The goal of an “eyelift” or blepharoplasty is to recreate the natural contours of a youthful, rested eyelid, in eyes that have developed skin excess, bags, or drooping secondary to senescence (aging), genetic predisposition, or accelerated photo-aging.
Blepharoplasty is the comprehensive terminology for the description of eyelid rejuvenation surgical procedures. These include:
Upper Blepharoplasty (upper eyelid)
- Removes the excess upper eyelid skin
- The incision follows the natural crease of the eyelid, and upon healing, the scar is virtually undetectable
- Often performed with concomitant fat resection or fat transfer to volumize the peri-orbital and return youthful fullness
Lower Blepharoplasty (lower eyelid, outside)
- Removes the excess lower eyelid skin and fat pockets
- Often performed with fat resection to correct under-eye bags or injectable dermal fillers to correct hollowing or tear trough deformities
Lower Eyelid “Skin Pinch” Blepharoplasty
- Removes the excess lower eyelid skin
- Does not remove fat
- The incision follows the lower lash line, and upon healing, the scar is virtually invisible
- Removes fat, and skin when necessary, to treat pseudo-herniation of fat bags around the eye
It is important to note that blepharoplasty cannot lighten dark under eye circles, eliminate lower eyelid fine wrinkles, or diminish or eliminate crow’s feet.
- Preparation: During the pre-operative consultation, Dr. Vallecillos will assess your eyes and review your medical history. Please bring the following to your consult:
- Results of any recent eye tests from your opthamologist
- Contact lenses or glasses if you wear them
- Relevant health records related to the conditions above
To prepare for blepharoplasty, you should discontinue the use of blood-thinning vitamins, herbs, and medications for two weeks before the surgery. If you smoke cigarettes, you should quit for at least two weeks before and after surgery. If you are over the age of 45, medical clearance by an independent physician may be required before undergoing surgery.
- Anesthesia: Depending on the type(s) of procedures being performed, a local anesthetic, IV sedation, or a general anesthetic will be administered.
- Enormous strides have been made in blepharoplasty, with a trend towards conservatism. Excess fat is carefully resected and in appropriate cases, repositioned throughout the eye to impart a youthful fullness to the eye. Muscle is typically spared, avoiding dated techniques that left patients with an inanimate, unnatural expression.In general, the procedure lasts anywhere from 45 minutes to two hours.Often, patients who present with sagging over the eyelids in fact need a brow lift instead of blepharoplasty. Browliftsare almost exclusively performed by an endoscopic approach, allowing for minimal incisions and precise repositioning of the brow to its more youthful state.Several ancillary procedures exist that can augment the results of your blepharoplasty. Dr. Vallecillos will discuss beforehand which option is best for you, given your specific diagnosis and circumstances. Some of the more commonly performed eyelid procedures are as follows:
Tear Trough Management with Fat Transfer
Through senescence, or aging, the peri-orbital area can lose volume, creating a hollowed look. Additionally, mid-face descent leads to the development of prominent naso-jugal folds. To correct this, fat transfer may be performed in conjunction with the upper and/or lower eyelift procedure, thus eradicating the hollowing and eyelid/cheek delineation of aging. An added benefit is an improvement of the lower eye dark circles as well, which is secondarily supplemented with IPL Treatments.
Lateral Canthal Suspension Technique
The goal of these techniques is to strengthen the structural elements of the outer corner of the eyelids (lateral canthus) hence lending to better support of the lower eyelid. These eyelid suspension techniques employ various specific sub-procedures, depending on the precise nature and requirements of the particular eyelid. They include canthopexy, canthoplasty, tarsal strip resuspension, inferior and lateral retinacular suspension techniques. Canthoplasty and canthopexy procedures are often times described interchangeably by surgeons, but are entirely different in their indication and nature.
A Canthoplasty procedure reinforces the lower eyelid support by detaching the lateral canthal tendon from the orbital bone and reconstructing it. Conversely, a Canthopexy procedure is much less invasive and essentially stabilizes the existing lateral canthal tendon without removing it from its normal anatomic attachment. In rare and severe cases, as with significant lower eyelid retraction (ectropion), a concomitant midface lift may be recommended to lend to caudal support of the lower eyelid. In these cases, insurance coverage may be possible, depending on the carrier, especially if the patient is at risk for dry eye syndrome or keratoconjunctivitis secondary to profound lower eyelid retraction.
From an aesthetic standpoint, these procedures are employed to correct an unappealing lower eyelid shape, such as an overly round eyelid shape, a pulled down eyelid (ectropion) or a sagging lower eyelid with too much “white” of the eyeball showing (scleral show). These eyelid problems may be resultant of previous eyelid or midface surgery, senescence, and other hereditary factors.
Botox Injections are often performed in the peri-orbital rejuvenation to shape and lift the brow, minimize crow’s feet, and soften under-eye wrinkles. Fractionated Laser or IPL Rejuvenationis routinely utilized by Dr. Vallecillos in conjunction with eyelid rejuvenation procedures to add to the overall effect of the result.In fact, in most cases, Lumenis Total FX peri-orbital resurfacing is included in the eyelid lift procedures, allowing for superior results.
Who is a candidate for blepharoplasty?
You should consider blepharoplasty if you are a healthy adult and non-smoker seeking realistic rejuvenation of the upper and lower eyelids and surrounding areas. The procedure can also be used to treat patients who may have excess skin obscuring the upper eyelid fold, Asian patients who want a defined upper or “double” eyelid crease, and patients with hollows or “dark circles” around their lower lids.
Patients who suffer from serious eye conditions should not undergo blepharoplasty. Be sure to tell Dr. Vallecillos if you suffer from thyroid disorders, such as Grave’s disease or an overactive thyroid, cardiovascular and circulatory disorders, hypertension or diabetes.
What is the recovery time for blepharoplasty?
Sunglasses should be worn immediately after surgery, as eyes may be sensitive to light. Patients should arrange to have friends, family members, or other caregivers available to help during the first week after surgery. During this period, you’ll want to limit your activities. Refrain from strenuous activity for at least two weeks. Sutures are usually removed 5-7 days after surgery. Dr. Vallecillos will provide you with aftercare instructions that include proper eye hygiene, head elevation, and cold compresses to reduce swelling and bruising.
Are there risks or side effects with blepharoplasty?
Complications from eyelid surgery are extremely rare, but can include bleeding, infection, dry eye, damage to underlying structures, eyelid retraction or ectropion, and the need for revision surgery. Carefully following Dr. Vallecillos’ recommendations, both before and after surgery, will minimize your risk of complications.
How long do the results last?
Results from blepharoplasty will usually last for years. Procedures such as Botox Cosmetic, IPLs, laser treatments, and good skincare can help. However, the aging process will eventually render additional procedures necessary in order to maintain results.