Cosmetic Eyelid Surgery

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Beth Longware Duff, Medical Editor

Beth Longware Duff is an experienced writer and reporter whose work on a wide variety of topics has been published in numerous newspapers and magazines. Her health and medical writing credits include nationally distributed videos for the March of Dimes Birth Defects Foundation, and she is the recipient of numerous awards including an American Cancer Society Media Award and a New England Press Association Award for Health Reporting. She holds a degree in Communications from Ithaca College.


June 25 2008

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Eyelid Surgery or Blepharoplasty
Blepharoplasty – it's a big word for a little procedure more commonly known as an eye lift. The term has been around since 1818 when the technique was first used to repair deformities caused by cancer. Today eyelid surgery is both functional and cosmetic. An eye lift surgically reshapes the upper or lower eyelid by removing or repositioning excess skin, fat, and atrophied muscle. It is often combined with a face and neck lift.

According to American Society for Aesthetic Plastic Surgery statistics for 2007, almost 40% of all blepharoplasties performed in the United States were on patients between the ages of 35 and 50; 42% were done in the 51 to 64 group, and just over 14% of patients were 65 or older. Of the 1.8 million surgical cosmetic procedures reported, eyelid surgery ranked fourth at 241,000, says the American

Society of Plastic Surgeons
The area around our eyes gives off some of the first clues that we are aging: loose and sagging skin, wrinkles and bags under the eyes, droopy lower lids, and extra fat that makes the upper lid appear puffy. "Fat deposits in the eyelids have nothing to do with your weight," explains Teresita Mascardo, MD, FACS, a plastic surgeon who has offices in New York City and Connecticut. "You can be very, very thin but still have a lot of fat there for genetic reasons."

Blepharoplasty Techniques
Dr. Mascardo adds that while some upper eyelid surgeries are done primarily for cosmetic reasons, excess skin and fat in that area can become a medical issue if it hangs over the eyelashes and causes a loss of peripheral vision. In that case, an upper eyelid blepharoplasty is performed to remove the excess skin.

Lower eyelid blepharoplasty, on the other hand, is almost always cosmetic since it is used to remove puffy bags under the eyes and reduce wrinkled skin in the area. "They make you look tired and old, so we remove a little fat and extra skin," says Dr. Mascardo. "The patient looks younger, rested, and better."

A third procedure, the so-called Asian blepharoplasty, or double eyelid surgery, creates a more prominent crease in the upper lids of people of Asian descent. "They want that Western crease in the upper eyelid," says Dr. Mascardo. "It's a personal preference. They think the Western upper eyelid that has a crease looks better than the Asian, crease-less look."

Blepharoplasty incisions are usually made within the natural creases on the outside of the eyelids or hidden within the line of eyelashes along the lower lid. Another option is a transconjunctival incision inside the lower lid, which is used to remove fat deposits. The incisions are closed with very fine sutures, and there is little or no visible scarring.

Recovery is relatively simple when compared to other cosmetic surgery procedures. Swelling is at its worst during the first 3 days and then starts to subside after a week, although it may take 3 weeks to totally resolve. Bruising may also be an issue, particularly because the tissues in and around the eye are especially delicate. The sutures are usually removed at about Day 3. Most patients can return to work in 7 to 10 days.

The two main complications associated with blepharoplasty are ectropion, which is when the lower eyelid droops, and entropion, where the lid curls inward and causes the eyelashes to rub against the eyeball. Either condition may require further surgery to correct. Other complications include temporary double or blurry vision, swelling, asymmetry of the eyes during healing, tiny whiteheads on the eyelids, and excessive scarring. Too much fat removed from under the eyes results in a hollow, tired, and aging look, or smaller, rounder eyes, or eyes that do not close properly. Eyelid surgery is contraindicated when the patient has dry eye syndrome as the surgery will make them even drier.