Blepharoplasty or Eyelift Surgery is a plastic surgical procedure that is used for correcting defects, deformities, and disfigurations of the eyelids, and more recently, it has been used for achieving aesthetic modification of the periorbital region of the face.
Surgery involves removal or repositioning of excess tissue as well as reinforcement of surrounding muscles and tendons to reshape the upper eyelid, lower eyelid or both. The operation typically takes one to three hours to complete, depending on the technique and extent of surgery done.
What are the Types of Blepharoplasty?
Based on desired results, blepharoplasty can be done either for functional or cosmetic purposes.
Functional or Reconstructive Blepharoplasty: Done to restore peripheral vision by removing excess skin, muscle and fat which blocks the visual axis.
Cosmetic Blepharoplasty: Done to accentuate the appearance of the eyes at the patient’s request and is not done to improve peripheral vision.
Anatomically, blepharoplasty can be done on either the UPPER or LOWER eyelids, or BOTH eyelids.
Upper eyelid Blepharoplasty ("eye lift"): Reduces excess skin and fat in the upper eyelids.
Lower Eyelid Blepharoplasty: Lower eyelid blepharoplasty is almost always done for cosmetic reasons - to improve puffy lower eyelid "bags" or to reduce wrinkling of skin.
Combined Upper and Lower Blepharoplasty: Involves removal of excess skin and fat in both the upper as well as lower eyelids with smoothing of the muscle and other tissues.
The blepharoplasty surgical details
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 then trims away any excess skin that is obstructing vision or contributing to a droopy or tired appearance. Excess fat is then trimmed and muscles are repositioned. The remaining skin is lifted and reattached for a more youthful look. Finally, the incisions are closed with fine sutures.
After the procedure, the initial swelling and bruising takes one to two weeks to resolve. Subsequently, several months elapse before the final result becomes obvious. The results of a blepharoplasty procedure lasts for about 5 to 7 years or until age supersedes the corrective measures.
Depending upon the scope of the procedure, the operation takes one to three hours to complete.
Stepwise description of Blepharoplasty
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.
Local Anaesthesia: Once marking is done, blepharoplasty is done under local or modified local anaesthesia and patient co-operation is absolutely essential for a symmetrical surgical outcome. Local anaesthesia is injected for each eyelid.
Incision Design: The design of the blepharoplasty incision depends on the patient’s eyelid, facial and eyebrow contours. The incision should be made along the eyelid creases or traverse transconjunctivally 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 could 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. External skin resurfacing with a chemical peel or carbon dioxide laser could be performed simultaneously. This allows for a faster recovery process.
Skin Excision: The initially incision is at the eyelid crease and cuts through the skin and orbicularis oculi muscle but avoiding the levator muscle just below the skin. The second incision is along the curvilinear superior aspect where deep incision is possible. The third incision is the lateral extent of the eyelid, from the lateral canthus towards the lateral eyebrow.
Orbital Septum Excision: A strip of septum is removed across the entire upper eyelid to gain access to the underlying fat pads.
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 taut. Fat can also be redistributed or dermal fillers applied to hollow areas for a plump, healthy looking face to correct sunken eyes.
Achieving Haemostasis: It is very important to stop bleeding during a blepharoplasty as it can lead to retroorbital haematoma and loss of vision. The most common site of bleeding is the Orbicularis oculi muscle which is extremely vascular.
Closing the Incision Sites: Blepharoplasty incision sites are closed using interrupted absorbable or non-absorbable sutures perpendicular to the lateral canthus. Scarring is negligible with meticulous wound closure and timely suture removal at 7 to 8 days following
Surgery Step-by-Step Animation
Recovery after eyelid surgery
After blepharoplasty, there will be discoloration bruising and swelling for up to 7 days but several months are needed until the final result becomes stable. Ice, restricted activity, and an elevated head position can all promote rapid, uneventful recovery from blepharoplasty.
The effects of blepharoplasty are consolidated over a few months and could last for several years, and for some lucky patients, they could even last for a lifetime.
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 result becomes stable. Blepharoplasty's effects are best appreciated by comparing before and after photos of surgical patients.
Expectations after surgery
The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect the cosmetic and functional outcomes. Factors which are known to cause complications include:
dry eyes - which could 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