By J. Charlie Finn, MD
Published on August 01, 2006
If the eyes are the windows to the soul, then bags and droops surrounding them can be significant detractors. Such effects, which inevitably develop over time, can leave a person looking tired and worn down. Blepharoplasty, or eyelid rejuvenation surgery, provides a means of restoring an image of vitality and good health. When performed on its own or in combination with other procedures, blepharoplasty yields dramatic results.
The Cutting Edge
Blepharoplasty techniques have advanced significantly in recent years. Previously, bulging fat and skin was simply removed. Although initially there was substantial improvement with this technique, over the years a hollow, "operated" look tended to develop. Today, every effort is made to instead preserve orbital fat and to distribute it to areas of relative deficiency.
The new process addresses an important factor that was not formerly considered. As the lower eyelid/cheek complex ages, not only do fat bulges and wrinkles develop, but the tissues of the mid-face also drop. This creates a groove below the eyelid called the "tear trough." This contour change is what causes shadow lines, especially in overhead lighting. By using an innovative technique that repositions orbital fat rather than excising it, the patient's own tissues are used to fill in the deficiency. If needed, the entire mid-face complex can also be repositioned upwards. This combination of techniques rejuvenates the entire complex of tissue, alleviating the effects of time while preventing that undesirable "operated-on" appearance.
Lower Eyelid Blepharoplasty
To achieve optimal results lower lid blepharoplasty must be customized. Because the aging process affects the lower eyelid differently in each individual, the type of surgical procedure used is determined according to the specific concerns in each patient's case.
The eye and its muscles are surrounded by and floating in fat. As a person ages, the membrane holding the fat into the orbit weakens, causing bulges and bags beneath the eyes. In some cases, genetic disposition produces these effects even in a young person. Another familiar lower eyelid problem occurs when the skin around the eye wrinkles and sags. At times, the muscles of the eye cause multiple bags under the eyes, or "festooning." Lower lid blepharoplasty addresses each of these problems as necessary.
For the patient with minimal wrinkles but significant fat in the lower eyelids, a transconjunctival blepharoplasty is usually performed. With this procedure, no external incisions are made; instead, the fat is repositioned through a small incision inside the lower eyelid. The result is a quicker recovery, less bruising, and no external scar formation. Transconjunctival blepharoplasty is frequently combined with laser resurfacing in order to tighten the skin of the lower eyelid.
For the patient with excess skin or overly loose muscles surrounding the eye, a better alternative is the transcutaneous blepharoplasty. With this approach, a small incision is made just below the eyelashes trailing out into one of the crow's feet. Through this incision, the surgeon is able to tighten the skin and muscle of the lower eyelid. Healing is usually rapid and sutures are removed in five days. Bruising may last from seven to ten days, and redness in the lateral portion of the incision may last for several weeks, but may be covered up with makeup after seven days.
Upper Eyelid Blepharoplasty
With aging, the skin in the upper eyelids becomes loose and hangs down. Occasionally, this may be so severe as to limit vision. Through upper lid blepharoplasty, the excess skin, muscle, and fat are removed creating a natural looking, rejuvenated, and sculpted upper eyelid. This may be done with local anesthetic and bruising is minimal. Patients are typically able to return to work in five to seven days. The sutures, hidden in the natural fold of the eye, are removed in five days. However, as swelling from surgery continues to decrease over time, it may take several weeks to see the final results.
While most people think of blepharoplasty as pertaining strictly to eyelid surgery, in the case of the upper eyelid area the eyebrows frequently cause more problems than the upper eyelids themselves. This occurs because as the face ages, the eyebrows tend to droop, and it is this that creates a 'heaviness' in the upper eyelid area. If the problem lies in the brow instead of the eyelid, a better repair known as the endoscopic brow lift can be performed. In this procedure, small incisions are made behind the hairline and the tissues of the scalp and forehead are lifted using special operating telescopes. The tissues of the brow are then re-suspended upwards. The end results are a rejuvenation of the upper eyelid, a decrease in the formation of crow's feet, and a more awake, refreshed appearance. Further benefits of endoscopic brow lift include dramatic reduction in forehead wrinkles and relaxation of the muscles of the forehead.
Upper lid blepharoplasty and/or brow lift may be simulated on your surgeon's computer, allowing you to help decide which procedure will be best for you.
Preparing for Surgery
Once you decide to proceed with rejuvenation of the eyes, you will be given a detailed explanation as to what to do to prepare for surgery. Preoperative advice from you're your surgeon may include the following:
- Visit your eye doctor for a checkup prior to surgery.
- To minimize bruising and swelling, avoid any aspirin-containing products and all non-steroidal anti-inflammatories such as Advil or Naprosyn for at least two weeks before surgery. You may take Tylenol before surgery.
- Avoid taking Vitamin E supplements as this may also result in more bruising.
- Using Vitamin K cream and a homeopathic herb called "Arnica Montana" tends to reduce bruising.
- It is important to be well rested for surgery.
- A mild sedative may be given for the night before surgery if you are anxious.
Sometimes surgery is done with a local anesthetic, but at times intravenous sedation will be desired as well. If you are undergoing sedation, it is important to avoid eating and drinking from midnight onward the night before surgery. If you have high blood pressure or take other medications, these medications may be taken with a sip of water the morning of surgery.
It is important to rest and minimize activity during the days immediately following surgery. Ice packs may help reduce bruising and swelling and should be used for the first 24 to 48 hours. A bag of frozen peas is often the best way to cool the eyelids. You may be given antibiotic ointment to use on the incision or occasionally in the eye. You may also be given lubricating ointment to use at night or lubricating eye drops to be used during the day. Pain is usually mild and can be controlled with Tylenol. If necessary, a stronger pain reliever may be given.
J. Charlie Finn, MD is President of the Cosmetic Surgery Center of North Carolina, and serves as Assistant Consulting Professor of Surgery at Duke University.