Q: What is Blepharoplasty?
A: Blepharoplasty, also called eyelid surgery, removes excess folds of skin in the upper lids and eye bags under the lower eyelids. In this procedure excess fat, muscle, and skin is removed to improve the appearance of drooping upper lids and puffy eyes and thus lend a rejuvenated look to the face.
Although this surgery is done mostly for cosmetic reasons to give a more rested, alert and youthful look, in some cases, it may be therapeutic – to correct the peripheral vision caused by excessively drooping upper eyelids in the elderly.
One should keep in mind that this surgery does not correct wrinkles, crow's feet lines, dark circles under the eyes, or sagging eyebrows. To correct these problems, blepharoplasty needs to be combined with other corrective procedures like brow lift, skin resurfacing techniques and anti-wrinkle injections.
Depending on the need, one might thus go in for either an upper lid surgery (upper blepharoplasty) or lower lid surgery (lower blepharoplasty). Some people may require both upper and lower eyelid surgery (Quad Blepharoplasty), which can be done in the same surgical setting.
Q: What are the conditions that can be treated with this surgery?
A: Blepharoplasty or Eyelid Surgery could be done for Functional/reconstructive or Cosmetic reasons. Following conditions might benefit from an eyelid surgery:
Conditions where cosmetic correction can be done (Cosmetic Blepharoplasty):
Puffy bags below the eyes
Fatty deposits or puffiness on upper eyelids
Drooping upper eyelids (this has to be differentiated from Ptosis – for which a different surgery is required)
Skin folds over the upper eyelid
Stretched skin of the lower eyelids leading to wrinkling.
Medical reasons that necessitate a Blepharoplasty to improve functionality (Functional Blepharoplasty):
When loose skin from upper eyelid droops low enough to impair vision
Difficulty in wearing glasses or contact lenses due to puffy/baggy upper/lower eyelids
To relieve skin irritation because of excessive folds of skin over eyelids
To ease forehead discomfort because of excessive use of forehead muscles needed to lift eyelids heavy with excessive folds.
Q: How does aging affect the area around the eyes?
A: Besides being one of the most noticeable areas of one’s face, the skin around the eyes is very delicate, with less supportive tissue and fewer oil glands. This causes the signs of aging to be most visible in this area.
The aging process leads to a decrease in the elasticity of the skin and the added constant pull of gravity leads to the collection of skin folds on upper and lower eyelids. Stress, fatigue, sun exposure (direct effect of sun rays and outcomes of frequent squinting) and hereditary factors may enhance this normal aging process, and hence some people develop more signs than others despite having the same chronological age.
Over time this normal aging process leads to droopiness or bagginess of the eyelids. These drooping eyelids might come in the way of vision in some cases and might lead to forehead discomfort. In some people, the fat cushioning the eyeball from the skull can bulge out and lead to the formation of unsightly eye bags. This happens as a result of the weakening of membranes holding it in place, and hereditary factors may also play a role.
Q: What is the right age to go in for eyelid surgery?
A: Most patients who seek a cosmetic eyelid surgery are usually older than 40 years, but if there is a tendency in the family to have droopy, baggy and puffy eyelids, one might go in for the surgical correction at a younger age.
Q: Are there any contraindications for this surgery?
A: When Droopy eyelids, eye bags, and excessive skin is caused by Thyroid problems, Excessive dry eyes, Hypertension or cardiovascular disease, then one must get these conditions treated before considering surgery. A good doctor will rule out these causes before suggesting surgery to you.
Q: Who are the best candidates for this surgery?
A: One must remember that a cosmetic blepharoplasty can enhance one's experience, give a fresh look to ones face and thus pep up one's confidence but it can’t drastically change ones looks. Therefore one must have realistic expectations and must discuss them at length with the surgeon.
The best candidates are therefore men and women who have realistic expectations from the surgery, who are psychologically stable and who have no medical conditions that might interfere with the healing process. Therefore one must avoid surgery while harboring uncorrected medical conditions like thyroid abnormalities, hypertension, cardiovascular diseases, and diabetes. Although, one can proceed with the surgery once these conditions are optimally corrected.
People with eye conditions like glaucoma, dry eyes, retinal detachment, and puffy eyes because of thyroid conditions must get the baseline conditions corrected by an ophthalmologist before seeking an eyelid surgery.
Q: What are the alternatives to this surgery?
A: Although there are no medical alternatives for this surgery, the wrinkles around the eyes can be reduced with anti-wrinkle injection treatments or laser resurfacing.
Q: What other surgeries can it combine with?
A: Eyelid surgery can be combined with a Browlift surgery if a patient has a droopy or sagging brow along with droopy eyelids. A Face Lift could also be combined in the same sitting if one wants to smoothen out the loose skin over the face and the neck. Both these surgeries could add significantly to the fresh and pulled up look. Other surgeries that can be combined with Blepharoplasty are Rhinoplasty, Facial Fat Grafting, Otoplasty (ear reshaping).
Q: How is the surgery done?
A: Blepharoplasty is done as a day care procedure, and it usually takes about 1.5-2.5 hours depending on whether it is an upper or lower eyelid procedure or both upper and lower eyelid procedure.
After giving anesthesia (Local or general) or IV sedation, an incision along the natural crease of the upper eyelid (for the upper eyelid) and just below the lower eyelash line (for, the lower eyelid). These surgical approaches are designed to conceal the scar lines as much as possible so that there is minimal visible scarring.
For the lower eyelid, a trans-conjunctival approach (from inside the lower lid) could also be used, which leaves no visible scar.
After this the fat may be relocated or removed, the muscles may be tightened, and excess skin may be removed depending on the requirement of the case.
Finally, the incision is closed using sutures (could be absorbable or non-absorbable) or surgical glue and covered with a sterile dressing or tape.
Q: What is the kind of Anaesthesia required?
A: Usually, Local Anesthesia suffices for eyelid surgery, and the surgery is done as a day care procedure. It may be combined with conscious sedation. However, in some instances, General Anesthesia may be required especially if other surgeries are combined with this surgery.
Q: What should one expect in the consultations?
A: One must go in for a consultation with an open mind and should be prepared to discuss one's expectations, medical history, drug allergies, medication history, and lifestyle problems. This will help the surgeon plan an appropriate surgical technique and suggest alternatives if available after evaluating your general health and taking note of the risk factors. Depending upon your health status specific investigations may be ordered, and medical consultations may be sought for any other medical condition. During the consultation, the surgeon explains you the potential risks and complications, brief you on the preoperative preparations required, discuss the expected outcome, show you pre and postoperative photographs so that you have realistic expectations. He might also take preoperative baseline photographs to compare with your postoperative result.
One must ask the surgeon to explain the surgical technique that shall be used, anesthesia planned and the hospital setting where the surgery is to be performed.
Q: What is the preoperative preparation and planning required?
A: In the preparation for this surgery, the surgeon may ask you to get a few laboratory investigations done depending on your medical condition. Additional consultations from specialists might be required if you have any other medical condition to optimize the condition and to revise the medication schedule if needed.
One must stop smoking at least two weeks before surgery (to allow proper healing of the surgical wound) and the surgeon might advise you to stop taking Aspirin or other drugs for blood thinning which increase the risk of intraoperative bleeding. However, this should be done only in consultation with a specialist.
For the night before the surgery, one might have to take pre-anesthetic medication if prescribed. This usually includes an anti-anxiety agent and an antiemetic. One must adhere to the pre-operative fasting guidelines as suggested by the surgeon (typically nothing by mouth about 6-8 hours before surgery).
The plan for postoperative visits and follow up care also should be worked out before surgery. One must plan to arrange for an escort for accompanying to the hospital and for driving back home.
One must plan for a work-off for at least 7-10 days for only eyelid surgery. However, it might need more time if combined with a Brow lift or another procedure.
At home, the arrangement should be made for ice packs, sterile dressing packs, clean towels and some house help. Arranging for a driver for a week might come handy keeping in mind that one wouldn’t be allowed to drive for about a week.
Q: What is the recovery process after this surgery?
A: Eyelid surgery is mostly performed as a day care procedure if performed without ant other added surgery. Mostly it requires Local Anesthesia or with or without sedation. Sometimes it could be done under General Anesthesia in which case the patient can’t be discharged until the effects of GA have worn off.
Immediately after surgery, one could expect to experience mild pain or discomfort that becomes apparent as the local anesthetic wears off. To prevent this, the patient is usually prescribed some painkiller medication.
There could be some persisting numbness because of residual effects of the local anesthetic. It commonly wears off in a few hours after surgery.
Swelling and bruising generally begin to appear few hours after surgery with a possible bruising on the whites of the eye (sclera). Although medication is given postoperative swelling, one must be prepared to see some swelling. It can also be decreased by using cold compresses (by using ice wrapped in a towel since it is not advisable to apply ice directly) and keeping head elevated for about 72 hours after surgery. This swelling usually subsides 2-3 weeks after surgery.
Some people may experience irritation or dryness of the eyes which may persist for up to 2 weeks. Few people may experience increased sensitivity to light, which can be prevented by using dark tinted glasses soon after surgery and avoiding sun exposure. This usually subsides soon.
Sometimes the patient might experience transient blurring of vision
The patient is usually advised not to drive back home and must have an escort for the first 24 hours of surgery. One might need help to use eye drops postoperatively. Driving is allowed after the effects of anesthesia have worn off, the swelling has subsided, and the vision is normal.
The stitches are usually removed on the 7th day of surgery, but the surgeon may recommend the use of sterile strips for a few more days to support the eyelids. Until the removal of stitches, one must avoid using makeup, doing strenuous workouts and resuming normal work. The contact lenses should not be worn for 2-3 weeks after surgery as the patient may experience some drying, which usually subsides by this time. One must be careful in applying and removing makeup and contact lenses even after that.
Time to full recovery varies from patient to patient depending upon the individual healing response. The normal appearance of eyelids is usually regained within two weeks.
Q: What are the risks and complications associated with this surgery?
A: There's always an element of risk in any surgery – be it major or minor. Although every operation will have many reported complications, there is a little likelihood of facing them in the hands of an experienced surgeon. One must, therefore, do thorough research on the surgeon before going under the knife.
The minor side effects that are generally observed after surgery include swelling & bruising around the eyes, excessively dry, itchy or watery eyes, increased sensitivity to light & blurred vision. These side effects, however, are generally transient and usually the patient recovers in a few days. If they don't subside in a matter of a few days, one should report it to the doctor. Sometimes, small, white cysts can develop along the suture line, but the surgeon can remove these with a needle.
The post-operative scars which might cause concern initially, usually diminish over time. However, if the scars are too prominent, a scar revision surgery might be needed, but this is not recommended until at least one year after surgery.
There have been other reported complications of the surgery that one must be aware of. These include reaction to an anesthetic, infection, hematoma (bleeding under the skin), bleeding behind the eye, which if large enough, may press on the optic nerve and might lead to vision loss. These complications are however rare.
In some instances, the eyelid correction may lead to an uneven look that can be corrected by revision surgery. Sometimes the eyelid may be overcorrected leading to an ectropion, which can also be corrected, by revision surgery. These complications, however, are infrequent in experienced hands.
Q: How soon can the patient go to work?
A: The patient can join back work about 7-10 days after surgery as in this time the swelling usually subsides substantially and stitches have been removed.
Q: What kind of self-care is required after the surgery?
A: The patient must follow all the postoperative instructions including the intake medications that include oral painkillers, antibiotics, and ointments. One must avoid all trauma to the eyes and should avoid rubbing the eyes for a few days. The postoperative swelling can be reduced by keeping the head propped up by using an extra pillow and application of cold compresses (ice packs wrapped in a clean towel may be used). Direct sunlight should generally be avoided, and one may use sunglasses if there's a need to go out for a few weeks. The hygiene around the eyes must be maintained by gently cleaning the area around the eyes with plain water and clean towels. Makeup is generally avoided until after suture removal.
Q: How long after the surgery should one expect to see the full results?
A: Although the results of eyelid surgery can be noticed within a few weeks postoperatively, it will take about 3-4 months for the incision lines scars to fade. Until that time the scars might be reddish and more prominent. In about six months time the redness of the incision line vanishes, and the appearance of the scar usually changes and improves further for up to to1-2 years following surgery.
Q: Are the results of this surgery long lasting?
A: The results can be expected to last for about 6-10 years. The results don't last forever since the normal aging process continues, and the upper eyelid might begin to show skin folds again. This can usually be corrected by a repeat surgery or a brow lift. The lower eyelid, however, rarely requires repeat surgery.