blepharoplasty

Cosmetic surgery of the eyelids is generally directed towards the improvement of eye related changes to the tissues about the eye, although in some people these changes occur prematurely or may be the result of a medical condition.

'Cosmetic surgery' is not an ideal term as it has connotations of self-indulgent or unnecessary surgery. In reality, all eyelid surgery has a cosmetic aspect, whether it be for reconstruction following excision of an eyelid tumour or the excision of excess skin.

There is often a functional reason for removing excess upper lid skin which occludes part of the visual field. The preservation of facial cosmetics is particularly important as this is the area concentrated on when recognising or conversing with another person.

Tissue changes

Skin

Changes to the elastin in skin reduces the tone of the tissue resulting in drooping of the eyebrows and redundant skin in the upper and lower eyelids.

Tendons

Laxity of the tendons cause a slackening of the eyelid support structures which can lead to poor positioning of the eyelids.

Fat

Atrophy of the fat around the eye socket may give a sunken appearance to the eye.

Fascia (connective tissue)

A weakness in this plane of tissue in the eyelid may allow orbital fat to escape forward and, particularly in the lower lid, causes the appearance of 'bags' under the eyes.

While these changes most commonly occur with age, they may be seen in the relatively young, or with medical conditions such as dysthyroid eye disease. Facial nerve palsy may cause eyebrow droop and poor eyelid closure with sagging of the lower lid from loss of nerve supply to the eyelid and forehead muscles.

Surgery

The most commonly performed surgical procedures are the eyebrow lift and the upper and lower lid blepharoplasty. In a blepharoplasy, excess or redundant skin, muscle, fat or a combination of these can be removed via incisions which are hidden in natural skin lines. Close attention is paid to the position and symmetry of the upper lid skin creases as well as the height of the upper lids.

There is a racial difference between the upper lids in Europeans and Asian people, with the latter having very low or absent skin creases. 'Asian Blepharoplasty' involves creating a skin crease in the upper lid, forming what is known as the 'Double Eyelid'.

How long is the recovery period after surgery?

The surgery can be performed under local or general anaesthesia (more commonly local) and post-operatively the eyelids take one to two weeks to settle. Bruising and swelling is minimised by firm patching initially and the regular use of ice pads for 48 to 72 hours after the surgery.

Is blepharoplasty covered by medical insurance?

Most insurance policies exclude 'cosmetic surgery' as a rule but will accept the costs if there is a functional reason for the surgery (ie, improving the field of vision) or if the problem is caused by a medical condition such as thyroid eye disease. Surgery for eyelid malpositions such as ptosis or ectropion is not considered cosmetic and is covered by medical insurance.

Can it affect my eyesight?

There have been reported cases of loss of vision with lower lid blepharoplasty although this is very rare and is estimated at only one per 40,000 cases. This exceedingly rare complication should be avoidable with careful surgery and appropriate post-operative care. More commonly there is some transient blurring after surgery from a mild alteration to the blink and tear film.

Can blepharoplasty be performed with laser?

In some patients having lower lid blepharoplasty, laser resurfacing may be the preferred technique. In upper lid blepharoplasty, skin is excised and the laser does not have significant advantages over other methods used to cut tissue or diathermy vessels.

The main function of the eyelids is to protect the eye and it is therefore imperative that the eye is thoroughly examined pre-operatively to rule out any condition for which surgery may be contraindicated.

For further information and support talk to an optometrist or eye specialist. Optometrists are listed in the "Yellow Pages" of your telephone book. Eye specialists are listed with registered medical practitioners at the front of the white pages of your telephone book.

Original material provided by Auckland Eye, and reviewed May 2005. Edited by everybody.