What is a Blepharoplasty?
A Blepharoplasty is a surgical procedure to remove excess skin and puffiness of the upper and/or lower eyelid areas. Downward sagging of the brow and redundant skin of the eyelids are some of the first signs of the aging process. Later, fat from around the eyeball pushes forward into the eyelids, giving them a "baggy" appearance.
What are the benefits of this surgery?
Since your eyes are the focus during conversations, a blepharoplasty can have a dramatic impact in restoring a youthful appearance. Sometimes the puffiness can cause your eyelids to feel heavy, or the extra skin can obstruct peripheral vision, both annoyances which could be removed with a blepharoplasty. A blepharoplasty may be performed as an isolated procedure or in conjunction with a face lift or brow lift.
How is a Blepharoplasty performed?
Usually, local anesthesia with sedation is used. Surgery of the upper eyelid involves making an incision along the crease of the upper eyelid. The incisions are extended out past the corner of the eye into the region of the "crow's feet" wrinkles. The excess skin, fat, and muscle above the crease are removed, and the incision closed with sutures.
On the lower eyelid an exterior incision just below the eyelash margin in the lower eyelid can be used to remove excess skin and fat. Alternatively, the lower eyelid can be pulled downward and an internal incision (transconjunctival blepharoplasty) on the eyelid can be performed to remove the fat from the inside, leaving no external scars. This also has the advantage of a faster recovery, and is ideal in patients where the puffiness of the lower eyelid is the main issue. The lower eyelid skin can be re-surfaced if necessary with a laser or chemical peel to help smooth the skin.
What about the scars?
Scar tissue is the normal product of the body's healing process, so surgery is not possible without scars. However, Dr. Horton carefully plans the incisions so they will lie inconspicuously in normal skin folds and at facial borders, to minimize the visibility of the scar. Post-operative wound care instructions must be followed to promote optimal healing. Your individual genetic healing characteristics are the main factors in determining scar appearance.
After eye surgery, there is generally significant discoloration and swelling around the area for several weeks. The scars will generally be slightly raised and pink for several months, but then tend to flatten and fade into the normal skin lines that surround the eye.
What are the more common complications?
Although most patients do not have any complications with this operation, there is always some risk with any surgical procedure. The complications of anesthesia are part of the risk for even minor surgery.
Prolonged swelling and bruising, subscleral bruising (in the white area of the eye), bleeding, hematoma (collection of blood beneath the eyelid skin), and infection are potential problems in a blepharoplasty. Rarely, poor scar formation results. Occasionally as the scar heals small cysts (milia) can form. Minor asymmetries of the scar placement or of the amount of skin and fat removed are not infrequent. The lower eyelid incision adjacent to the eyelash margin can rarely result in alteration or loss of the eyelashes.
The possibility of excess tightening of the lid skin or scar may make it difficult to close the eyelids. Occasionally the scarring of the lower eyelid can pull the eyelid down and away from the eyeball (ectropian). This usually resolves itself with time and exercise, but may also benefit from a touch-up operation. Older patients with poor muscle and tissue tone in the lower eyelids are more prone to this problem.
An excess or decrease in tear production is seen in some patients, giving the eye a watery or dry sensation. This is usually temporary, and may require the use of eye drops. Eyelids that are pigmented before surgery do not loose their pigment, and may in fact become darker after the operation. Although cases of blindness have been noted following blepharoplasty, this has been extremely rare, and to date the cause and effect relationship between the two has not been established.
What is the cost of the operation?
This surgery may be performed for functional or cosmetic reasons. If the upper eyelid skin is so redundant that it obscures the vision it is a functional problem and may be covered by the medical plan. To be covered the British Columbia Medical Plan requires a severe restriction on the Visual Fields eye exam. Lower lid surgery is not normally covered. For cosmetic surgery this is not a benefit of the plan and the patient is responsible for the facility fees, surgical fees, and anesthetic fees if required.