from the area. In some cases, the surgeon may also tighten the muscles and connective tissue in the eyelids to improve their appearance.

Assessment of the Lower Eyelid

During the preoperative evaluation, the lower eyelids should be assessed for excess skin and herniation of fat. This typically presents as medial, central, and lateral fat pads. Lower eyelid fat becomes more prominent in upgaze and less prominent in downgaze.

Downward displacement of the lateral canthus can result from disinsertion, laxity, or the presence of a prominent eye. The lower lid distraction test can determine the degree of laxity and guide lower eyelid canthal repositioning. It is crucial to note the posterior displacement of the orbital rim in relation to the anterior cornea and lower lid margin, a negative vector, preoperatively. Prominent or deep-set eyes should be documented with exophthalmometry. Malar anatomy needs to be evaluated for periorbital hollows.

Assessment of the Eyebrow

Brow ptosis, or sagging of the eyebrow, is another common issue that can be addressed during blepharoplasty. Evaluating the position of the eyebrow in relation to the superior orbital rim is crucial during the preoperative evaluation. Asymmetry in the upper and lower eyelids and brow position is common and should be recognized and addressed individually.

After the surgery, the incisions will be closed with sutures or skin adhesives, and the patient will be given instructions for post-operative care. Patients should follow these instructions carefully, as this can help to minimize the risk of infection and other complications.

Recovery from blepharoplasty typically takes several weeks, and individuals may experience some swelling, bruising, and discomfort during this time. Most people are able to return to work and other normal activities within a week or two. Post-op, patients should avoid strenuous activities and to protect the incisions from sunlight and other irritants during the recovery period.

Blepharoplasty Eyelid Surgery Risks and Complications

In general, blepharoplasty is a safe and effective procedure that can provide significant aesthetic improvements to the eyes. However, as with any surgical procedure, there are potential risks and complications that should be discussed with a qualified plastic surgeon before undergoing the surgery. Some potential complications of blepharoplasty include infection, scarring, dry eyes, and changes in vision. In rare cases, more serious complications such as blindness or paralysis of the facial muscles may occur.

Blepharoplasty Eyelid Surgery References

Blepharoplasty – Medical Policy Article

Blepharoplasty – StatPearls – NCBI Bookshelf

Blepharoplasty: An Overview