Blepharoplasty Latest Facts: A Comprehensive Look at Eyelid Surgery

What is Blepharoplasty?

Eyelid surgery, also known as blepharoplasty, is a procedure that repairs problems associated with vision and removes any extra fat, muscle, and skin around the eyelids. Although the primary goal of the procedure is to improve the visual field, the procedure has also been used to enhance the appearance with a focus on facial aesthetics. According to the American Society of Plastic Surgeons, eyelid surgery was considered among the top 5 cosmetic procedures in 2018, with over 206,000 surgeries performed annually.

Blepharoplasty. Courtesy of Paravis

Why is it needed?

Aging is associated with changes in the muscle and skin. As you age, the skin loses its elasticity, and the muscles supporting the eyelids weaken, thereby causing excess skin to gather around some regions of the eyelids. According to Thomas Quigley, M.D of quigleyeye.com the accumulation of the changes on the lower eyelid can cause wrinkles, while on the upper eyelid this can impair vision. Sagging of upper eyelids can be a serious medical problem due to the decreased entry of light, which can in turn narrow the visual field and impair vision. As such, these changes to the eyes can alter a person’s appearance significantly and may result in a jaded look that can affect self-esteem and self-confidence in any affected individual.

Who is the right candidate for the surgery?

The best candidates for the surgery are usually those above 35 years of age who are in good health with no preexisting conditions and have saggy or droopy eyelids that are impairing their vision.

Prior to the surgery, the physician and the patient will meet to discuss medical history, expectations, and perform specific examinations. These examinations include a physical exam, a vision exam, and eyelid photography.

If you have any preexisting conditions, specifically other pathological eye conditions such as cataracts, glaucoma, or keratoconus, then you might not be a good candidate for surgery. Eye conditions such as dryness or glaucoma can affect the outcomes of your surgery. It’s essential to inform your physician of any conditions prior to surgery to ensure your safety.

After the discussion and completion of the required examinations, the physician will inform the patient of the next steps. If the surgery is a go, the physician will likely ask the patient to kindly stop taking anti-coagulant medications, quit smoking, and have someone drive them home after the procedure.

What does Blepharoplasty involve?

This procedure is usually performed in an outpatient setting with either local or general anesthesia depending on the surgeon’s preferences and the location of the surgery. The process will differ slightly depending on whether the patient is undergoing upper eyelid surgery, lower eyelid surgery, or both.

If both upper and lower eyelid surgeries are being performed, the procedure usually takes around 2 hours. For upper eyelid surgery, the physician marks the lines and makes an incision through them along the fold of the eyelid removing as much excess skin, muscle, and fat as possible, and stitching the cut.  On the other hand, lower eyelid surgery involves the physician making a cut under the lashes or inside the lid and removing excess fat, muscle, and skin then closing the cut either with or without stitches.

Who will perform my surgery?

Both oculoplastic surgeons and plastic surgeons are qualified and have the required skill set to perform this surgery. Oculoplastic surgeons train specifically in eye surgery (ophthalmology), which involves an in-depth understanding of the eye and the structures surrounding it.

This type of surgery requires detailed knowledge of anatomy and the ability to individualize the procedure to the patient based on their gender, facial features, and expectations. Therefore, it’s crucial that patients do their research prior to choosing any surgeon. Patients should ask the surgeon about their previous experience, training, and pictures of their work.

What to expect after the surgery?

Skin and Fat Removed after Blepharoplasty. Courtesy of Paravis – Michael S. Schwartz, M.D

The patient is transferred to the recovery room after surgery and monitored for any complications then subsequently discharged the same day. They’ll be prescribed an ointment to prevent dryness and will be recommended to apply cold compresses by the physician. Additionally, it’s preferred that the patient keeps their head elevated for a couple of days after surgery. Following surgery, it’s reasonable to experience blurred vision, sensitivity to light, swelling, and pain, which will diminish after several weeks. Moreover, the stitches used should be removed within a week.

Some recommendations that your physician might suggest: the use of ice packs multiple times a day, avoid bright lights, avoid the use of contact lenses, and always keep the area of eyelids clean to prevent the risk of infection.

Healing after the surgery usually takes between 7 to 10 days. Patients should be expected to limit physical activity or any strenuous exercises. After a week, patients usually return to work and resume other activities. Scars usually take up to a couple of months to fade; therefore, it’s normal to see some visible scarring after surgery.

As you recover, the team of healthcare professionals will check in on your progress and make sure that everything is running smoothly!

What are some of the risks associated with it?

Although the risks of eyelid surgery are low, it’s crucial for the patient to understand the possibility of unwanted complications. These risks can include scarring, dry eyes, infection, skin discoloration, blurred vision, and rarely permanent loss of eyesight.

It’s essential to weigh the benefits and risks associated with this surgery and make an informed decision about whether this is something you’d like to pursue.

What is the cost of Blepharoplasty?

Blepharoplasty is an expensive procedure that may cost up to thousands of dollars. In 2019 the American Society of Plastic Surgeons estimated an average of $3,282.  This cost includes the procedure but might not include other medically-related expenses. Therefore, it’s essential to check in with your surgeon to see what the cost will include. Moreover, the cost can differ significantly based on the surgeon’s experience, the location of the surgeon, and the type of procedure.

If the eyelid surgery has been performed for medical reasons, then insurance companies may potentially cover the costs. Typically, upper eyelid surgery is performed for medical reasons and should be covered by insurance.  Patients should inquire about this before the surgery to avoid any financial issues. However, if the surgery was performed for cosmetic purposes, then the cost will have to be out of pocket. Lower eyelid surgery is usually performed for aesthetic reasons such as smoothing out wrinkles.

What are the outcomes of this surgery?

Prior studies have shown positive outcomes of eyelid surgery specifically for those patients who are presenting with blurred vision. Moreover, patients have exhibited positive psychological effects, such as an increase in self-confidence and self-image.

In general, it’s hard to discern whether the results will last a lifetime or whether a follow-up surgery is required. Upper eyelid surgery has been shown to last for more than five years. Researchers have demonstrated that some patients required follow-up surgery. The reasons for this are multifactorial and depend on how each patient reacts to the procedure. As such, there’s no guarantee of the outcomes of the procedure. In contrast, lower eyelid surgery has rarely demonstrated a need to be repeated in the future.

What are some other surgical procedures?

If the patient does not have excess fat or droopy eyelids, the surgeon might recommend a different surgical procedure known as the skin pinch technique. The skin pinch technique removes only excess skin but not excess fat from around the eyelids.

What are some non-surgical procedures?

Some patients do not like the idea of performing a surgical procedure, so there exist various non-surgical alternatives.

These non-surgical procedures include micro-needling, chemical peels, or injectable fillers. Micro-needling is a technique known as collagen induction therapy that reduces eye bags by stimulating the cells to produce collagen. Chemical peels contain various ingredients to stimulate skin rejuvenation on the outer layer of the skin. Lastly, injectable fillers of hyaluronic acid are temporary fixes that are used to reduce eye bags.

In some cases, patients require a combination therapy of surgical and non-surgical procedures. For example, lower lid blepharoplasty can be combined with injectable fillers or lateral canthal resuspension. Upper lid blepharoplasty is combined with other cosmetic procedures such as endoscopic brow lift.

What are some new interventions?

The bladeless blepharoplasty is a new technique that involves removing excess skin with the use of a special stylus in place of a scalpel. Recent studies have outlined less bruising, bleeding, and faster recovery time in patients who underwent this intervention in comparison to a regular blepharoplasty. Additionally, this novel method is safer and more cost-effective compared to traditional approaches.

CO2 Laser blepharoplasty is another intervention that can be performed in place of a traditional blepharoplasty. This procedure uses a laser instead of a scalpel to mark the incision lines around the eyelids. The laser beam seals blood vessels and lymphatic tissue, allowing for less bleeding and swelling. Moreover, this intervention reduces the risk of scarring and has a faster recovery time compared to conventional surgical blepharoplasty.

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2840922/