Upper Eyelid Surgery Explained
Upper Eyelid Blepharoplasty Before and After
What is an upper eyelid blepharoplasty:
An upper eyelid blepharoplasty is the 3rd most common cosmetic surgery performed in the United States. It is a surgical procedure done to remove excess skin and fat, a condition known as dermatochalasis, from the upper eyelid. The eyelid skin is the thinnest skin on the body, so this is the area that shows the signs of aging first. Even in our 30s some people may begin to notice drooping skin on the upper eyelids. And there is certainly a genetic component to this.
As an oculoplastic surgeon Dr. Martin is uniquely qualified to perform a blepharoplasty. He did a fellowship in eyelid surgery at the renowned Bascom Palmer Eye Institute. He lectures around the world on the latest techniques for blepharoplasty, including using a laser to perform the procedure.
When a patient comes to the office complaining of a droopy lid there are several things that need to be examined. First is the level of the eyebrow. Many patients have a low eyebrow. When the brow is low, the skin on the lid can will look heavy and redundant. So for many people a browlift is actually what is needed to improve the appearance of the upper lids. The browlift can be done by itself, or in combination with the upper lid blepharoplasty.
It is also important to evaluate the actual lid height to check for ptosis. Ptosis is a condition where the lid margin is low due to a weak or stretched levator muscle. If someone has ptosis and this is not corrected at the time of the blepharoplasty surgery, the eyelid will still appear droopy post-op.
The amount of excess skin and fat are evaluated during the consultation. A discussion is done to determine how much skin and fat will be removed. Excision of a lot of fat can hollow out the upper eyelid and change the appearance of the eye. We now try to preserve more fat in the upper eyelid to create a softer appearance post-op.
For an upper eyelid blepharoplasty, a line is marked for the lid crease, usually at about 8mm above the eyelid margin. A special instrument is then used to determine the amount of excess that can be removed. Local anesthesia is injected into the eyelid to numb up the area and also decrease bleeding. The outlined ellipse of skin is then excised with either scissors or a laser. Excess fat is also removed. If a patient has a deep sulcus (hollow upper lid) the nasal fat pad can be moved laterally to add volume to the lid and make it appear less hollow. The skin is then closed with sutures. (can add picture here of the marking on the eyelid)
Dr. Martin is one of the only surgeons in south Florida who uses the CO2 laser when performing blepharoplasty. Using the laser results in less swelling and bruising and a faster recovery.
This surgery can be done with either straight local anesthesia or local sedation. With straight local, the patient is given a pill for anxiety, but is awake and will feel the injections of local anesthesia which will burn. After that there should be minimal to no discomfort. For patients who are very anxious or sensitive to pain, IV sedation can be administered. General anesthesia is not needed for this surgery.
For the first 3 days we have patients use ice compresses over the lids to decrease bruising, swelling and pain. After 3 days warm towels can be used. An ointment is applied to the incision 3 times a day. There is very little pain with this surgery. Sutures are dissolvable, but can be removed in 7-10 days if they haven’t dissolved on their own.
Most patients will have some bruising and swelling for about 10 days, but minimal discomfort. The vision may be a little blurry, and many patients experience some dryness in their eyes. We have everyone use some artificial tears for the first couple of weeks to help with the dryness.
Full healing can take up to 6 months. Some patients will have some intermittent edema or redness of the lids during this period, but it will resolve.
The main complications with an upper eyelid blepharoplasty are under or over correction. Many patients may have difficulty closing the eye completely for the first few days post-op due to the swelling. If too much skin has been excised, closure may be impaired for a longer period of time and a dry eye can develop.
If under corrected, there will be some redundant skin present after the surgery. It is important to once again evaluate the brow height. If the brow has fallen after the surgery, there will appear to be excess skin. In those cases a browlift is needed. If the brow looks okay, and there is just some extra skin in the eyelid, this can be removed at 6 months post-op.
Other complications include dry eye, blurred vision, suture reactions, and slow healing. These will all resolve with time and appropriate intervention.
An upper eyelid blepharoplasty can be done by itself or combined with any other cosmetic facial surgeries a patient may want, such as browlift, lower lid blepharoplasty, and face/neck lift.