Indications for upper eyelid blepharoplasty include redundant and lax eyelid skin (dermatochalasis) and preaponeurotic fat herniation (steatoblepharon) that result in either functional visual symptoms or cosmetic concerns in affected patients. Dermatitis of the redundant skin can also be an indication for surgery.
As we age, the decline in collagen and elastin production can cause eyelid skin to sag, leading to a condition known as eyelid ptosis. This occurs when the skin’s descent becomes noticeable, and can be caused by the detachment of fibers connecting the eye-opening muscles. In some cases, fat can protrude into the thin eyelid tissue due to weakened connective fibers, resulting in puffy and droopy eyelids. Brow ptosis can also contribute to eyelid ptosis, requiring a brow lift for correction. To develop an effective treatment plan, it’s essential for a plastic surgeon to identify the underlying cause of eyelid ptosis. Additionally, the surgeon will assess for dry eyes and adjust the surgical procedure and post-operative care accordingly.
A surgeon will perform a thorough examination and take multiple measurements to achieve the best outcomes. Photographs are taken to document your appearance both before and after the procedure.
Before your eyelid surgery, the doctor will ask you to avoid smoking, drinking alcohol, and taking blood-thinning medications and supplements. If using a general anesthetic, you’ll be asked to fast the night before your surgery. You’ll also want to arrange for a ride home ahead of time.
First, a surgeon will inject a local anesthetic into your eyelid. This will help numb the area so you don’t feel any pain or discomfort during the procedure. In some cases, a general anesthetic may be used.
During an upper blepharoplasty, a surgeon makes incisions along the eyelid crease so they can then peel back excess skin and remove bulging fatty tissues. Any loose skin is removed before a surgeon reshapes the eyelid and closes the incision. Sutures may be needed to close the incision.
In all, an upper blepharoplasty may take up to 2 hours to complete. This timeframe doesn’t include preoperative and postoperative time, though you’ll likely go home the same day of your surgery.
After eyelid surgery, a doctor may place you in a recovery room to make sure you’re well enough to go home. Before being discharged, they’ll speak with you about using cold compresses or ointments on your eye and give you prescriptions for pain medications, if needed.
The procedure may be done with local or general anesthesia. Technically, the procedure involves identifying the upper eyelid crease on each eyelid and designing a skin excision that removes enough skin to alleviate the issue and preserves enough to allow normal eyelid closure. In some cases, a small amount of the orbicularis oculi (the muscle that closes the eyelid) is removed. Fat is typically preserved over the middle of the eyelid, but some removal may help with aesthetic contour in cosmetic eyelid surgery. When the procedure is complete, the eyelid is closed with sutures. The incision should lie in the eyelid crease, making it less visible after healing.
Typically, patients may have mild bruising or swelling around the eyes for 10 to 14 days. Some surgeons may recommend avoidance of makeup for 2 to 3 weeks. Glasses may be worn immediately, but patients may be instructed to avoid contact lenses for a few weeks, depending on surgeons’ preferences.
Complications of blepharoplasty are relatively rare. The primary issue to consider is removal of too much upper eyelid skin, resulting in difficulty closing the eye. This in turn may cause chronic dry eye issues and pose a risk of injury to the cornea. For this reason, conservative skin excision is recommended. Other complications include ptosis of the eyelid (due to injury of the levator muscles), asymmetry of the eyelids, or blindness, which is exceedingly rare.
Upper eyelid surgery is good for at least 5-7 years, and the results may last the rest of your life. Lower eyelid surgery rarely needs to be repeated. Of course, your eyes will still age after the procedure.
If your lids sag again, a forehead lift rather than another eye lift may be the preferred procedure.
Keep in mind that you won’t immediately look your best after surgery. You’ll have bruising and swelling for up to about 2 weeks, and small scars that will take a few months to fade completely. However, once you have healed fully, you can expect to look more youthful and better rested, which should help you feel more self-confident. And, if your vision had been affected by your eyelids, you should be able to see better.
Your doctor will probably put ointment in your eyes to keep them moist and cover them with cold compresses while you’re in the recovery room. Right after surgery, you may have blurry vision from the ointment and be sensitive to light. Your eyes may feel dry or watery.
It will help to put ice packs on your eyes and sleep with your head raised the first night after surgery. Your doctor will give you detailed instructions for taking care of yourself.
While some forms of blepharoplasty may treat the under-eye area, an upper blepharoplasty involves the upper eyelid only.
While surgery isn’t the best option for everyone, a blepharoplasty may help treat upper eyelid concerns. Read on to learn more about this procedure, including the possible risks and recovery considerations you may wish to discuss with a doctor or healthcare professional.