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Blepharoplasty (Eyelid Surgery)

Upper Eyelid Surgery Introduction

As key elements in facial expression, the eyes convey messages of emotion, vitality, and age. Over time, the eyes undergo changes that often make people feel as if they appear sad or tired. The aging process can cause the eyelids to sag and droop, which in combination with bags and puffiness can make you look tired and older than you really are. Eyelid surgery can help freshen and revitalize your face by reducing the appearance of heavy and sagging eyelids, puffiness, and bags under the eyes.

What Causes Eyelids to Change?

Before you understand how eyelid surgery works, it is important to understand the underlying structure of the eyelids. Like the rest of the face, eyelids are composed of layers of skin, muscle, and fat. With time, age and environmental factors like sun damage, cause the skin's support network in the dermis to break down. As a result, the skin loses its structure and elasticity and becomes lax.

The muscle layers also weaken, which with the skin's loss of elasticity and the effects of gravity, cause the eyelids to droop and sag. Fat deposits normally give eyelids a full appearance. However, fat too is depleted over time and shifts in response to weakened, sagging muscles, which results in puffiness and bags around the eyes. While eyelid surgery addresses these problems, the procedure cannot correct crow's feet, dark circles under the eyes, or sagging eyebrows. In these instances, eyelid surgery performed with other procedures may produce better results.

How Does Eyelid Surgery Work?

While there are several different techniques that a physician can use to alter the appearance of the eyes, the standard surgical technique usually involves removing or redistributing fat deposits, as well as removing excess skin and muscle from regions of the upper and lower eyelids. Depending on the specific problems that need correction, the physician may treat the upper eyelids, lower eyelids, or both sets of eyelids. Your physician will help you determine which treatment is best for you. This animation describes the surgical technique used to correct the upper eyelid.

Surgery Preparation

An eyelid surgery procedure may last approximately one to two hours, depending on the extent of treatment. Prior to the start of your procedure, the treatment area will be cleansed and anesthesia will be administered. The procedure will most likely be performed under local anesthesia with sedation, in which the eyelids and surrounding areas are numb and you are in a relaxed state during the procedure. Alternatively, the physician may choose to administer general anesthesia, in which you are asleep during the procedure.

Incisions

Before making the incisions, incision guidelines may be drawn. This will ensure that the incisions follow the natural contours of the eyelid and the resulting scars will be as inconspicuous as possible. To begin, the physician will carefully make an incision in the fold of the upper eyelid.

Skin and Muscle Removal

Using a variety of surgical instruments, the physician will carefully dissect a layer of excess skin from the upper eyelid, exposing the underlying muscle layer. In some instances, the physician will choose to remove a small strip of muscle from the upper eyelid, exposing the layers below.

Fat Removal

In order to gain access to the two fat deposits in the upper eyelid, the physician must first make very small incisions in the orbital septum, which is a thin membrane that lies between the layers of muscle and fat. By pressing on the upper eyelid, the physician will expose the fat deposits through each of the incisions. Using a series of instruments, the physician will remove a portion of each fat deposit to reduce the puffy appearance in the upper eyelid. The portion remaining will be allowed to recede back through the opening.

Incision Closure

After sculpting the fat deposits, the physician will close the incisions with non-absorbable or absorbable sutures. The physician may apply a protective ointment, and in some cases small sterile bandages to keep the incisions moist and promote proper healing.

Upper Eyelid Surgery Recovery

As with any surgical procedure, you will likely experience some discomfort, swelling, and bruising which can be alleviated with cold compresses and pain medication. Non-absorbable sutures are typically removed in five to seven days, and you will begin to notice an improvement in the bruising around your eyes in seven to ten days. Although you will feel well enough to return to work in approximately a week, you should continue to avoid strenuous activity such as heavy lifting or exercise for at least two weeks following the procedure.

Upper Eyelid Surgery Results

You will start to notice the results from your procedure within a few weeks as the bruising and swelling continue to fade. While you will have small scars, they are usually well hidden by the contours of the eyelid. The scars may be slightly red at first but will fade over several months to a very faint white line. While the results of an eyelid surgery are long-lasting, it is important to realize that your face will continue to age. However, eyelid surgery can successfully restore a youthful, revitalized appearance to your eyes for years to come.