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Cosmetic Eyelid Procedures: Blepharoplasty

Published by Auckland Eye on Wednesday, 07 Aug 2019
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Tired-looking eyes are a big giveaway of ageing. Gradually over time, you may notice the development of fine lines, droopy eyelids and puffy bags under your eyes. To restore a more energetic and youthful appearance, eyelid surgery (also known as Blepharoplasty) is one of the most common cosmetic procedures, vastly improving the appearance of the skin around the eye area. This surgery can be performed on both the upper and the lower eyelids to help rejuvenate tired eyes, as well as to restore a full field of vision for those who find that the excess skin is obstructing their peripheral vision.

 

 

The Eyelid Aging Process

As skin ages, it gradually loses its elasticity. A lack of elasticity plus the constant pull from gravity causes excessive skin to collect on the upper and lower eyelids.

Excess skin on the lower eyelid causes wrinkles and bulges. On the upper eyelids, an extra fold of skin can hang over the eyelashes and get in the way of seeing. Muscles around the eye may also become thickened (hypertrophic), particularly in smokers.

In addition, many people lose fat around the eye (atrophy), resulting in a sunken appearance. The connective tissue layers in the eyelids may thin out, causing fat to be moved downwards and form bags under the eyes. This loss of elasticity and subcutaneous fat often leads to an increase in wrinkle formation (rhytid) and permanent lines such as frown lines.

 

Common Reasons For Eyelid Surgery:

Cosmetic Reasons

Due to these changes of the skin around the eye area, eyelid surgery can help repair these signs of ageing to restore a more youthful and alert look for cosmetic purposes, which is the main reason motivating most patients to opt for blepharoplasty surgery.
The most common cosmetic concerns regarding the eyelid region include:

  • An overhang of upper lid skin
  • Puffy looking eyelids
  • The appearance of 'bags' in the lower lids
  • Hollowing associated with the 'tear trough'
  • 'Dark circles' around the eyes

Functional Blepharoplasty

In most cases, a functional eye lift is performed to remove excess loose skin from the upper eyelid if it droops low enough to impair your vision for driving or other visual tasks. Eyelid surgery may also be recommended for other medical and functional reasons, such as:

  • Difficulty wearing glasses or contact lenses, whether from baggy upper or lower eyelids.
  • Irritation from excess folds of eyelid skin rubbing together.
  • To reconstruct the eyelid following removal of an eyelid tumour
  • Forehead discomfort from overused muscles that strain to lift sagging skin in the eyelid area.
  • Ptosis is the abnormally low position of the upper eyelid — a condition that may affect one or both eyes. Ptosis that is present since birth is called congenital ptosis. Droopy eyelids, in general, occur when the edge of the upper eyelid (eyelid margin) falls from its normal position, which can be corrected with cosmetic eyelid surgery.

 

Surgical Eyelid Treatments Offered at Auckland Eye

  • Upper Blepharoplasty

Upper blepharoplasty is the most common cosmetic surgical eyelid procedure performed. There is a very high satisfaction rate amongst patients and it should achieve a significant cosmetic improvement in the upper lids while still maintaining a natural appearance.

Upper eyelid surgery is often recommended for functional or cosmetic reasons or a combination of the two. Brow surgery may also be recommended, although this is far less commonly indicated. Most medical insurance companies will cover upper blepharoplasty surgery if the conditions for functional visual impairment are met.

Generally, surgery involves excision of some redundant skin, underlying muscle and if necessary, excess fat. The skin crease is an important structure in the upper lid as this determines the position of the fold which drapes the upper lid. The skin crease is typically higher in women than men and is lower or absent in most oriental ethnicities. Loss of the skin crease can contribute to the overhang of skin and often reformation of the crease is indicated during blepharoplasty surgery.

 

  • Asian Blepharoplasty

This procedure goes by a number of names but the term "double eyelid" is often used by the patient and refers to eyelid skin being seen above and below a crease. The surgery involves the creation of a skin crease in the upper lid in patients with a particularly low or absent skin crease. Attention needs to be paid to the significant differences in the Asian and Caucasian eyelids, as well as variations within Asian ethnicities.

  • Lower Blepharoplasty

This surgery involves removal of skin and removal or redistribution of fat. There has been a move away from skin excision in recent years as this is more likely to result in lower lid retraction or ectropion formation. Another trend has been towards reducing the removal of fat in the lower lid, as this can skeletonise the face, ultimately hastening the ageing process.

A prominent hollowing (termed the "tear trough") can occur at the junction of the lower lid and cheek, and this usually relates to a combination of loss of fat over the rim, fat prolapse above this and cheek descent. Fat may be redistributed into the tear trough to address this condition though more recently tissue fillers have been found to give very good improvement and now are often the treatment of choice.

The current approach to lower blepharoplasty, therefore, is to assess whether to remove, reposition or replace tissue.

Surgery: What is Involved?

In upper lid surgery, the incision is made through the skin crease and following the removal of excess tissue, the resulting wound is sutured. These sutures are removed within five to seven days.

In the lower lid surgery the incision is made just below the lashes if the skin is exercised, but in the case where only fat is removed, the incision is made from inside the lid through the conjunctiva. These structures dissolve without the need for removal.

Bilateral upper or lower blepharoplasty generally takes only 60 to 90 minutes and the majority of cases are performed under local anaesthetic as an outpatient, although some patients choose intravenous sedation (or very occasionally a general anaesthetic).

Recovery and Results

Following surgery, although your eyes don't need to be padded,  it is recommended that you apply ice masks regularly for 48 to 72 hours after the surgery to help reduce bruising. Due to gravity, the swelling and bruising will often appear in the lower lids or cheeks even with upper eyelid surgery. Some temporary discomfort is normal at first and dryness in the eyes is common as well.

After surgery, the eyes look younger and more defined, giving you an alert and refreshed appearance. The total healing time varies from person to person, especially if other procedures were included. However, in most cases, the eyelids will take one to two weeks to settle and heal.

 

Book an Appointment

If you are unhappy with the extra skin around the eyelids or are experiencing vision problems due to an overhanging excess eyelid skin, you may be a candidate for blepharoplasty. Eyelid surgery can help you to restore a more energetic and youthful appearance — giving stunning and quick results within a short recovery time.

Cosmetic eyelid surgery is part 'art' and part 'science', as every patient requires an individually tailored solution to provide the safest and most natural aesthetic results possible. To book a consultation with one of our ophthalmologists that specialise in cosmetic eyelid procedures, call 0800 25 53 93.

Auckland Eye - New Zealand Centre of Excellence for Eye Care