Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When an advanced amount of upper eyelid skin is present, the skin may hang over the eyelashes and cause a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin. Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete.
The anatomy of the eyelids, patients' skin quality, patients' ages, and the adjacent bony and soft tissue all affect the cosmetic and functional outcomes after blepharoplasty. Factors which are known to cause complications after surgery include failure to recognize factors such as
The manner in which blepharoplasty surgery can alter a person's appearance is best appreciated by comparing before and after photos of surgical patients.
An upper blepharoplasy in someone who is east Asian is termed Asian blepharoplasty or double eyelid surgery. It is the most popular form of cosmetic surgery among those of east and southeast Asian background. Due to anatomic differences between the Asian and occidental eyelid, about half of this population are born without a supratarsal eyelid crease and are called single-lidded. Surgery can be used to artificially create a crease above the eye.
Transconjunctival blepharoplasty involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Because there is no external incision, excess skin can not be removed during the surgery, but skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. This allows for a faster recovery process.
This is a technique using injectable fillers like Restylane or Juvederm to replace volume in the tear trough area between the lower eyelid and the cheek. As we age, some of the fat in the upper central cheek area moves lower and shrinks. This gives a tired appearance to the face as a dark shadow falls into the concavity left behind by the fat loss. This is what we call dark circles under the eyes. Some people have more of a genetic predisposition to this happening than others, but it happens to most people at one point or another with age. Injecting Restylane or Juvederm into this area is very effective in correcting the tired appearance and eliminating most of these dark circles. The technique does not work for people who have much fat bulging inside the lower eyelid or if the indentations are severe. In the former case, blepharoplasty and fat repositioning is the indicated procedure, whereas in the second, fat transfer (fat injection) will fill in the lost volume.
As newer, longer lasting and more effective injectable fillers have come on the market, non surgical alternatives to common cosmetic procedures have become possible. The Non Surgical Blepharoplasty takes 10 minutes to perform, is essentially painless (with some topical numbing cream) and results in little to no bruising. Most people can go back to work immediately. The effects last for 18 months or more. The unusually long duration of effect is probably due to collagen stimulation in the tear trough area, since Juvederm and Restylane usually last only 6 or 7 months when injected elsewhere.
This procedure should be performed with care and only by specialists with training in cosmetic procedures and in the anatomy of the eye area. The medi-spa at the mall is not a good place to have this procedure performed. After the first injection session, the doctor should want to see you again in two weeks or so to make sure no touch-ups are necessary. It is very common to have some swelling or bumpiness after Non Surgical Blepharoplasty. This can sometimes be massaged away by the doctor. If not, there is an enzyme available (hyaluronidase) that dissolves hyaluronic acid (Restylane and Juvederm). Injecting tiny amounts of that into the bulge should reduce it, without dissolving all of the material and losing the effect. Any doctor performing this procedure must be comfortable using hyaluronidase. This should be established during the consultation. If the doctor does not use it, you should move on. Swelling happens all the time and you should not risk having puffy eyes for two years just because your doctor is inexperienced.
Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.
The roots of the present cosmetic advancements began around 3000 years ago with the ancient Egyptians. Documents “written on papyrus text detail how surgeons, even in that primitive age performed reconstructions on lips, noses, and ears using skin grafts cut from folds from the forehead or cheek”. As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Celsus, a first century Roman, described making an excision in the skin to relax the eyelids in his book De Medicine. Knowledge of blood circulation and tissue health were discovered and spread throughout the ancient world allowing techniques to improve. However, during the middle ages, plastic surgery was prohibited because it was viewed as something that was spiritual and unethical. This ban was also due to poor hygiene. Luckily, during the Renaissance, modern intellectuals from ancient Greece and Rome developed text illustrating the rediscovery of surgical procedures and techniques.
As the 19th century approached developments were being made that would eventually be the foundation to modern cosmetic surgery. The First World War was the first major event that really relied on the dedication of surgeons and advancements in cosmetic surgery. This gave doctors a chance to practice and perfect reconstructive surgical procedures. It also prepared medical personnel for the tragedies of World War II and other subsequent catastrophes. As with any medical advancements, the development of surgical techniques goes through a period of trial and error as reconstructive surgery did during World War I. Each improvement eventually becomes the root of future advancements allowing physicians to combine procedures such as a basic lid fat resection and chemical peels ensuring a speedy recovery.