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Blepharoplasty

Our eyes communicate how we are feeling to the world.  Eyelid surgery can restore a more youthful, open appearance to the eye area. The eyelid lift procedure is unique to each patient and will address their specific concerns.  These can include correcting puffiness, sagging skin, wrinkles and aging around the eyes.  Restoring a more rejuvenated, youth appearance to the eye area can increase self-confidence and in cases where sagging skin has affected a patient’s vision, that will be improved as well.

EVALUATION

Evaluation of the upper eyelid consists of determining the amount of excess skin and
fat there is, as well as the position of the eyebrow. If your brow is lower than it should
be, it can be the primary source of the problem and would need to be addressed
separately. If the brow is in satisfactory position, then removing excess skin and fat
may be all that is necessary.

TECHNIQUE

An upper eyelid blepharoplasty alone can be done as an office procedure with a local
anesthetic and oral sedation, if desired. There is very little discomfort with the
numbing process when it is administered slowly.

The proposed amount of skin to be removed is marked in a manner that will result in
an inconspicuous scar that lies in the skin crease above the lashes and into a wrinkle
of a crow’s foot.

The excess skin is removed along with a sliver of underlying muscle, and then the
exposed fat is removed or contoured as needed depending on patients’ individual
needs and anatomy.

Any bleeding is controlled and the incision is closed with fine, dissolvable stitches
which are usually gone in a week.

RECOVERY

Recovery is primarily dependent on the amount of bruising and swelling there is in the
first two to three days. This varies, of course, from one patient to the next. But there
are many things that will be done to help minimize this and expedite the process.
Typically, most patients are quite presentable in one week. Any persistent bruising
can be disguised after this point.

RISKS AND COMPLICATIONS

As with any operation, bleeding and infection are the most common problems that
can occur, but they are rare. Sterile technique, antibiotics, meticulous attention to
detail, and adherence to pre- and post-operative instructions will diminish these risks.

Excessive removal of skin is to be avoided, as it can result in an unnatural appearance
of the eyes and may even cause chronic dry eye syndrome.

Unsightly scars are rare, due to the thinness of the skin, but in some patients it takes several months for the scars to smooth out and blend with the surrounding skin.

LOWER EYELID

EVALUATION

Proper evaluation of the lower eyelid will determine which technique is best for you.
Critical factors to consider are eyelid tone or strength, amount of fat in each of the
three lower lid compartments, and the condition of the excess skin. Other factors,
such as the size of the cheek bones, position of the cheek fat pads, and the amount of
eye protrusion can all effect the ultimate outcome and should be recognized and
considered.

TECHNIQUE

There are several different approaches to the lower eyelid. The recommended
procedure is determined by the condition of your skin, the amount of existing fat
protrusion, and the laxity of your eyelid.

If you have excessive bulging of the lower lid, but no significant wrinkling, then a
transconjunctival approach can be utilized. This is where the fat is accessed from the
inner surface of the lid, away from your eye. Reestablishing a natural contour to the
lower lid without any visible incisions on the outside is the desired outcome.

For those with excess fat and excess wrinkling, then an inside/outside approach is
employed. This combines the transconjunctival technique with either laser
resurfacing of the skin or a skin pinch excisional technique to remove excess lower
lid skin. If you do not have an excess amount of fat bulging, then either laser
resurfacing or a skin pinch technique can be done alone.

For those with an excessive amount of skin folds, wrinkles, and muscle folds requiring
a significant amount of removal, then an incision is created immediately beneath the
lash line and along a line in a crow’s foot. Through this incision the skin and muscle is
elevated, exposing the underlying fat. This can then be repositioned or removed as
necessary. The support structures of the eyelid are secured with deep stitches and the
excess skin and muscle is removed and closed with dissolvable stitches.

RECOVERY

The length of time it takes to recover depends primarily on how much bruising and
swelling you have after the procedure, and which operation was performed. Typically,
most patients are presentable after one week. If the laser was used, redness can be
covered with make-up within one week, if it persists.

RISKS AND COMPLICATIONS

Bleeding and infection are rare, but represent the most common problem associated
with this type of surgery. Good technique, antibiotics, and adherence to the
perioperative recommendations diminish this problem.

The more serious problems arise from patients with poor eyelid tone who require a subciliary (under the lash line)
approach. Because the main support structure of the lower lid (orbicularis oculi
muscle) is incised, it becomes weak until healing is complete. This can lead to poor
position of the eyelid or exposure of the eye resulting in excessive dryness and a poor
cosmetic result. To help prevent this, the cartilage of the lower lid is suspended in
place to maintain its position and provide needed support. Judicious removal of skin,
fat, and muscle is paramount as well.

Incisional scars heal extremely well, but may
take some time to acquire the normal color of the surrounding skin. This is true of any
laser resurfacing techniques as well.

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