In the patients who have bulging upper eyelid skin and a loss of definition of the eyelid crease, upper blepharoplasty is the operation of choice. It opens the eyes, removes the excess hooding, improves visual obstruction and the scar, although always present. is concealed in the upper eyelid crease.
It opens the eyes, improves visual obstruction and appearance, all with a virtually invisible scar.
The upper lids need to be assessed in relation to the forehead and the eyebrow position. Often the brows have drooped as well and this makes the extra skin around the eyes more noticeable. Occasionally the problem is not to do with the eyelid skin at all and a brow lift may be needed instead.
A medicare item number may be applicable in some patients.
In all patients the operation involves removal of a conservative amount of skin and this part of the operation is virtually risk free. This gives most (about 80%) of the final cosmetic result. This scar sits in the natural crease of the eye such that when the eye is open it is invisible. The scar can only be seen when the eye is closed and is imperceptible even then. Select patients will also benefit from removal of fat behind the eye which gives the final 20% of the result. This fat is often seen as bulging on the inner aspect of the upper eyelid.
A common misperception is that a lower eyelid tuck is the same as an upper but unfortunately nothing could be further from the truth. A lower lid blepharoplasty is a much more difficult operation and is less predictable than the upper lid. It is designed to remove the bags under the eyes and improve the hollow tear-trough deformity. The incision is placed just under the lid margin below the eyelashes and usually heals very well.
Once again the lower lids cannot be observed in isolation and need to be assessed with the midface (cheek region). A common occurrence is that the midface has descended with age and this causes the lower eyelid to be longer than it should be as the junction between the eyelid skin and the cheek also drops (lid-cheek junction). This causes a long eyelid which is an obvious sign of ageing.
In concept a lower blepharoplasty is similar to the upper eyelid in respect to the major steps of the procedure being the same – which is to remove excess skin and fat. The same very rare risk of blindness exists as with the upper lid however the main risk from the operation is called ectropion or in its mildest form – scleral show. This is where the lower lid is pulled down and the white of the eye becomes more obvious.
In patients who only have bulging fat and no skin excess, an incision can be made inside the lower eyelid and the fat can be removed with no visible scar – this is call a transconjunctival blepharoplasty.
If you suffer from dry or irritated eyes it is important to inform you surgeon as this may be temporarily exacerbated after surgery. Typically the recovery involves bruising and swelling (a black eye) for about a week. If performed alone without other procedures then it can be done as a day case in an accredited hospital under twilight or general anaesthesia. In select patients it is possible to do skin only upper blepharoplasty in the consulting rooms under local anaesthetic.