Blepharoplasty is surgical modification of the eyelid. Excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.
Blepharoplasty is often done as an elective surgery 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. Asian blepharoplasty or double eyelid surgery is a special type of blepharoplasty that creates a crease in the upper eyelid. This "supratarsal epicanthic fold" is common in many races but absent in about half of Asians. Surgery can artificially create this crease and make a "single-lidded" patient appear "double-lidded".
Blepharoplasty is sometimes needed for functional reasons. When an advanced amount of upper eyelid skin is present, the skin may protrude over the eyelashes and causes 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.
Blepharoplasty is usually 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. Incisions may be made from the inside surface of the lower eyelid (transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed. External skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. This allows for a faster recovery process.
The operation typically takes one to three hours to complete. Initial swelling and bruising resolve in one to two weeks but at least several months are needed until the final result becomes stable. Blepharoplasty's effects are best appreciated by comparing before and after photos of surgical patients.
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
|Transconjunctival blepharoplasty of the right lower eyelid.|
|This section does not cite any references or sources. (January 2013)|
The recovery process after a blepharoplasty may take up to a few weeks. Patients will receive instruction for during the home care and most of the time they receive painkillers that ease the pain caused by the incisions.
The first two days after the operation has been performed, the patient receives an ointment treatment to keep the incisions lubricated. Doctors recommend keeping iced eye pads on the eyes to reduce bruising and swelling. Eye drops may also be prescribed as they may help in pain management and in preventing infections. Patients are recommended to keep their heads higher than the body while sleeping as this will accelerate the recovery process.
Different medications can help in moderating bruises and swelling resulted after surgery and also to accelerate the patient's recovery. One of them is Wobenzym, an agent that helps in moderating swelling. Wobenzym should be administrated the second or third days after surgery and three times a day. The patient's condition will improve without this medication as well as it is only an additional treatment. Auriderm is another medication that has quite a similar effect as Wobenzym. Auriderm must be applied 10 days before the blepharoplasty and twice a day. There are however many products like these that could accelerate one's recovery and they must be discussed with one's surgeon.
The third day after surgery, the patients are advised to keep lukewarm eye pads for comfort and wearing dark glasses for at least one week is also recommended to prevent irritation that may be caused by the wind and sun exposure.
The stitches are usually removed two days after the operation. The patient's eyelids will be discolored and swollen for about seven to ten days, and feel "tight" or "stiff" for a while. Patients should lubricate their eyes by exercising closing their eyes or looking at the ceiling.
During the first few weeks after a blepharoplasty, patients normally experience excessive tearing, light sensitivity and sometimes double or even blurred vision. The whites of the patient's eyes can turn red or have red splotches. These symptoms usually disappear on their own within two or three weeks after the operation.
Wearing contact lenses is prohibited until the incisions are completely cured. Patients who need them will be advised by their doctor when it is safe to wear them again.
Patients who undergo a blepharoplasty may watch TV and are able to read after two or three days after surgery. Patients may go to work in a week or ten days after the operation. The scars may however still be visible, but one can use makeup to cover them.
As a part of blepharoplasty recovery, the patient must avoid bending at the waist for about five days and strenuous activity (especially activities that raise one's blood pressure, such as lifting and rigorous sports) for about ten days to two or three weeks.
Surgery will leave scars, but they are usually well hidden and normally fade in time.
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.” 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. 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 spiritually unethical. This ban was also due to poor hygiene. During the Renaissance, intellectuals rediscovered texts from ancient Greece and Rome illustrating surgical procedures and techniques.
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.
Laser blepharoplasty 
Laser blepharoplasty is the performance of eyelid surgery using a laser instead of a scalpel. Laser blepharoplasty is often combined with laser eyelid rejuvenation, as the two procedures can be performed in conjunction.
Historically there has been some contention as to the categorisation of laser treatment on upper or lower eyelids as blepharoplasty, which is itself by definition surgical. The statutory definition of surgery and that supported by the American College of Surgeons states that surgery is the "treatment ... by any instrument causing localized alteration or transportation of live human tissue, which include lasers.." .
Non-surgical alternatives 
Non-surgical alternatives have shown improvement with patients exhibiting early indications of facial aging. 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 preceded by "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.
In so–called "non-surgical blepharoplasty" topical applications of acids are used to tighten and decrease skin volume in the upper and lower eyelids. 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.
See also 
- Eye surgery
- Cosmetic surgery
- Plastic surgery
- Maxillofacial surgery
- Asian blepharoplasty
|Wikimedia Commons has media related to: Blepharoplasty|
- Kami Parsa, MD
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- John Kitzmiller, “Blepharoplasty, Lower Lid Subciliary” 2006. eMedicine. Ed. 25 September 2006, http://www.emedicine.com/plastic/topic4.htm
- Cecilia Tran,“Preoperative Considerations in Blepharoplasty,” Baylor College of Medicine, 25 September 2006, http://www.bmc.edu/oto/grand/04_22_04.htm
- Grill, C, 'Defining surgery' Bulletin of the American College of Surgeons, May 2012, http://www.facs.org/fellows_info/bulletin/2012/grill0512.pdf