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Excess skin that obscures the natural fold of the upper eyelids and puffy "bags" under the lower eyelids can create a perpetually tired, aged and sad facial appearance. In some patients, there is so much excess skin that it blocks the field of vision laterally. Some patients note they have "heaviness" of the upper eyelids that seems worse by the end of the day. Blepharoplasty, or eyelid surgery, removes excess skin and fat in the upper and lower eyelids to create a brighter, more alert and refreshed facial expression. Fat is sometimes repositioned rather than removed in the Lower Lid Blepharoplasty.
Blepharoplasty patients range in age from 20 to late 80s. Genetic predisposition often plays a role in patients who are quite young but have extensive fullness of the upper and/or lower eyelids. Despite being well rested, these patients often look exhausted. In older patients, the cause is usually related to aging, gravity and tissue laxity.
Procedure
The surgical technique used during Lower Lid Blepharoplasty is determined by the status of the lower lid, the extent of skin laxity and patient preference. The 2 techniques Dr. Barr uses are the Transconjunctival Lower Lid Blepharoplasty and Subciliary Lower Lid Blepharoplasty. Eyelid surgery is performed using local freezing with sedation and is an outpatient procedure.
Transconjunctival Lower Lid Blepharoplasty
This procedure is usually performed on young patients with excessive lower eyelid skin fat but minimal skin laxity (looseness). A small incision is made within the pink (conjunctival) tissue, inside the lower lid. Through this incision excessive fat can easily be removed or repositioned. If there is any skin laxity, it can be treated with either the CO2 Laser or TCA Peel (during the Blepharoplasty procedure). No visible scar exists with this procedure, since the incision site is inside the lower lid.
Subciliary Lower Lid Blepharoplasty
Patients who have excessive lower eyelid skin as well as excess muscle and fat are the best candidates for the Subciliary surgical method. During this procedure, the incision is made in the natural crease just below the eyelashes. Through this incision excessive muscle, fat, and skin is removed or repositioned. This incision line is usually not visible past 1 week.
Upper Blepharoplasty
During this procedure, a small incision is made in the natural upper eyelid crease. Excessive skin, muscle, and fat is removed through this incision. No visible scar remains after healing since the incision follows the natural crease and is hidden within it. Eyelid surgery is performed using local freezing and sedation and is an outpatient procedure.
Post-Operative Course
Eyelid surgery patients are discharged the same day of surgery. In Subciliary Lower Lid Blepharoplasty and Upper Lid Blepharoplasty patients, a buried suture is removed after 7 days when the skin is completely healed. Rest, keeping the head elevated and using ice packs regularly over the 2 days following surgery will minimize bruising and swelling. Bruising may persist for 7 to 10 days after surgery, but can be covered with camouflage make up after 1 week. Patients are requested to limit their activity for a period of 1 week and to participate in only light activity until 2 weeks post-operatively. Heavy lifting is possible after 3 weeks.
Concurrent Treatment
For patients with excessive "crow's feet", Dr. Barr will often suggest a pre-operative treatment with Botox or a resection of the muscles that caused these crows feet during the Lower Lid Blepharoplasty procedure. This dramatically reduces the recurrence of the crows feet, thereby providing better long term aesthetic results. In addition to this procedure, Brow Lift, Rhytidectomy, and CO2 Laser Resurfacing are commonly combined with Blepharoplasty surgery.
Alternative Treatments
Periorbital C02 Laser resurfacing alone, TCA Peels alone, and injectable agents (including Botox) can sometimes improve the lower eyelid area. These options usually offer less dramatic and less enduring improvement in the appearance of the eyelid area.
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