Eyelid Surgery, also called Blepharoplasty, may be required when a person develops flaws in their eyelids. These flaws include excess skin and fat over the natural fold or hanging loose skin impairing vision or puffiness and appearance of tiredness with respect to the upper eyelid. The flaws also include excess skin and fat, fine wrinkles, puffiness, bags and dark circles, droopiness with respect to the lower eyelid.
Also there is the Asian blepharoplasty or double eyelid surgery by which creases in the upper lids are created. The “supratarsal epicanthic fold” which is common among many races, is missing in the people from east and south east of Asia making their eyes appear single lidded. The surgery creates the creases and makes the eyes appear double lidded.
The methods for creating the double eyelid include full incision, part incision or no incision methods and each method has its advantage depending on the patient’s anatomic features and desires.
The origin of the eyelid surgery may be traced back to a much early period, that is to the first century A.D when a Roman, Aulus Cornelius Celus described excision of skin for relaxing the eyelids.
The term blepharoplasty was coined by Von Graefe in 1818 when a surgical procedure was adopted for repairing deformities of the eyelids caused by cancer. In 1951, Dr. Castanares described the fat compartment of the upper and lower eyelids in detail and the eyelid surgery has progressively become very popular in America.
The Procedure: For upper eyelid surgery the excision is done along the natural fold and extends beyond the outside corner into the laugh lines or other existing creases. The scar line gradually fades inside the natural crease line. The excess skin and the fatty tissues are removed through the incision.
For the lower eyelid, the incision is usually done just below the eye lashes. The excess skin, muscle and fat are removed or the fat is re-distributed to eliminate puffiness or bulges. Sometimes, eyelid surgery is performed to correct problems like muscle laxity. To avoid any scar line on the outside or for other reason, most of the time the surgeon and the patient decide to have the incision made inside the lower eye lid through which excess fat may be removed but excess skin cannot be removed. In such cases, the skin of the lower eyelid may be tightened by using laser technique.
The upper and lower eyelid surgeries may be performed on out-patient basis and done under local anesthesia with intravenous sedation or general anesthesia when required in certain conditions. The surgeries take about 1 to 3 hours.
The cost of the upper eyelid surgery is in the range $ 2500 to $3000 while the cost of the lower eyelid surgery is in the range $ 3000 to $3500. If done together, the patients often receive some reduction in the combined price. Unless the eyelid surgeries are for functional reasons such as for removal of partial obstruction to vision, the surgeries are considered as cosmetic in nature and the costs are not covered by insurance.
Recovery: The recovery period may last for several weeks. There may be bruising and pain for which medications including ointments and eye drops may be prescribed by the surgeon.
The patients would be advised to keep their heads higher than their bodies while sleeping to hasten recovery process. The patients must avoid bending at the waist for about five days and refrain from strenuous activity up to two to three weeks after the surgeries.
After two days or so, the patients may be advised to keep lukewarm eye pads for use and wear dark glass for about a week to avoid irritation from the sun and wind.
The stitches are usually removed about two days after the surgery and the eye lids may be swollen and stiff for several days. The patients would be advised to exercise their eyes by closing and looking at the ceiling.
In the initial few weeks, there may be tearing, light sensitivity, blurred vision, and whites of the eyes turning red, but these go away on their own within two to three weeks.
The patients may be able to read and watch TV after two or three days of the procedure and may wear contact lenses only after a time period to be advised by the surgeon.
The patients may rejoin work after seven to ten days of the procedure.
Risks: The incidence of significant complications from eyelid surgeries is quite infrequent. But like in any other surgery, there are risks of blood clots under the skin (hematoma), infection, changes in sensation, allergic reactions, damage to underlying layers, scarring, unsatisfactory results requiring additional procedures. There may also be dryness and irritation in the eyes requiring treatment and eyelid malfunction requiring additional surgery.
The patients should be well advised to consult with their surgeons on how to avoid the potential risks and follow up the surgeons’ advice and instruction fully in pre and post operative phases.