Blepharoplasty (Greek: blepheron, “eyelid” + plassein “to form”) is the plastic surgery operation for correcting defects, deformities, and disfigurations of the eyelids; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning (or both) of excess tissues, such as skin and adipocyte fat, and the reinforcement of the corresponding muscle and tendon tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the periorbita, which is the area from the eyebrow to the upper portion of the cheek.
The operative goals of a blepharoplastic procedure are the restoration of the correct functioning to the affected eyelid(s), and the restoration of the aesthetics of the eye-region of the face, which are achieved by eliminating excess skin from the eyelid(s), smoothing the underlying eye muscles, tightening the supporting structures, and resecting and re-draping the excess fat of the retroseptal area of the eye, in order to produce a smooth anatomic transition from the lower eyelid to the cheek.
In an eye surgery procedure, the usual correction or modification (or both) is of the upper and the lower eyelids, and of the surrounding tissues of the eyebrows, the upper nasal-bridge area, and the upper portions of the cheeks, which are achieved by modifying the periosteal coverings of the facial bones that form the orbit (eye socket). The periosteum comprises two-layer connective tissues that cover the bones of the human body: (i) the external layer of networks of dense, connective tissues with blood vessels, and (ii) the internal, deep layer of collagenous bundles composed of spindle-shaped cells of connective tissue, and a network of thin, elastic fibres.
The thorough pre-operative medical and surgical histories, and the physical examination of the patient’s periorbital area (eyebrow-to-cheek-to-nose), determine if the patient can safely undergo a blepharoplasty procedure to feasibly resolve (correct or modify, or both) the functional and aesthetic indications presented by the patient. Sequentially, lower eyelid blepharoplasty can successfully address the anatomic matters of excess eyelid skin, slackness of the eye-muscles and of the orbital septum (palpebral ligament), excess orbital fat, malposition of the lower eyelid, and prominence of the nasojugal groove, where the orbit (eye socket) meets the slope of the nose.
Concerning the upper eyelid, a blepharoplasty procedure can resolve the loss of peripheral vision, caused by the slackness of the upper-eyelid skin draping over the eyelashes; the outer and the upper portions of the field of vision of the patient are affected, and cause him or her difficulty in performing mundane activities such as driving an automobile and reading a book.
A blepharoplasty procedure usually is performed through external surgical incisions made along the natural skin lines (creases) of the upper and the lower eyelids, which creases then hide the surgical scars from view, especially when effected in the skin creases below the eyelashes of the lower eyelid. According to the technique applied by the plastic surgeon, the incisions can be made from the conjunctiva, the interior surface of the lower eyelid, as in the case of a transconjunctival blepharoplasty. Such a technique permits the excision (cutting and removal) of the lower-eyelid adipocyte fat without leaving a visible scar, but, the transconjunctival blepharoplasty technique does not allow the removal of excess eyelid-skin.
A blepharoplasty operation usually requires 1.0–3.0 hours to complete. Post-operatively, the initial swelling and bruising consequent to the surgery will subside and resolve with 1–2 weeks; the final, stable results of the blepharoplastic correction will become apparent after several months. The results of a blepharoplasty procedure are best appreciated by comparing pre- and post-operative (before-and-after) photographs of the eye region of the patient.
The anatomic condition of the eyelids, the (wear-and-tear) quality of the patient’s skin, his or her age, and the general condition of the adjacent tissues, consequent to the anatomic conditions of the patient, affect the functional and aesthetic results achieved with the eyelid surgery. Additional to the anatomic conditions of the eye region of the patient, the occurrence, or not, of medical complications is determined by factors such as:
- Dry-eye syndrome — which can become exacerbated by the disruption of the natural, lacrimal (tear) film of the eyes
- Palpebral skin laxity — looseness of the lower eyelid margin, which predisposes the lower eyelid to malposition
- Eyeball prominence — the protrusion of the eyeball in relation to the malar (cheek) complex, which predisposes the lower eyelid to malposition
|Transconjunctival blepharoplasty of the right lower eyelid.|
Asian blepharoplasty (double eyelid surgery) is a blepharoplasty procedure used to create a supratarsal epicanthic fold in the upper eyelid of the patient who lacks such a crease. The supratarsal epicanthic fold is common to most ethnic groups, but is absent in approximately half of the Asian.
|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 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 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.
- Eye surgery
- Cosmetic surgery
- Plastic surgery
- Maxillofacial surgery
- Asian blepharoplasty
|Wikimedia Commons has media related to Blepharoplasty.|
- Kami Parsa, MD
- Pan, Brian S, Lower Lid Subciliary Blapharoplasty (2011)
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- 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