Blepharoplasty(Eye Bags)

The Basics
The eyes play an important role in the beauty of the face. They reflect emotions such as anger, fear, coyness, and happiness. The surgery to improve the aging affects on the lids is called Blepharoplasty. This mainly improves the baggy lids.

The skin around the eyes changes with age. It loses elasticity, becoming loose and redundant; the muscles around the eyes become slack; and excess fat in the pocket above and below the eyes become prominent. Certain sleep patterns can affect the eyes. Genetics and exposure to the sun play important role in the aging of the eyes.. The eyelids are also affected by gravity and muscle pull, such as habitual squinting, allergies, cardiac problems, as well as thyroid and renal disorders can also be responsible for eyelid changes. The various components of the baggy lids can be excess fat, redundant skin and/ or the lax muscles around the eyes,

Bags which form at the junction of the lower eyelids and upper part of the cheeks are medically referred to as malar bags. These bags are due to chronic swelling not muscle weakness or excessive fat accumulation and will not be improved by a blepharoplasty. Malar bags may be excised directly during eyelid surgery, but are best treated by laser resurfacing. Blepharoplasty also cannot correct or alter deep, dark circles under the eyes, cyclical edema, allergies, crow’s feet, and fine wrinkles around the eyes. Other types of intervention are required to deal with these problems.

Type of Aneasthesia

Most Blepharoplasties are performed under lacal aneasthesia on a day care basis that means you can go home in the evening after the operation.

The Procedure
When a facelift is combined with upper and lower eyelid surgery, the upper eyelids are corrected first. The surgeon will remove the appropriate amount of excess skin and fat, leaving symmetrical eyelids with inconspicuous incisions and well defined eyelid creases.

Upper eyelid:

The following are the steps taken to improve the upper eyelid (the procedure usually takes around one hour from start to finish);

• A surgical plan is drawn on the eyelids.
• A local anesthetic is administered. In most cases an intravenous sedation to relax the patient is used in conjunction with the local anesthetic.
• An incision is made with either a scalpel or a carbon dioxide laser. The CO2 laser seals the blood vessels and nerve endings as it cuts so there is less bleeding during the procedure. If a scalpel is used bleeding is controlled with bipolar diathermy.
• First the excess skin is removed which exposes the underlying muscle.A strip of muscle 5 to 8 mm (1/8 to 1/4 inches) wide is removed to create a deeper eyelid crease.
• After removal of muscle exposed fat pads are assessed. Excess fat is removed carefully.
• The incision is closed with sutures which are removed in 3 to 5 days.

Lower eyelid:

There are two methods used to perform lower eyelid correction, an external incision technique or a transconjuctival technique.

• In both cases a local anesthetic in combination with intravenous sedation is administered.
• The external technique involves the removal of excess fat, skin and muscle, through an incision made in the skin just below the eyelashes. The eyelashes are never cut.
• The transconjunctival technique is mainly suitable for cases which have only excess fat, but no excess skin or muscle.It is being performed through an incision usually made within the inner lining of the eyelid.

• Once the incision has been made below the lower eyelash using the external technique, a skin and muscle flap is created exposing three fat pads; the excess fat is carefully removed. A skin and muscle flap is not necessary when the incision is made in the inner lining of the conjuctival because the fat pads are readily accessible. They are simply opened and the excess fat is removed. The surgeon is careful not to remove too much fat or the eye will have a sunken appearance.

• The transconjuctival technique is usually performed in combination with laser resurfacing to smooth out the texture of the skin and to remove the wrinkles around the eyes. It is for this reason that the excess skin and muscle do not need to be removed because the laser resurfacing causes the redundant skin to tighten. Sutures are not required when the transconjuctival technique is used; the incision is simply left to heal on its own.

• When the external technique is used, excess skin, and muscle are removed. Care is taken not to remove too much skin or the sclera (the white part of the eye below the iris) will show. The incision is closed and sutures are removed or absorbed in 3 to 5 days.
  
  

FAQs

Does the surgery hurt?

There is no pain during the surgery. As the freezing wears off, some discomfort will be felt which can easily be managed with painkillers. Acetylsalicylic acid (aspirin) products or similar agents should not be used as they encourage bleeding.

What will the eye look like after the surgery?

Some swelling and bruising will occur immediately after surgery, but it is unlikely the eyes will swell shut. It usually takes 10 to 14 days for swelling and bruising to disappear, thereafter normal activities can be resumed.

Eyelid surgery makes the eyes look brighter and wider. The puffiness from the excess fat will be gone as well as the redundant skin and bagginess. If the lower eyelid transconjuctival technique with the CO2 laser is used in combination with laser resurfacing the wrinkles and texture changes around the eyes will also be improved. These problems are not addressed if the external technique is used.

Will there be a scar?

The incision for an upper lid blepharoplasty is placed in the crease of the eyelid so the scar will be inconspicuous when healed. Most eyelid scars fade rapidly after surgery and are quite faint in 6 weeks to 3 months. They may, however, take as long as 6 months to a year to fade, depending on how quickly the patient heals. The scar will not fade faster if a special diet is eaten or if creams such as vitamin E are applied. Makeup may be applied to camouflage the scar until it fades.

No visible scar occurs with a lower lid transconjunctival blepharoplasty because the incision is inside the eyelid. There is a scar just under the eyelashes of the lower lid when the external technique is used. in woman this scar can be camouflaged with makeup, men however find it more difficult to manage and generally prefer the transconjuctival technique for this reason.

When may makeup, glasses and contact lenses be worn?

Makeup could be used to camouflage bruising 4 days after the surgery. Makeup however should not be applied to the actual scar until 10 days after surgery, and false eyelashes should not be used for 3 weeks.

Eyeglasses may be worn immediately after the surgery. Contact lenses should not be worn for at least 3 weeks to avoid pulling and stretching the incision.

Are there any restrictions on driving and flying?

Driving should be avoided for 2 or 3 days after the surgery. As to flying there is no restriction unless you are the pilot.

What is the ideal age for blepharoplasty?

Cosmetic surgery, including that of the eyes, can be performed at any age. Anyone who feels young but looks old is a candidate for cosmetic surgery. The actual chronological age may be a consideration, only because younger tissue tends to recover better than older tissue does.

Can blepharoplasty be combined with other surgery?

Eyelid surgery is often performed in combination with other cosmetic procedures, such as laser resurfacing, facelifts, facial liposuction, and brow lifts.

How long do the effects of a blepharoplasty last?

The surgery do not stop the aging process, soft tissue around the eyes will continue to develop the signs of aging. It is however unlikely that a second full blepharoplasty will be needed. Usually, secondary procedures, such as lid tightening or laser resurfacing, are sufficient to correct minor imperfections around the eyes in the future.

Can eyelid surgery affect vision?

The surgeon is always very careful when working in the area of the eye, since there is a danger that the eye itself could be harmed.

Though rarely a problem, excess swelling and large hematomas could cause enough pressure around the eyes to affect a person’s sight and in the worst case scenario may cause blindness. For this reason, the physician will monitor vision carefully.

What are the alternatives to eyelid surgery?

In the early stages of eyelid drooping, resurfacing with the CO2 laser may be adequate to tighten the skin around the eyes so that eyelid surgery can be postponed for a number of years.

Other alternatives approaches for improving the eye area are either hazardous or ineffective. Injecting silicone implants into the eyelids to fill the skin out is medically unsound. Steroid injections into the fat pads in order to shrink the fat have proven to be unsuccessful.

Possible Complications

• Scarring: scars normally fade to fine white lines and are only a problem in patients who are hereditarily predisposed to develop thick, raised scars. Even if a person is prone to scarring, it may none the less resolve itself over time. Minute amounts of cortisone sometimes are injected into the scar to flatten it and make it less obvious and one of the vascular lasers can remove persistent redness.

• Puffiness: occasionally, lid puffiness is prolonged due to a problem with the lymphatic vessels in the eyelids which, when functioning normally, reduce tissue fluid. This problem usually resolves itself over time.

• Scleral show: A problem that may occur with an external lower lid blepharoplasty is Scleral show, where the whites of the eyes are exposed under the iris. This happens because the scar contracts as it heals, causing the edge of the lower eyelid to be pulled downward. This can occur even in most carefully executed surgery. Scleral show can usually be resolved by upwardly massaging the lower lid on a regular basis over a period of time. If the problem does not resolve itself, then itself too much skin was removed or the lower lid has a poor tone. In the former case, a lid tightening procedure could be done. Any corrective surgery should be postponed a full year following the original surgery in order to ensure that healing is complete. If the lower eyelid is lax 6 months later, a wedge of tissue is removed from the outer third of the lower lid to tighten it.

• Lack of symmetry: if one eyelid looks different from the other after surgery, it is usually due to a difference in the amount of scarring and swelling in each lid. In most cases, this is resolved over time, as the scar heals and the swelling subsides. If the problem persists, either the eyelids were different before the operation and the surgeon did not take this into account, or some variation in the surgery occurred from one eyelid to the other. This is why eyes are always photographed prior to surgery.

• Eyelid lag: an inability to close the eyelids completely is a temporary complication which resolves as the swelling settles and the scar fades. It may be necessary to protect the cornea from drying out until the problem is resolved.

• Numbness: numbness around the eyes may occur, but this is usually temporary and slowly resolves over a few months.

• Hematomas: although extremely rare, excessive bleeding may put pressure on the eye which may result in altered vision or blindness.

What result cause dissatisfaction?

In some cases there may be excess skin remaining in the eyelids. It is usually seen as a drooping eyebrow. A brow lift, rather than further surgery to the eyelid, will correct this problem.

If the lower lid continues to sag, it may be due to malar bags, which are best treated with laser resurfacing.

Eyelid’s surgery will not remove crow’s feet. Laser resurfacing is the best treatment alternative for crow’s feet. However, if a person prefers not to go through the post surgical recovery time required for laser resurfacing, collagen injections may be reasonable alternative.

Noticeable contour irregularities may be due to bulges that occur when there has not been enough fat removed from the fat pads. This is easily corrected by removing more fat. At the other extreme, the eye may look hollowed out or sunken if too much fat has been removed.

Eyelid surgery will not remove dark circles under the eye. In fact, it may worsen the problem because, with removal of fat, the resulting concavity will give an illusion of even darker circles under the eyes if they are due to pigment changes in the skin and not the underlying vasculature showing through the thin transparent skin of the lower eyelid. It may also be possible to resolve the problem using a pigment removal laser such as the Q- switched Nd: yag although it is not always effective.

Prolonged discoloration following extensive bruising may occurs but is usually resolved within a few weeks. In unusual cases, it may take 1 to 2 years to disappear, but bruises are really permanent.