Other names: Eyelid lift, eye lift, cosmetic eye surgery, laser eyelid surgery, laser blepharoplasty
Primary goal: Removal of excess skin, fat, and/or orbicularis muscle to improve appearance
Secondary goals: Enhancement and/or deepening of lid crease, uplift of drooping eyelashes, increase in peripheral vision
Anesthesia: Most commonly performed under local anesthesia with oral sedation in an office operating room or with intravenous sedation as an out-patient at a hospital or surgicenter.
Operative technique:
The amount of excess skin to be removed is marked. The initial incision is made along the normal eyelid crease across the entire lid and extending slight upward and outward into the lateral canthus. The second incision is made a variable distance above the first, depending on the amount of skin to be removed. If the orbicularis muscle is thick or in excess, a small strip may be excised.
The orbital septum is then opened along its entire length, thus exposing the fat pockets overlying the levator aponeurosis (tendon of the eyelid opening muscle). The first or "middle" pocket is removed using a process of dissection, clamping, excision, and cauterization. The second or "nasal" pocket requires deeper dissection. Removal is done is a similar fashion.
The skin edges are closed using either dissolving or permanent sutures. The latter seem to give a more predicable and finer scar.
Variations:
Laser blepharoplasty eyelid surgery, in which the role of the traditional scalpel and scissors are taken over by a laser, has received widespread attention and heavy marketing. While some advocates have claimed quicker operating time with laser blepharoplasty due to decreased bleeding (primarily an advantage to the surgeon), objective studies have not demonstrated less bruising or a more rapid recovery. Many surgeons feel that the skin scars after healing from laser eyelid surgery are slightly more irregular and take longer to strengthen than those made with a scalpel ("cold steel").Other approaches to incising and excising skin and deeper eyelid tissues have been and are currently used, including electrocautery, heat cautery, heated scalpels, and radiofrequency energy. As with laser eyelid surgery, such approaches may each have some proponents. None, however, have demonstrated convincing advantages over scalpel and scissors.
At the discretion of the surgeon and patient, a modification known as "deep fixation" may be used (primarily in women) to deepen the eyelid crease , achieve a more stable platform of skin on which to apply cosmetics, strengthen support for drooping eyelashes, and prevent later scar "migration" out and above the hidden area of the normal crease. At the time of skin closure, the cut skin edges are lightly attached to the underlying levator aponeurosis (tendon) using either permanent or dissolving sutures.
A tissue adhesive (Dermabond) resembling super-glue may be used to help close the upper eyelid incision, but usually at least a few sutures are placed for reinforcement.
If the lacrimal gland (tear gland) has dropped down from its normal position just inside the orbital rim of bone, it may create a bulge that mimics eyelid fat at the lateral (towards the temple) side of the upper eyelid. If severe, the gland may require resuspension with sutures.
Advantages: Upper eyelid blepharoplasty is a relatively safe and proven operation. Because the eyes are the focal point on the face, the procedure may achieve anything from a subtle to dramatic improvement in a person's appearance, depending of the starting point and patient preferences. For this and such reasons as its relatively modest cost and much quicker recovery, many people choose blepharoplasty over full face lift.
Limitations: If performed aggressively in the presence of a weakened or drooping eyebrow, further descent of the brow may occur. "Crow's feet" (wrinkles at the lateral canthus) are minimally improved. If true ptosis (a droopiness of the eyelid due to a defective levator muscle or aponeurosis), blepharoplasty alone will not remedy the problem.
Comments:
While a few cosmetic surgeons seem to emphasize brow and forehead lifting to the virtual exclusion of upper eyelid surgery, one procedure does not replace the other.
"Functional blepharoplasty" or blepharoplasty undertaken with the primary purpose of increasing the field of vision narrowed by overhanging skin, entails the removal of eyelid skin only. While vision may be improved, the results compared to a full blepharoplasty and may, in fact, be disappointing to a patient who was hoping to coax his or her insurance company into paying for what is, for the most part, a cosmetic operation.
