SECOND QUARTER 2001, VOLUME 15, NO 2

Look into my eyes… what about around those eyes?

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Look into my eyes… what about around those eyes?

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Our eyes may reveal our soul, but they also reveal our age. If you look in the mirror and notice puffiness, sagging, or extra folds of skin, blepharoplasty, or eyelid surgery, may be right for you. Blepharoplasty removes excess fat, muscle, and skin from both the upper and the lower lids and creates a smooth, firmer area that exudes a youthful, bright appearance.

Changing Eyelids

As we age, our skin loses its elasticity and it appears stretched out. The eyelid skin, in particular, is the thinnest skin of the body and more apt to stretch. The muscles and membranes that hold fatty tissue around our eyes weaken and cause the fat to protrude or bulge. Our eyes tend to look worse in the morning due to fluid collecting in the fatty tissue while we have been lying down. Gravity may aid in drawing the fluid away, however, the more excess fatty tissue, the longer it may take to clear up. The loose skin combined with the distended tissues creates a tired, older look.

Younger patients can be affected by drooping upper lids and sagging lower lids. Heredity, excessive squinting, habitual eye-rubbing, and sun exposure can contribute to sagginess. Chronic allergies can cause acute swelling which speeds the development of overhanging upper lids or bags under the eyes.

Understanding the Procedure
Blepharoplasty provides different operations for reshaping and adjusting the lids for both cosmetic and functional purposes. After thorough examination and evaluation, you and your physician will decide if two or all four eyelids will be done and what techniques will be used in order to bring optimal results.

Cosmetically, you may want to reduce the excess skin in your upper eyelids to create a younger, more wide-eyed appearance. In upper eyelid surgery, your physician will follow the natural lines and creases of the eyelid in order to keep the scars as invisible as possible (see figure 1). The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incision to minimize the visibility of any scar. A variation of this surgery is the double eyelid procedure for patients who seek to add a crease to their upper eyelid. The surgery may also be used to correct ptosis, a drooping upper eyelid that is congenital or develops with age. Patients whose field of vision is limited due to ptosis may be able to seek insurance reimbursement since the procedure is medically necessary. Most people seek lower blepharoplasty to eliminate the bags under their eyes. There are two approaches for lower eyelid surgery. In the first approach, the surgeon makes an incision inconspicuously under the lower lashes and removes skin and fatty tissue (see figure 1). Again, scarring is hidden in the inherent folds.

The second approach, called trans-conjunctival blepharoplasty (see figure 2), involves making incisions from the inside of the lower lid to remove excess fat. This method works best for the patient who has a pocket of fat beneath the lower eyelid with no sagging skin. Transconjunctival blepharoplasty is usually performed on younger patients with thicker more elastic skin. The incisions may be closed with self-dissolving sutures, or they may not be sutured at all.
Blepharoplasty will neither eradicate the wrinkling around the eyes, crows feet, nor eliminate the dark circles under the eyes. There are procedures that may be performed in conjunction with blepharoplasty to address these concerns, so be sure to discuss your needs with your physician.

After the Procedure
Immediately following surgery, after the anesthesia wears off, the eye area may feel tight and sore. Your physician will prescribe a pain medication to control any discomfort you may feel. If both upper and lower lids are operated on simultaneously, swelling may make it difficult to close your eyes completely for two or three days. Overall, the convalescence period lasts one to two weeks.

Your physician will give you specific postoperative instructions to ensure a quick recovery; these may include the following:

  1. keep head elevated;
  2. use cold compresses to reduce swelling and bruising;
  3. apply prescribed eye drops to ease dryness or itching.

Two to seven days after surgery, the stitches will be removed. The swelling and discomfort will gradually diminish. You may notice increased tearing and sensitivity to light for the first few weeks after surgery. You may return to your normal routine immediately, although, your physician may limit certain activities or environments that would endanger or irritate your eyes.

The goal of blepharoplasty is to improve the appearance of your eyes. This surgery is popular with patients because it often provides dramatic improvement in overall facial appearance.

If you think you may be a candidate for the surgery, schedule a consultation with your facial plastic surgeon. During this visit be prepared to discuss your goals, expectations, and motivation for the surgery.

Whether your surgery is inspired by cosmetic or functional reasons, your surgeon will evaluate your face and answer all of your questions. Blepharoplasty may be the solution to brighten and revitalize those windows to your soul today.