WHAT IS BLEPHAROPLASTY SURGERY?
Blepharoplasty Surgery is done to reduce the baggy lower eyelids/ puffy lower eyelids/ loose upper eyelids. These bags under the eyes produce an aged or tired look to the face.
The upper eyelid bags can restrict peripheral vision reducing the field of vision and hence needs to be corrected.
In the Upper eye lids it is usually more of the excess skin which needs to be excised and is also called a Pinch Blepharoplasty. The sutures are out in a week and the scar is well hidden.
In the Lower Blepharoplasty, the procedure involves making a cut under the eyelashes or sometimes inside the eyelids also known as the Transconjunctival approach to remove any excess fat if necessary or as most often is the casee, redraped to give a better look.
The importance now is on fat reposition rather than fat excision as was being done about 15 years back. We have come to realise that removing the fat pockets just creates more hollowness around the eyes making them look sunken and older.
Repostioning the fat pockets and redraping them more uniformly gives you better long lasting results and a more youthful look.
In most cases, skin excision is actually quite minimal.
The incision is just under the eyelashes and heals well.
It requires proper evaluation and planning.
Sometimes a Mid face lift may be planned together. Or, the blepharoplasty can be combined with regular facelift.
We often get cases operated elsewhere for a reevaluation as they seem to continue to have many issues following their belpharoplasty procedure. The most common issues and their proposed corrections that were done are mentioned.
Here the eyelid is rotated outwards and the eye cannot close completely. This is the most common complication we encounter and is usually because of a lack of understanding of the problem and removal of too much skin.
The treatment usually involves putting back some skin into the eyelid by a Full thickness skin graft or if not too sever a canthoplasty might help.
2. DRY EYES & WATERING:
Another common complaint is eyes not closing fully and feeling of dryness and hence watering of the eyes.
Here the eyelids are not in proper contact with the globe of the eye and hence the tear film is not maintained and causes dry eyes. This is usually because of a lax ligaments of the lower eyelid.
The treatment involves a canthoplasty and rarely a tendon tightening procedure to bring the eyelid close to the globe.
3. BAD SCARS:
Might require a scar revision or maybe just to wait for the scars to mature. Sometimes the bad scarring can cause inward turning of the eyelashes.
If this is the case then needs to be corrected immediately and/or those eyelashes removed to prevent corneal scarring and opacities.
4. HOLLOWING :
Excess removal of the fat or overenthusiastic removal of fat causes the sunken hollow look of the eyelids.
Fat grafting is used to correct this deformity and may require more than one sitting.
Blepharoplasty Procedure is usually done under local anesthesia and the patient can go home on the same day. Sometimes sedation maybe required.
Sometimes, if excess skin is removed, there may be an everted eyelid called “ectropion”, hence the surgeon may err on the side of leaving a little behind rather than removing more and causing this problem.
If ectropion occurs, it may have to be corrected at a later date.
Though all care is taken to prevent such complications, rarely bleeding can occur, where in blood collects behind the eyes, called a retrobulbar haematoma which can even lead to blindness in rare cases. If a haematoma, occurs then it has to be evacuated.
Tear Trough Deformity
A common problem which is an early sign of ageing, manifested by a depression under the inner aspect of the lower lid this is called a Tear Trough Deformity.
This is more because of lack of volume or volume loss with aging. If not properly evaluated, might lead to aggravation of the deformity after a blepharoplasty.
In some instances a Transconjunctival blepharoplasty WITHOUT fat excision can be done.
This is most often corrected with the use of fillers (Juvederm/Restylane/MonaLisa) or fat grafting and is more because of volume loss rather than lax lower eyelid septum or excess skin.
Asian Eyelid Correction
Lack of a fold in the upper eyelids is common in people of south Asian descent or from the north eastern states of India.
Blepharoplasty Procedure is to create the attachment of the skin to the underlying muscle by an incision in the upper eyelid.
Done as an outpatient procedure and the patient can go home the same day. Procedure is done under Local Anasthesia or LA plus sedation.