Blepharoplasty (Eyelid Surgery)

What is a blepharoplasty surgery?
For a cosmetic reason to rejuvenate the appearance of the eyelid, or for a medical reason to improve vision, when the excess of skin, muscle, and fat of the upper and/or lower eyelid is removed, the surgical procedure is known as blepharoplasty. In Asian eyelid, which often lacks a fold that makes a double eyelid, and even if present, the fold height is often smaller, which thus remains unnoticed; in this condition, creation of the visible double eyelid is also a procedure termed as blepharoplasty. The other terms for blepharoplasty are eyelid surgery, or eyelid lift, and that done for the Asian eyelid is termed as double eyelid surgery.

Additional procedures that may be needed along with eyelid surgery:
1. Brow lift: a procedure to tighten the sagging skin in the forehead area.
2. Facelift: a procedure to reduce the signs of aging in the face and neck.
3. Resurfacing: a procedure to improve the texture and tone of the skin.

Who are the suitable candidates for blepharoplasty surgery?
1. A person who is having a loose or sagging skin that creates an extra fold or disturbs the natural contour of the upper eyelid.
2. A person with sagging skin on the upper eyelid, impairing vision.
3. A person with puffy eyelids, due to excess fat underneath.
4. A person with noticeable bags under the eyes.
5. A person with excess skin and wrinkles of the lower eyelid.
6. A drooping lower eyelid, revealing the white below the iris.
7. A person with Asian eyelid, or monolid.

Additional medical criteria for a good candidate
1. Healthy individual with no significant medical condition and serious eye conditions.
2. Must quit smoking and abstain from alcohol consumption.
3. A person whose goals are realistic.

Who are the authorized persons to perform the procedure?
Plastic surgeons, facial, plastic, and reconstructive surgeons, head and neck plastic surgeons, and ophthalmologists trained in blepharoplasty are the specialists who are authorized to do the blepharoplasty surgery.

What to expect during the consultation?
1. The surgeon will evaluate the general health status and any pre-existing health condition or risk factors that might impair wound healing.
2. The surgeon will discuss the surgical options and associated risks and complications.
3. He/she will explain the do’s and don’ts before and after the procedure.
4. The surgeon will explain the steps of surgical procedure in detail, and all the associated potential risks as well as the outcome.
5. The surgeon will discuss the type of anesthesia that will be used, and if needed, will then advise meeting with the anesthetist for further evaluation.
6. The performing surgeon will take photographs.

How is eyelid surgery performed?

Eyelid surgery includes the following steps:
Step 1: Anesthesia. Eyelid surgery can be performed using either general anesthesia or regional anesthesia, depending on the specific procedure.General anesthesia is a combination of intravenous (IV) medications and gases that put the patient in a deep sleep so that he/she won’t be aware of the procedure and will not feel any pain. Regional anesthesia involves injecting an anesthetic in the skin and tissues around the procedure area (local anesthesia) to numb a large area of the body, or simply using local anesthesia over the eyelid to numb the eyelid.

Step 2: The incision. The incision lines for eyelid surgery are designed so the resultant scars will be well concealed within the natural structures of the eyelid region. The upper eyelid can be corrected through an incision within the natural crease on the eyelid. This allows for removal or repositioning of fat deposits, tightening of muscles, and removal of excess skin.

Conditions of the lower eyelid may be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelid is removed. Again, the excess fat can be repositioned or removed. A transconjunctival incision, created on the inside of the lower eyelid, is an alternate technique to correct lower eyelid conditions and redistribute or remove excess fat. With this technique, no skin is removed.
Step 3: Closing the incision. Eyelid incisions typically are closed with sutures or skin glue. Sutures are removed within one week. The surgeon may also suggest use of a laser or chemical peel to reduce discoloration of the lower eyelids.

Step 4: Results. The results of eyelid surgery will appear gradually as swelling and bruising subside to reveal a smooth, better-defined eyelid and surrounding region, and a more alert and rejuvenated appearance.

On the day of eyelid surgery, what to expect?
1. Take a bath and a light snack before you leave the home if planned surgery is under regional or local anesthesia, and not eating or drinking anything if planned under the general anesthesia.
2. Do not apply any kind of make-up on the face.
3. Meet the doctor who will perform an exam and ensure that all needed tests are in order.
4. Remove all your clothing and jewelry and dress in the hospital gown. Give all jewelry and valuables to the accompanying family member.
5. Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
6. A surgical team member will start an IV.
7. The anesthesiologist or nurse anesthetist will start your anesthesia.
8. A tube will be placed in your windpipe to protect and control breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
9. The surgical team will monitor your vital signs and other critical body functions. This occurs throughout the surgery and recovery, until you are alert, breathing effectively, and vital signs are stable.

What are the risks and potential complications associated with the eyelid surgery?
As with all surgeries, blepharoplasty surgery also involves risks and potential complications. Complications may become serious and life-threatening in some cases. Complications can develop during surgery or recovery.
General risks of surgery
The general risks of surgery include:
a) Anesthesia reaction, such as an allergic reaction and problems with breathing
b) Bleeding, which can lead to shock
c) Blood clot, which can be life threatening
d) Infection

Potential complications of eyelid surgery
a) Pain, swelling, and bruising
b) Poor wound healing
c) Temporary eyelid numbness
d) Hematoma formation
e) Asymmetry within the eyelids
f) Blurred or impaired vision, dry and irritated eyes, and excessive tearing
g) Difficulty closing the eyes
h) Emerging sutures needing manual removal (instead of dissolving on their own)
i) Lid lag, a pulling down of the lower eyelid, or ectropion, rolling of the eyelid outwards to expose the inner eyelid surface. Both lid lag and ectropion are usually temporary
j) Scarring
k) Vision loss due to bleeding behind the eye

Reducing the risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
• Following the doctor’s instructions after surgery which includes elevating your head, applying cold compresses to reduce swelling, cleaning the eye area, and using lubricating eye ointment
• Stopping smoking, chewing tobacco, and alcohol consumption
• Notifying the doctor immediately of any concerns, such as bleeding, fever, increase in pain, or visual disturbances.
• Protecting your eyes from the sun by wearing dark-tinted sunglasses
• Taking the medications exactly and on time
• Telling all members of your care team if you have any allergies

What is the result that can be expected after the blepharoplasty surgery?
Usually, the result of the eyelid surgery will be long-lasting though due to the swelling and bruising, most of the people who have undergone the procedure will only be going out to the public place only on 10 to 14 days. And, it might take a few months before the final healing is completed.
Although certain conditions get corrected permanently, few recur, as everyone will age naturally. And there is no guarantee that only good results will be as expected. In some situations, worst complications can occur and few might require re-do operation to get the optimal result.

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