Upper Eyelid Blepharoplasty
Upper eyelid surgery is performed to remove the fat deposits and loose skin or drooping skin that may have formed around the upper eyelids due to the aging process. Heredity and sun damage can also hasten these changes. Younger individuals may also elect to have this procedure done to eliminate puffiness of the eyes from congenital excess fatty tissue deposits.
Upper blepharoplasty surgery can dramatically improve common problem areas such as excess skin on the upper eyelid itself (referred to as “hooding”). It can also greatly improve puffiness in the inner corner and middle of the upper eyelid caused by herniation (pushing forward) of fat in that area.
What Happens During an Upper Eyelid Blepharoplasty?
In a typical upper eyelid surgery, Dr. Rapaport first marks the individual lines and creases of the lids in order to keep the scars as invisible as possible along these natural folds. An incision is then made in order to remove excess fat and loose skin. The incisions are closed with fine sutures, thereby minimizing the visibility of any scars.
Lower Eyelid Blepharoplasty
While the main problem with the aging upper eyelid is generally excess skin, the main problem with the lower eyelid is generally excess fat or “bags.” As we age, the fat surrounding the eyelids diminishes, while the fat which causes the bags does not. Furthermore, the membranes which frequently hold that fat back in youth become more relaxed with age and so that fat bulges out more. The reason the fat in bags does not diminish with age is that it belongs to a different compartment than the superficial fat in the face; it is actually orbital fat, meaning fat which surrounds the eyeball. That is why people often refer to bulging lower eyelid fat as herniated fat.
Reducing the excess fat of the lower eyelid is generally quite straightforward, and as explained below, can be done either from within the eye (transconjunctival) or from outside the eye (open approach). Reducing the excess skin in the lower eyelid is an entirely different matter.
It is frequently not possible in the aging eyelid to surgically remove significant amounts of excess skin because the aging eyelid frequently lacks the support to tolerate such a removal. What this means is that if the excess skin is simply surgically cut away, the lower lid itself will become pulled down. This creates an unsightly appearance called “scleral show,” which means seeing the white of the sclera under the cornea in the lower lid. It can further lead to a phenomena called ectropion, which is an actual outward turning of the lower lid border. These issues can lead to tearing as well as significant dry eye problems in addition to the unsightly appearance it would cause.
For these reasons, Dr. Rapaport assesses each case individually and will advise whether any lower eyelid skin at all can or should be removed. In some cases, a procedure to improve the support of the lower eyelid is performed during lower eyelid blepharoplasty, and this is called a canthoplasty. This is a tightening of the actual support structure of the lower lid. It is not a simple procedure, and will be reviewed in detail if recommended.
What Happens During a Lower Blepharoplasty Procedure?
For eyelid puffiness primarily caused by excess fat, Dr. Rapaport can often remove the fat using a transconjunctival approach. With this approach, the incision is made inside the lower eyelid, and excess fat is either removed or repositioned to achieve an improved contour of the lower lid. Since the incision is inside the eyelid, no sutures are required in this case, and there is absolutely no visible scar. In cases where patients have excess skin of the lower eyelid, Dr. Rapaport will choose to make the incision in an inconspicuous site along the lash line and smile creases of the lower lid. Excess fat and skin are then trimmed away, and the incision is closed with fine sutures.
Anesthesia for Blepharoplasty Surgery
Upper Eyelid Blepharoplasty can readily be performed by Dr. Rapaport under local anesthesia. This is done frequently with oral pre-medication using a pill such as Ativan to help with relaxation. Most patients still prefer IV sedation. In this situation, the patient essentially has no memory of the procedure, but the anesthesia is minimally invasive, with the patient breathing on his/her own, and having a very rapid recovery.
Lower Eyelid Blepharoplasty is almost always performed with IV sedation.
Recovery Following Blepharoplasty
For the first night after blepharoplasty, it is important to rest with the head of the bed elevated about 30 degrees. Cold compresses are applied intermittently for the first week. It is also very important to avoid any straining or bending over for that first week. Sutures, if they are used, are removed on or around the fifth day after surgery. Patients can return to non-straining activities within 1 or 2 days, but many will take 5-7 days off because of the bruising that commonly occurs following the surgery. Dr. Rapaport typically allows makeup to be applied one week after blepharoplasty.
If you have questions regarding treatment options, or would like to schedule a consultation with Dr. Rapaport, please call 212.249.9955 or email firstname.lastname@example.org.