Blepharoplasty

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This article may require cleanup to meet Wikipedia's quality standards. Please improve this article if you can. (September 2008)

The incisions made during an upper eyelid blepharoplasty procedure.

Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons.

When an advanced amount of upper eyelid skin is present, the skin may protrude over the eyelashes and causing a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.

Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete.

The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect the cosmetic and functional outcomes. Factors which are known to cause complications include:

• dry eyes - which may become exacerbated by disrupting the natural tear film
• laxity (looseness) of the lower lid margin (edge) - which predisposes to lower lid malposition
• prominence of the eye in relation to the malar (cheek) complex - which predisposes to lower lid malposition

The fat (yellow tissue) and skin removed from a quadruple blepharoplasty. Lower-lid fat was removed using the transconjunctival technique.

The manner in which blepharoplasty surgery can alter a person's appearance is best appreciated by comparing before and after photos of surgical patients.

An upper blepharoplasy in someone who is east Asian is termed Asian blepharoplasty or double eyelid surgery.^[1] It is the most popular form of cosmetic surgery among those of east and southeast Asian background^{[citation needed]}. Due to anatomic differences between the Asian and occidental eyelid, about half of this population are born without a supratarsal eyelid crease and are called single-lidded. Surgery can be used to artificially create a crease above the eye.

Transconjunctival blepharoplasty involves removing lower eyelid fat through an incision on the back of the eyelid, eliminating the need for an external incision. Because there is no external incision, excess skin can not be removed during the surgery, but skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. ^[2] This allows for a faster recovery process.

[edit] History

Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.

The roots of the present cosmetic advancements began around 3000 years ago with the ancient Egyptians. Documents “written on papyrus text detail how surgeons, even in that primitive age performed reconstructions on lips, noses, and ears using skin grafts cut from folds from the forehead or cheek”. ^[3] As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Celsus, a first century Roman, described making an excision in the skin to relax the eyelids in his book De Medicine.^[4] Knowledge of blood circulation and tissue health were discovered and spread throughout the ancient world allowing techniques to improve. However, during the middle ages, plastic surgery was prohibited because it was viewed as something that was spiritual and unethical. This ban was also due to poor hygiene. Luckily, during the Renaissance, modern intellectuals from ancient Greece and Rome developed text illustrating the rediscovery of surgical procedures and techniques.^{[citation needed]}

As the 19th century approached developments were being made that would eventually be the foundation to modern cosmetic surgery. The First World War was the first major event that really relied on the dedication of surgeons and advancements in cosmetic surgery. This gave doctors a chance to practice and perfect reconstructive surgical procedures. It also prepared medical personnel for the tragedies of World War II and other subsequent catastrophes. As with any medical advancements, the development of surgical techniques goes through a period of trial and error as reconstructive surgery did during World War I. Each improvement eventually becomes the root of future advancements allowing physicians to combine procedures such as a basic lid fat resection and chemical peels ensuring a speedy recovery.

[edit] Non-surgical alternatives

Non-surgical alternatives have shown improvement with patients exhibiting early indications of facial aging. Lasers, chemical peels, botulinum toxin, and dermal fillers are all used in some degree to treat periorbital tissue. Although effective, these treatments are not technically "blepharoplasty" and yet some practitioners refer to any treatment involving the eyes as such; often precededby "laser", "non-surgical" or "lunch-time". Botulinum toxin, it should be noted, is used to relax the muscles in the forehead and between the eyes, therefore not addressing most of the issues a patient seeking a blepharoplasty would want fixed.^{[citation needed]}

In so called "non-surgical blepharoplasty" topical applications of acids and/or the use of lasers are used to tighten and decrease skin volume in the upper and lower eye lids. Injectable dermal fillers are also used to temporarily increase volume in the trough area between the lower eyelid and the cheek. These techniques are effective yet have not replaced surgical treatments, and should not be confused with blepharoplasty, which treats not only the superficial skin tissue, but also underlying connective and muscle tissues.

[edit] See also

• Eye surgery
• Oculoplastics
• Cosmetic surgery
• Plastic surgery
• Maxillofacial surgery
• Asian blepharoplasty

[edit] Image Gallery

[edit] References

[edit] External links

• Blepharoplasty images
• Video, 05/31/2008