The extent of an Upper Blepharoplasty depends on the individual patient. Some patients require removal of skin only whereas others require a more involved procedure. In these circumstances, an elongated piece of skin, part of the underlying muscle and a portion of the underlying two fat pockets are removed. Typically, very little fat is removed since we lose fat in our face with time. The trend now is to preserve as much fat as possible.
Care must be taken to ensure that just the right amount of skin and fat are removed. Excess skin removal can result in the patient’s inability to close the eye resulting in chronic dry eye symptoms. Excess fat removal may make the eyelid appear hollow giving the individual a sunken appearance to the eye.
Where is the incision for the Upper Blepharoplasty placed?
The incision used to perform the surgery is placed within the skin crease of the upper lid. Although healing of any incision will result in a scar, the eyelid skin is very thin and consequently heals very well. In addition, the incision runs in the natural upper eyelid crease and once healed is usually very difficult to see.
What is a Lower Blepharoplasty?
It is cosmetic surgery of the lower eyelids that addresses the wrinkles and puffiness of the lower lid eyes giving a more rested and youthful appearance.
How is a Lower Blepharoplasty performed?
Classically, a skin incision is placed directly under the lower lid lash line to remove the excess skin. The puffiness is usually due to the lower lid fat pads. These fat pads may be repositioned, or if there is excess fat, slightly resected. Some surgeons will use the lower lid skin incision to perform this procedure while others address the fat pads through a separate incision inside the lower eyelid.
The skin and fat pads of the lower eyelid must be treated with great respect. There is very little room for error, and as such skin excisions must be conservative. Excess skin excision from the lower lid results in a condition known as an ectropion, which is the pulling of the lid away from the globe. If minor, most patients will tolerate an ectropion. However, if significant, an ectropion will require surgical intervention to protect the eye itself and allow a more acceptable cosmetic appearance.
Excessive excision of fat from the lower lid results in hollowness with a sunken appearance to the eyes. This may at times create a worse and more aged appearance than the initial puffiness the patient wished to have addressed. In many situations, the fat causing the puffiness of the lower lids is repositioned along the natural bony groove along the lower portion of the eyelid to soften the overall appearance of the lid.
Are there scars associated with a Lower Blepharoplasty?
Usually once the scars heal, they cannot be seen because the incision is placed at the lash line.
In cases where the skin does not need to be treated, the Lower Blepharoplasty may be performed by making an incision inside the lower lid without any external incision. This procedure is called a transconjunctival blepharoplasty.