Baggy Eyelid Correction (Blepharoplasty)
Youthful eyes are almond shaped and slightly up-tilting on their outer aspect.
As one ages and tissues lose their tautness, the skin and eyelid structures start to drop and ‘sag’, producing deepened wrinkles, excess skin folds and bulging.
A so called ‘blepharoplasty’ addresses the problem of ‘baggy eyelids’.
Multiple problems may contribute to the appearance of the eyelids:
- Skin droop – as the skin ages it loses elasticity and gravity causes it to sag. This adds to the appearance of deep wrinkles and folds of eyelid skin
- Fat herniation – fat which forms a cushion deep around the eye bulges out of position due to a weakening of the structures that contain it. This forms bulges in both upper and/or lower eyelids
- Fat atrophy – the fat of the eye and around the outside of eye loses its position, firmness and bulk
- Slackening of structures around the eye – the soft tissue and eyelid muscles lose tone and start to sag, contributing to droopiness of the lids
- Muscle creases – action of the muscles around the eye over the long term produce furrows and creases in the overlying skin and may also contribute to some flattening of the underlying bone
- Bone resorption – as we age the bone around the eye partly resorbs, making the eye cavity a little larger and giving a flatter and sometimes more sunken appearance
Additionally – the upper eyelids are a continuum of the brow. A heavy brow flattens the eyebrow which in turn puts even more skin onto the upper eyelid.
The lower eyelid is in continuity with the cheek. As the cheeks fall they drag the lower eyelids with them so lengthening the lower eyelid.
Each case then is potentially unique and careful evaluation is needed to consider what components need correcting in an individual to give the best result.
The upper eyelids and lower eyelids can be operated on separately or both together.
This can be done under a local or general anaesthetic.
If just the upper eyelids are being operated on this is usually performed under a local anaesthetic only.
A cut is made across the shadow area of the upper eyelid. Extra skin and any bulky muscle is removed, any bulging fat esp. in the inner corner is removed and the normal attachment of skin to muscle is resecured.
The skin is then stitched closed.
For a full blepharoplasty i.e. upper and lower eyelids or lower eyelids alone – a general anaesthetic is not uncommon, although local anaesthetic is still more usual.
In lower eyelid surgery cuts are made beneath the lashes of lower eyelids and tissue resuspended and excess removed. Fat bulging deep to this tissue was traditionally removed but is now more commonly repositioned. If necessary the lower eyelid muscle is tightened. Excess skin is removed.
The cuts in the eyelids generally heal exceptionally well and once healed are difficult to detect even on close inspection.
Bruising and swelling reach a peak at about 24-36 hours and thereafter subside. You should expect to take things fairly quietly for the first 48 hours (i.e. sit or lie head up) to minimise swelling.
It generally takes about 7 days for this to settle and a little swelling or discolouration may persist in the lower eyelid for a further week.
Sutures are removed at 4-7 days.
- Bruising and swelling is to be expected and can range from almost non-existant to quite marked. Sometimes not enough tissue is removed and a little extra is required to achieve the desired cosmetic effect. Scars can sometimes be irritating for a while.
Eye irritation, esp. if one has a tendency to dry or irritated eyes before the procedure, can be exacerbated.
True complications are uncommon.
- Is a more significant procedure than upper eyelids in terms of what is done and the potential problems that can arise
- Drooping of the lower eyelid – scar tissue can cause the lower eyelid to pull downwards. This is more likely if the lower eyelid is lax. Sometimes massage of the eyelid or taping is necessary to counteract this. The problem is usually temporary if managed well. Occasionally a procedure will need to be done to tighten the lower eyelid further
- Eye Irritation – the eye can be reddened or appear irritated for a prolonged period and may require eyedrops and several weeks to settle
- Hematoma – excess bleeding may collect around the eye and need to be removed to avoid it causing distortion
Depend on whether you have an operation performed
– solely on your upper eyelids, lower eyelids or both upper and lower eyelids together
– under a general or local anaesthetic (general anaesthetic procedures must price in an anaesthetist and hospital charges which will double the cost of the procedure)