Blepharoplasty is a surgical procedure which provides aesthetic improvement of the eyelids. The upper eyelids andlower eyelids can be approached alone or together using a variety of techniques which are chosen based on the individual patient’s aesthetic concerns and goals. The choice of technique is as important as the skill and judgement of the surgeon. Methods for aesthetic improvement of the skin of the eyelid region also exist such as chemical peeling and laser resurfacing. These methods, however, do not change contour. Blepharoplasty, like many other aesthetic procedures, is generally offered to patients who are felt to be good candidates. It is required that a patient displays appropriate self-motivation and has reasonable expectations regarding his or her outcome.
The individual requesting upper lid blepharoplasty should be examined for the presence of excess down-hanging skin of the upper eyelids, bulging fat pads and redundant muscle. Evaluation of eyebrow position is quite important due to the frequent finding of brow ptosis (drooping of the eyebrow) in the patient desiring upper lid blepharoplasty. The relationship of the eyebrow and upper eyelid should be discussed carefully during the consultation. It is very important to avoid over-resection of skin and fat during upper lid blepharoplasty surgery. Overzealous removal can result in a conspicuous appearance. A successful outcome produces a sharp upper eyelid crease in a natural position. Patients are frequently told by friends and family members that “…they look brighter…less tired…more awake”.
Although the anatomy and function of the upper lid and lower lid share similarities, the differences are very significant. Aesthetic improvement of the lower eyelids is, in many ways, more complex. The reasons for this are understood when one considers the normal anatomy of the lower eyelid and the changes that occur over time that often precipitate aesthetic and functional problems. The patient should be examined for skin excess, bulging fat pads, sagging of the orbicularis muscle, lower lid tone and support, lower lid position/malposition and the relationship of the globe (eyeball) to the orbit (eye socket). A careful history is important to determine if any factors are present, (such as dry eyes), which may increase surgical risk and/or influence the surgical approach. Lower lid blepharoplasty is at times performed using an internal (transconjunctival) approach which avoids a skin incision and allows for removal of fat alone. Ancillary procedures may be recommended in certain patients who have poor support of the lower eyelid.
Under certain circumstances, blepharoplasty may be performed with the assistance of a laser, either alone, or in combination with skin resurfacing of the eyelid and/or other regions of the face. Blepharoplasty surgery alone does not remove all of the wrinkling in the region of the eye socket (orbit). Laser skin resurfacing or chemical peeling can be helpful in certain patients.
Techniques for upper and lower lid blepharoplasty have changed and evolved greatly in recent years. These changes have been spawned by the desire of plastic surgeons to enable patients to look natural and inconspicuous while minimizing risks and recovery. These procedures demand concentration, precision and, above all, careful planning, so that the appropriate approach is chosen for each patient. If these conditions are satisfied, patients are usually quite happy with their outcome. The following topics are typically covered during the office consultation:
- Medical and Surgical History
- History of Eye Disease and Ocular Trauma
- Occupation and Job Requirements
- Participation in Sports and Hobbies
- Examination of the eyelids and orbital region
- Recommendations regarding blepharoplasty surgery and ancillary procedures
- Discussion of alternatives (if applicable)
- Discussion regarding anticipated recovery and limitation of post-treatment activities
- Follow-up care in the office
- Financial Requirements/Considerations Scheduling Surgery
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