Eyelid Surgery (Blepharoplasty)
| Eyelid Surgery Cost Approximate Cost : $3,000 – $8,000 Recovery: 5 – 10 days Possible complications: Bleeding and bruising are common, rare risk of: infection, temporary or permanent droopiness of eyelid, temporary blurred or double vision, dry eyes, difficulty in closing eyes completely (rarely permanent), pulling down of the lower lids (may require further surgery |
Blepharoplasty is surgical modification of the eyelid. Excess tissue such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. It can be both a functional and cosmetic surgery.
Blepharoplasty is often done as an elective surgery for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid “bags” and reduce the wrinkling of skin. Asian blepharoplasty or double eyelid surgery is a special type of blepharoplasty that creates a crease in the upper eyelid.This “supratarsal fold” is common in many races but absent in about half of Asians. Surgery can artificially create this crease and make a ‘single-lidded’ patient appear ‘double-lidded’. It is the most popular form of cosmetic surgery among those of east and southeast Asian background.
Blepharoplasty is sometimes needed for functional reasons. When an advanced amount of upper eyelid skin is present, the skin may protrude over the eyelashes and causes a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision.
Procedure
The fat (yellow tissue) and skin (linear tissue) removed from a quadruple blepharoplasty. Lower-lid fat was removed using the transconjunctival technique.Blepharoplasty is usually performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids. Incisions may be made from the inside surface of the lower eyelid (transconjunctival blepharoplasty); this allows removal of lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed. External skin resurfacing with a chemical peel or carbon dioxide laser may be performed simultaneously. This allows for a faster recovery process.
The operation typically takes one to three hours to complete. Initial swelling and bruising resolve in one to two weeks but at least several months are needed until the final result becomes stable. Blepharoplasty’s effects are best appreciated by comparing before and after photos of surgical patients.
The anatomy of the eyelids, skin quality, age, and the adjacent tissue all affect the cosmetic and functional outcomes.
Factors which are known to cause complications include:
* dry eyes – which may become exacerbated by disrupting the natural tear film
* laxity (looseness) of the lower lid margin (edge) – which predisposes to lower lid malposition
* prominence of the eye in relation to the malar (cheek) complex – which predisposes to lower lid malposition
Transconjunctival blepharoplasty of the right lower eyelid.
An incision is made on the inner eyelid surface. A suture holds the inner eyelid tissue over the eye.
Fat is held with forceps (left) and clamped with a hemostat (right). A small retractor (bottom right) keeps away extra tissue.
The fat is cut away with surgical scissors (right).
Recovery
The recovery process after a blepharoplasty may take up to a few weeks. Patients will receive instruction for during the home care and most of the time they receive painkillers that ease the pain caused by the incisions.
The first two days after the operation has been performed, the patient receives an ointment treatment to keep the incisions lubricated. Doctors recommend keeping iced eye pads on the eyes to reduce bruising and swelling. Eye drops may also be prescribed as they may help in pain management and in preventing infections. Patients are recommended to keep their heads higher than the body while sleeping as this will accelerate the recovery process.
Different medications can help in moderating bruises and swelling resulted after surgery and also to accelerate the patient’s recovery. One of them is Wobenzym, an agent that helps in moderating swelling. Wobenzym should be administrated the second or third days after surgery and three times a day. The patient’s condition will improve without this medication as well as it is only an additional treatment. Auriderm is another medication that has quite a similar effect as Wobenzym. Auriderm must be applied 10 days before the blepharoplasty and two times a day. There are however many products like these that could accelerate one’s recovery and they must be discussed with one’s surgeon.
The third day after surgery, the patients are advised to keep lukewarm eye pads for comfort and wearing dark glasses for at least one week is also recommended to prevent irritation that may be caused by the wind and sun exposure.
The stitches are usually removed two days after the operation. The patient’s eyelids will be discolored and swollen for about seven to ten days, and feel “tight” or “stiff” for a while.[5] Patients should lubricate their eyes by exercising closing their eyes or looking at the ceiling.
During the first few weeks after a blepharoplasty, patients normally experience excessive tearing, light sensitivity and sometimes double or even blurred vision. The whites of the patient’s eyes can turn red or have red splotches. These symptoms usually disappear on themselves within two or three weeks after the operation.
Wearing contact lenses is prohibited until the incisions are completely cured. Patients who need them will be advised by their doctor when it is safe wearing them again.
Patients who undergo a blepharoplasty may watch TV and are able to read after two or three days after surgery. Patients may go to work in a week or ten days after the operation. The scars may however still be visible but one can use makeup to cover them.
As a part of blepharoplasty recovery, the patient must avoid bending at the waist for about five days and strenuous activity (especially activities that raise your blood pressure, such as lifting and rigorous sports) for about ten days to two or three weeks.
Surgery will leave scars but which are usually well hidden and they normally fade in time. Blepharoplasty may leave patients with bruises on their faces or swelling and sometimes patients become depressed from this reason.
These are some of the side effects of surgery, which are completely normal and which disappear in few weeks, after a complete healing.
Blepharoplasty costs in the United States and around the world
The cost is determined in part by a patient’s geographical location and the actual surgeon who is performing the surgery but also by the related fees.
According to the American Society of Plastic Surgeons, in the United States, the national average cost of blepharoplasty surgeon fees in 2007 was $3,134. Here are some regional averages: New England states: $3,063; Middle Atlantic states: $2,199; North Central states: $2,254; South Central states: $2,143; and Mountain/Pacific states: $2,378. The surgeon’s fee does not include the cost of the operating facility (outpatient surgery facility, surgery suite or hospital.) It does not include the cost of anesthesia, the cost of medications, or the cost of any post-surgery supplies.
An insurance carrier may only agree to cover this surgery if the patient’s eyelids are drooping to a level that impairs his or her vision. Otherwise, the procedure is considered cosmetic and not medically necessary.
In the United Kingdom, a blepharoplasty may be performed for an average price of 1,006 GBP,the equivalent of $1,500.
History
Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids. The roots of the present cosmetic advancements began around 3000 years ago with the ancient Egyptians. Documents “written on papyrus text detail how surgeons, even in that primitive age performed reconstructions on lips, noses, and ears using skin grafts cut from folds from the forehead or cheek”.
As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Celsus, a first century Roman, described making an excision in the skin to relax the eyelids in his book De Medicine.Knowledge of blood circulation and tissue health were discovered and spread throughout the ancient world allowing techniques to improve.
However, during the Middle Ages, plastic surgery was prohibited because it was viewed as something that was spiritual and unethical. This ban was also due to poor hygiene. During the Renaissance, intellectuals rediscovered texts from ancient Greece and Rome illustrating surgical procedures and techniques.
Initial incision along the upper left eyelid.
As the 19th century approached developments were being made that would eventually be the foundation to modern cosmetic surgery. The First World War was the first major event that really relied on the dedication of surgeons and advancements in cosmetic surgery. This gave doctors a chance to practice and perfect reconstructive surgical procedures. It also prepared medical personnel for the tragedies of World War II and other subsequent catastrophes. As with any medical advancements, the development of surgical techniques goes through a period of trial and error as reconstructive surgery did during World War I. Each improvement eventually becomes the root of future advancements allowing physicians to combine procedures such as a basic lid fat resection and chemical peels ensuring a speedy recovery.
Non-surgical alternatives
Non-surgical alternatives have shown improvement with patients exhibiting early indications of facial aging. Lasers, chemical peels, botulinum toxin, and dermal fillers are all used in some degree to treat periorbital tissue. Although effective, these treatments are not technically “blepharoplasty” and yet some practitioners refer to any treatment involving the eyes as such; often preceded by “laser”, “non-surgical” or “lunch-time”. Botulinum toxin, it should be noted, is used to relax the muscles in the forehead and between the eyes, therefore not addressing most of the issues a patient seeking a blepharoplasty would want fixed.
In so called “non-surgical blepharoplasty” topical applications of acids and/or the use of lasers are used to tighten and decrease skin volume in the upper and lower eye lids. Injectable dermal fillers are also used to temporarily increase volume in the trough area between the lower eyelid and the cheek. These techniques are effective yet have not replaced surgical treatments, and should not be confused with blepharoplasty, which treats not only the superficial skin tissue, but also underlying connective and muscle tissues.
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