Summary

Blepharoplasty surgery is shown when the eyelids require recontouring. Specifically, blepharoplasty is most useful when excess skin needs to be removed, the muscles are enlarged or require tightening, or eye fat needs to be removed or redistributed. Upper eyelid lift surgery typically involves an incision made in the natural crease above the eye, through which your cosmetic surgeon will remove a precise amount of excess skin and fat and adjust the surrounding muscles to make the desired improvements. There are a variety of surgical techniques that cosmetic surgeons can use to improve the lower eyelids; incisions are located on the outer edge of the lower eyelid, just beneath the eyelashes, or inside the eyelid. Depending on the case, I may remove excess, sagging skin or tighten the lower eyelid muscle to supply the most natural, effective results.

Blepharoplasty surgery is indicated when the eyelids require recontouring. Specifically, blepharoplasty is most useful when excess skin needs to be removed, the orbicularis oculi muscle is hypertrophic or requires tightening, or orbital fat should be removed or redistributed.

Patient Selection and Preoperative Evaluation of Eyelid Lift (Blepharoplasty)

As is suitable before performing any eyelid or periorbital procedure, the patient assessment begins with measuring visual acuity using a standard eye chart or a near card. The visual acuity is recorded in the table. The eyebrow position is assessed by placing the patient upright with the eyes gazing straight ahead. In this manner, the eyebrows and forehead are assessed, noting height above the orbital rim, the presence of horizontal furrows, and photoaging of the skin. The eyebrows are examined for the ROOF pad’s position, contour, and fullness as manifested by the prominence of the superior lateral orbital rim below the eyebrow. The position of the globe is noted relative to the orbital rim. In the setting of a flattened malar eminence, a shallow orbit, or axial myopia (seen in a near-sighted patient with a large globe), the eye will appear prominent, and the upper and lower eyelids may appear retracted. In such cases, removal of tissue from the eyelids must be performed with exceptional care as the proptosis appearance of the globe may be emphasized, creating an aesthetically unacceptable “staring” look and possibly even limiting the ability of the eyelids to close completely. Exophthalmometry measurements may detect true proptosis. I should then turn attention to the upper eyelid itself. The eyelid position is observed, and retraction or ptosis is noted. The skin is inspected for evidence of medial canthal webs or epicanthal folds, wrinkling, old surgical scars, pigmentary change, and tumors or other defects, which may need to be addressed. The superior sulcus is examined for fullness or concavity. Gentle pressure on the globe through a closed eyelid will demonstrate the size and position of the central and nasal fat pads. If the superior sulcus is relatively concave preoperatively, I should avoid aggressive resection of orbital fat as this may produce excessive indentation of the superior fornix.

Next, the lateral portion of the eyelid is examined for the presence of fullness, which may represent brow ptosis, the descent of the ROOF into the eyelid, prolapse of the lacrimal gland, or a combination of these factors. The position and definition of the upper eyelid crease are noted. If the ridge is poorly defined or there is an asymmetry between the eyelids, I should use the mirror to demonstrate this difference. The “normal” position of the upper eyelid crease is slightly higher in females than males but again will vary from one individual to the next. There are significant differences in eyelid crease position and contour between Asian and Occidental eyelids. Because of the social significance of this feature by most Asian societies, these differences must be recognized and respected. Patients usually are much more likely to notice a difference between their eyelids after surgery due to the careful attention typically given to the lids during the postoperative recovery period. Finally, a comprehensive ophthalmic examination is completed.

Why Consider Eyelid Lift (Blepharoplasty)?

Our eyelids are home to the thinnest, most delicate skin on our bodies, so it’s no surprise that signs of aging will begin to appear around our eyes earlier than in most other areas. Aging eyelids can affect a person’s appearance in ways beyond just looking older—because so much emotion is expressed with our eyes, sagging, drooping eyelid skin can cause a tired, sad, or even angry appearance, also when a person feels great. Cosmetic eyelid lift surgery is designed to help counteract these changes and restore a naturally refreshed, youthful appearance to the eyes. The results can be life-enhancing, helping a patient feel more confident in their appearance. If others mistakenly perceive you as tired or upset, an eyelid lift can help your eyes more accurately portray your emotions. Also, if sagging eyelid skin obstructs your ability to see, eyelid lift surgery can eliminate the problem and open your eyes more fully.

Who is the right candidate for Eyelid Lift (Blepharoplasty)?

• Good candidates for eyelid lift surgery include:
• Healthy individuals with no medical conditions that can impair healing
• Nonsmokers
• Individuals with a positive outlook and realistic goals
• Individuals without severe eye conditions

Remember that the eyelids are part of the face. The appearance of a drooping upper lid may also be due to the relaxation of the forehead skin and eyebrows. Sometimes stretching out of the upper eyelid muscle may cause a drooping eyelid. This is called eyelid ptosis and requires a different surgical treatment. Prof Moawad will evaluate your facial anatomy thoroughly and will discuss what procedures might best remedy your concerns.

What should I Expect During a Consultation for Eyelid Lift (Blepharoplasty)?

During your eyelid lift surgery consultation, be prepared to discuss:

• Your surgical goals
• Medical conditions, drug allergies, previous medical treatments, and precisely any problems you have had with your eyes
• Current prescription medications, including vitamins, herbal supplements, alcohol, tobacco, and drug use
• Previous surgeries

Your Cosmetic surgeon will also:

• Evaluate your general health status and any pre-existing health conditions or risk factors
• Take photographs
• Discuss your eyelid lift surgery options
• Recommend a course of treatment
• Discuss likely outcomes of eyelid lift surgery and any potential risks
• Discuss the type of anesthesia that I will use

It’s natural to feel some anxiety, whether excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with your plastic surgeon.

What are the Risks of Eyelid Lift (Blepharoplasty)?

The decision to have plastic surgery is highly personal. You will have to weigh the potential benefits of achieving your goals with eyelid lift surgery’s risks and possible complications. Only you can make that decision for yourself. You will be asked to sign consent forms to ensure that you fully understand the procedure and any risks and potential complications.

• Anesthesia risks
• Swelling and bruising
• Bleeding from the incision lines
• Dryness to the eyes
• Sensitivity to the sun or other bright light
• Difficulty closing your eyes
• Ectropion, an outward rolling of the lower eyelid
• Infection
• Lid lag, a pulling down of the lower eyelid, may occur and is often temporary.
• Temporary or even permanent change in vision and the infrequent chance of blindness
• Changes in skin sensation or numbness of the eyelashes
• Pain, which may persist
• The possible need for revision surgery
• Unfavorable scarring

I will thoroughly discuss these risks and others before your consent. You must address all your questions directly with your plastic surgeon.

How should I prepare for Eyelid Lift (Blepharoplasty)?

In preparing for eyelid lift surgery, you may be asked to:

• Get lab testing or a medical evaluation
• Take certain medications or adjust your current medications
• Stop smoking
• Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding and bruising.
• Eyelid lift surgery should be performed in MSI office-based surgical facility. Be sure to arrange for a friend or family member to drive you to and from surgery and stay with you the first night following surgery.

Eyelid Lift (Blepharoplasty) Surgical Options

Eyelid lift surgery encompasses several different surgical techniques; which techniques a cosmetic surgeon will depend on a patient’s anatomy and the changes that need to be made to achieve a patient’s goals. For any given patient, an eyelid lift may include upper eyelid lift surgery, lower eyelid lift surgery, or both.

Upper eyelid lift surgery typically involves an incision made in the natural crease above the eye, through which your cosmetic surgeon will remove a precise amount of excess skin and fat and/or adjust the surrounding muscles to make the desired improvements.

There are a variety of surgical techniques that cosmetic surgeons can use to improve the lower eyelids; incisions are generally located on the outer edge of the lower eyelid, just beneath the eyelashes, or inside the eyelid. Your cosmetic surgeon will explain the approach they determine is best for you. Through the incisions, your cosmetic surgeon will remove or reposition fat to create a smooth, natural contour beneath the eyelid. Depending on the case, excess, sagging skin may be removed, or the lower eyelid muscle may be tightened to provide the most natural, effective results. Lower eyelid transconjunctival blepharoplasty is readily accomplished using the CO2 laser or standard incisional devices (radiofrequency)

Combining Eyelid lift surgery with Another Procedure

If you are like many patients, you may want to address aging in a few different areas of your face. While eyelid lift surgery alone can significantly rejuvenate your appearance, it’s quite common to have a facelift, brow lift, or both performed in conjunction with an eyelid lift to achieve more comprehensive facial rejuvenation.

What are the steps of Eyelid Lift (Blepharoplasty)?

An eyelid lift surgery procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best option for you.

Step 2 – The incision

The incision lines for eyelid lift surgery are designed so the resultant scars will be well concealed within the natural structures of the eyelid region. The upper eyelid can be corrected through an incision within the natural crease on the eyelid. This allows for the removal or repositioning of fat deposits, tightening of muscles, and replacement of excess skin. Conditions of the lower eyelid may be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelid is removed. Again, the excess fat can be repositioned or removed. A transconjunctival incision, created on the inside of the lower eyelid, is an alternative technique to correct lower eyelid conditions and redistribute or remove excess fat. With this technique, no skin is removed.

Step 3 – Closing the incisions

Eyelid incisions typically are closed with sutures or skin glue. Sutures are removed within one week. Prof Moawad may also suggest the use of a laser or chemical peel to reduce discoloration of the lower eyelids.

Step 4 – See the results

The results of eyelid lift surgery will appear gradually as swelling and bruising subside to reveal a smooth, better-defined eyelid and the surrounding region, and a more alert and rejuvenated appearance.

What should I Expect After Eyelid Lift (Blepharoplasty)?

During your eyelid lift surgery recovery, lubricating ointment and cold compresses may be applied, and in some cases, your eyes may be loosely covered with gauze after your procedure is completed. You will be given specific instructions that may include how to care for your eyes, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your overall health, and when to follow-up with your plastic surgeon. Initial healing may include some swelling, bruising, irritation, dry eyes, and discomfort that can be controlled with medication, cold compresses, and ointment. Irritation at the incision sites is also possible. You must practice diligent sun protection and use darkly tinted sunglasses until the healing process is fully complete.

What results should I expect after Eyelid Lift (Blepharoplasty)?

The results of eyelid lift surgery will be long-lasting. While there usually is little pain involved in this surgery, there can be swelling or bruising. Most patients are presentable to the public in 10-14 days. However, it may take a few months before the final healing is completed. While eyelid lift surgery can be expected to correct certain conditions permanently, you will continue to age naturally. Ongoing sun protection will help to maintain your results.

It’s always essential to follow y Prof Moawad’s instructions after any procedure, and after eyelid lift surgery you will have to make a few unique but relatively simple modifications to ensure your newly rejuvenated eyelids heal optimally. Expect your eyes to get tired more quickly than usual for the first few weeks, and it’s important to let them rest as needed. If your job requires you always to be at a computer, consider resuming work part-time initially, then gradually increasing your workload as you continue to recover.

You must protect your eyes from the sun and wind. Wear dark sunglasses with frames that provide plenty of coverage whenever you go outdoors. You will have to avoid lifting, straining, and bending down to pick things up for up to 4 weeks after eyelid lift surgery. This can be an inconvenient restriction, but it is crucial that you do not induce sudden increases in blood pressure until your incisions have healed adequately. Although good results are expected from your procedure, there is no guarantee. In some situations, it may not be possible to achieve optimal results with a single surgical procedure, and another surgery may be necessary.

With a healthy lifestyle and good skincare habits, the results of cosmetic eyelid surgery should last for years.  With the excess, sagging skin was gone, your eyes will always look better refreshed and more youthful than they would have without an eyelid lift. Likewise, if you have lower eyelid surgery, those puffy eye bags will be gone. While nothing can stop the normal aging process, your results will age naturally with you.

You can keep your eyes looking more youthful by wearing sunscreen daily, becoming or remaining a non-smoker, and practicing proper nutrition and health habits. Non-surgical treatments, such as Botox or filler injections, or skin resurfacing, can also help you touch up your youthful appearance by smoothing wrinkles around the face and eyes. Your cosmetic surgeon can recommend the treatment options that will best meet your needs.

Notes

The specific risks and suitability of this procedure for a given individual can be determined only at the time of consultation with your cosmetic surgeon. All surgical procedures have some degree of risk. Minor complications that do not affect the outcome occur occasionally. Major complications are unusual.