Aesthetic surgery of the eyelid, also known as blepharoplasty, involves the removal of excess loose skin and fat from the eyelids to give the eye a fresher, more alert and rested appearance. With the passage of time and also due to certain hereditary factors, the upper eyelids become heavy and droop over the eyelashes while the lower lids sag, forming skin festoons. A fatty bulge may also form below the lower lids. These problems can be addressed very effectively by blepharoplasty, achieving quite a stunning result.
There is an operation for the upper lid and quite another one for the lower lid. Most often both are done together in a procedure called 4-lid Blepharoplasty. Of all the areas of the body, the eyelids provide perhaps the best outcome for surgical scars. The upper lid incision is hidden in the natural upper lid crease. The lower lid incision is placed a few millimeters below the lid margin, again hidden by the lower eyelashes. I usually perform lid operations with the aid of Radiofrequency device which ensures minimal bleeding [Radiosurgery].
Who is a candidate? The following criteria may help you decide if you are a candidate for Blepharoplasty.
- Excess skin causing a “double fold” of the upper lid
- Visual impairment by the fold of skin.
- Eyelids feel heavy and tired towards the end of the day.
- A puffy appearance of the upper lids.
- Fine wrinkles of the lower lids
- Bags under the lower lids
- Droopy lower lids showing the white below the colored portion of the eye.
- Deep groove and hollow under eye
Your personal consultation will involve a discussion on what you perceive to be the main problems. Also, a complete medical history will be taken with particular emphasis on allergies, high blood pressure, thyroid problems, diabetes and ‘dry eyes’. Patients are advised to see an eye specialist before surgery in order to establish a baseline of eye function and to rule out dry eye.
Upper Blepharoplasty: The upper lid operation is simpler and consists of removal of a carefully measured ellipse of excess skin and muscle plus removal of highly localized fat bulges.
Lower Blepharoplasty: The lower lid operation is different. Here the cut is made just below the eyelashes and the muscle is raised. Deeper fat is partly trimmed, partly redistributed to cover the lower bony rim, in accordance with modern fat-preserving principles. The lower lid is tightened by re-fixing it to the outer bony rim [lateral canthopexy]. The muscle is then overlapped to tighten it. Any excess muscle is removed and finally the excess skin is trimmed prior to closure.
Trans-conjuctival Blepharoplasty: Some young persons may have bulging fat in the lower lid zone. This is usually due to genetic reasons and is most commonly seen in East Asians. For this condition, the surgery is simple being limited to removal of excess fat using a cut on the inner side of the eyelid. There are no external scars.
Refinements: Blepharoplasty has now been extended to achieve more through the same cut. In this, additional procedures are done to lift the tissues of mid-face cheek, thereby giving dramatic results. This is quite often combined with fat grafting for face and lips if required. The area of outer orbit also receives fat grafts to produce a truly dramatic rejuvenation