The Blepharoplasty Operation
Surgery on the eyelids may be done as an isolated operation or in conjunction with a facelift, brow lift, or other procedure (see Chapters 11-13). Both upper and lower eyelids can be corrected at the same operative setting; alternately, one pair of eyelids can be corrected as an isolated procedure. The procedure is almost always performed around both eyes.
Blepharoplasty is an outpatient procedure that is typically done with intravenous sedation and local anesthesia. Some surgeons prefer to have a patient remain awake. Certain procedures, especially in the upper eyelids, can be done with local anesthesia in the office. However, lower-eyelid surgery and more invasive techniques may require deeper anesthesia.
Surgery for each set of lids takes about 45 minutes to 1 hour, and the surgery on all four lids lasts 1-1/2 to 2 hours. If all four lids are being operated upon, most surgeons will perform the upper-lid operation first. Patients typically go home shortly after the sedation has worn off. Upper-Eyelid Surgery The main goals of an upper-eyelid blepharoplasty are to remove excess skin and muscle and correct protruding orbital fat (see Figure XIV-2). Figure XIV-2. Photographs of eyelids before and after surgery. Patients will be positioned either sitting or lying face-up, and after adequate sedation or anesthesia is established, the face and eyes are cleansed with an antiseptic solution. The eyelids are marked carefully after determing the anticipated effect; the marked skin is then excised to remove hanging skin and provide a youthful appearance. After skin removal, a strip of orbicularis oculi muscle is then removed to create a new supratarsal fold (the fold that runs along the upper eyelid, also known as the superior palpebral fold). A small incision is made in the orbital septum (fascia layer) to provide access to the two fat compartments of the upper lid. Excess fat behind the orbital septum is then teased out and removed. Prominence at the sides of the upper eyelid may be caused by an enlarged or hanging lacrimal tear gland, which should not be resected but can be elevated and resecured. The levator muscle may need to be shortened or plicated. Any bleeding is controlled with an electrical device that coagulates the bleeding points, called a bovie (see Chapter Two). The incision is then closed with small sutures. Most surgeons prefer to use a running, continuous stitch located just beneath the surface of the skin, typically with the ends of the sutures held in place with adhesive tape. Lower-Eyelid Surgery Lower-lid blepharoplasty is also designed to remove excess skin and to correct the bags and puffiness caused by fat protrusion (see Figure XVI-3). The amount of skin removed is usually very little because aging occurs to a greater extent in the deeper structures, namely in the orbicularis oculi muscle and three fat compartments, in the lower lid. Excess skin resection leads to ectropion, eyelid retraction with a less protected globe that is both unsafe and unappealing. Figure XIV-3. Photographs of eyelids before and after surgery. …show more content…
Typically, a cutting CO2 laser is used to make the incision.. The procedures are essentially the same as those outlined for upper- and lower-lid blepharoplasty. However, the cutting is done with a laser rather than with knife and scissors. Proponents of laser blepharoplasty believe that there is less oozing, and therefore, less bruising and swelling after surgery.
Recovery
The most common complaints after blepharoplasty are oozing, crusting, swelling, bruising, dry eye, and pain. The pain or discomfort that develops as anesthesia wears off can be readily controlled with prescribed medication. Oozing and crusting may occur but can be limited with good care. After any form of blepharoplasty, using ice packs or ice-soaked gauze and elevating the head for the first 48-72 hours will help minimize swelling.
Bruising and swelling will develop within several hours of the procedure and usually peak at 48 to 72 hours. After surgery on all four eyelids, lids may swell to cause almost complete closure of the eyes. Usually by the fifth day, swelling will have resolved significantly. Bruising is variable, peaking anywhere between several days to a week after surgery. Resolution can be quite rapid over another several days, but it may take up to 10 to 14 days to
Surgery on the eyelids may be done as an isolated operation or in conjunction with a facelift, brow lift, or other procedure (see Chapters 11-13). Both upper and lower eyelids can be corrected at the same operative setting; alternately, one pair of eyelids can be corrected as an isolated procedure. The procedure is almost always performed around both eyes.
Blepharoplasty is an outpatient procedure that is typically done with intravenous sedation and local anesthesia. Some surgeons prefer to have a patient remain awake. Certain procedures, especially in the upper eyelids, can be done with local anesthesia in the office. However, lower-eyelid surgery and more invasive techniques may require deeper anesthesia.
Surgery for each set of lids takes about 45 minutes to 1 hour, and the surgery on all four lids lasts 1-1/2 to 2 hours. If all four lids are being operated upon, most surgeons will perform the upper-lid operation first. Patients typically go home shortly after the sedation has worn off. Upper-Eyelid Surgery The main goals of an upper-eyelid blepharoplasty are to remove excess skin and muscle and correct protruding orbital fat (see Figure XIV-2). Figure XIV-2. Photographs of eyelids before and after surgery. Patients will be positioned either sitting or lying face-up, and after adequate sedation or anesthesia is established, the face and eyes are cleansed with an antiseptic solution. The eyelids are marked carefully after determing the anticipated effect; the marked skin is then excised to remove hanging skin and provide a youthful appearance. After skin removal, a strip of orbicularis oculi muscle is then removed to create a new supratarsal fold (the fold that runs along the upper eyelid, also known as the superior palpebral fold). A small incision is made in the orbital septum (fascia layer) to provide access to the two fat compartments of the upper lid. Excess fat behind the orbital septum is then teased out and removed. Prominence at the sides of the upper eyelid may be caused by an enlarged or hanging lacrimal tear gland, which should not be resected but can be elevated and resecured. The levator muscle may need to be shortened or plicated. Any bleeding is controlled with an electrical device that coagulates the bleeding points, called a bovie (see Chapter Two). The incision is then closed with small sutures. Most surgeons prefer to use a running, continuous stitch located just beneath the surface of the skin, typically with the ends of the sutures held in place with adhesive tape. Lower-Eyelid Surgery Lower-lid blepharoplasty is also designed to remove excess skin and to correct the bags and puffiness caused by fat protrusion (see Figure XVI-3). The amount of skin removed is usually very little because aging occurs to a greater extent in the deeper structures, namely in the orbicularis oculi muscle and three fat compartments, in the lower lid. Excess skin resection leads to ectropion, eyelid retraction with a less protected globe that is both unsafe and unappealing. Figure XIV-3. Photographs of eyelids before and after surgery. …show more content…
Typically, a cutting CO2 laser is used to make the incision.. The procedures are essentially the same as those outlined for upper- and lower-lid blepharoplasty. However, the cutting is done with a laser rather than with knife and scissors. Proponents of laser blepharoplasty believe that there is less oozing, and therefore, less bruising and swelling after surgery.
Recovery
The most common complaints after blepharoplasty are oozing, crusting, swelling, bruising, dry eye, and pain. The pain or discomfort that develops as anesthesia wears off can be readily controlled with prescribed medication. Oozing and crusting may occur but can be limited with good care. After any form of blepharoplasty, using ice packs or ice-soaked gauze and elevating the head for the first 48-72 hours will help minimize swelling.
Bruising and swelling will develop within several hours of the procedure and usually peak at 48 to 72 hours. After surgery on all four eyelids, lids may swell to cause almost complete closure of the eyes. Usually by the fifth day, swelling will have resolved significantly. Bruising is variable, peaking anywhere between several days to a week after surgery. Resolution can be quite rapid over another several days, but it may take up to 10 to 14 days to