Comprehensive Guide to Blepharoplasty Surgery

Anatomical Approaches to Blepharoplasty

1. Upper eyelid Blepharoplasty (eyelift): Reduces excess skin and fat in the upper eyelids.
2. Lower Eyelid Blepharoplasty: Lower eyelid blepharoplasty is mostly performed for cosmetic reasons – to reduce puffy lower eyelid “bags” or to reduce wrinkling of skin.
3. Combined Upper and Lower Blepharoplasty: Involves removal of excess skin and fat in both the upper as well as lower eyelids.

Blepharoplasty Surgery Process and Recovery

• Blepharoplasty is done either under local anaesthesia or under general anaesthesia as per the preference of the surgeon and the patient.
• Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or through the inside surface of the lower eyelid.
• The surgeon trims away any excess skin that is obstructing vision or contributing to a droopy or tired appearance. The remaining skin is lifted and reattached and the incisions are closed with fine sutures.
• After the procedure, swelling and bruising will occur for one to two weeks.
• Depending upon the scope of the procedure, the operation takes one to three hours to complete.
• Patients might consider an addtional blepharoplasty 15-20 years later.

Step-by-Step Guide to the Blepharoplasty Procedure

1. Marking incision sites: This is perhaps the most important part of the procedure as it dictates the outcome of the procedure. Meticulous marking of incision sites is done prior to the surgery.
2. Local anaesthesia: Once marking is done, blepharoplasty is performed under local or modified local anaesthesia.
3. Incision design: The design of the blepharoplasty incision depends on the patient’s eyelid, facial and eyebrow contours. The incision is made along the eyelid creases to ensure that the incision sites are not obvious or in plain sight. Blepharoplasty is usually performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids. Incisions might be made from the inside surface of the lower eyelid (transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed.
4. Skin excision: The originally incision is at the eyelid crease and cuts through the skin and muscle and avoiding the levator muscle. The second incision is along the curvilinear superior site where deep incision is possible. The third incision is the lateral extent of the eyelid, from the lateral canthus towards the lateral eyebrow.
5. Orbital Septum Excision: A strip of septum is removed across the entire upper eyelid to gain access to the underlying fat pads.
6. Fat Removal and Redistribution: Excess fat is meticulously removed or redistributed to obtain a smooth and younger-looking surface in the upper eyelid, above the cheek and under the eyes. Muscle laxity is also corrected by sutures that make it tighter. Fat can be redistributed and/or dermal fillers applied to hollow areas.
7. Achieving haemostasis: Bleeding is controlled to avoid retroorbital haematoma and loss of vision. The most common site of bleeding is the orbicularis oculi muscle which is extremely vascular.
8. Closing the incision sites: Blepharoplasty incision sites are closed using interrupted absorbable or non-absorbable sutures perpendicular to the lateral canthus. Scarring is hidden in creases with meticulous wound closure and timely suture removal at 7 to 8 days following surgery.

Eyelid Surgery Recovery: What to Expect

• After blepharoplasty, there will be discoloration bruising and swelling for up to 7 days but several months are needed until the final lead to becomes stable. Ice, restricted activity, and an elevated head position can all promote rapid, uneventful recovery from blepharoplasty.

The operation typically takes one to three hours to complete. Initial swelling and bruising resolve in one to two weeks but at least several months are needed until the final lead to becomes stable. Blepharoplasty‘s effects are best appreciated by comparing before and after photos of surgical patients.

What to Expect After Eyelid Surgery

The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect cosmetic and functional outcomes. Factors which are known to cause complications include:

• dry eyes – which might become exacerbated by disrupting the natural tear film
• laxity (looseness) of the lower lid margin (edge) – which predisposes to lower lid malposition
• prominence of the eye in relation to the malar (cheek) complex – which predisposes to lower lid malposition

Below is a surgical video demonstrating an actual upper eyelid blepharoplasty