Upper & Lower Eyelid
Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons.
- Eyelids (and your eyes) are, perhaps, what other people notice initially.
- Eyelid surgery to improve the appearance of the eyelids is often called 'eyelift' or 'blepharoplasty'.
- As we age, your eyelids (both upper and lower) could become 'droopy' or 'baggy'. The eyelid skin stretches and muscle tone weakens
- In addition, your eyebrows could also droop.
- Your droopy upper eyelids and droopy brows could give you the appearance of being sleepy, tired and aging prematurely
- In addition, this sagging, could lead to brow/eyelid strain
- Excess skin can hang over the eyelid and interfere with vision
This surgery can be performed on both the UPPER and on the LOWER eyelids - or both.
- Patients with a less severe amount of excess skin could have a similar procedure performed 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.
- Blepharoplasty is 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, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable.
- Depending upon the scope of the procedure, the operation takes one to three hours to complete.
Combined Upper and Lower Eyelid Blepharoplasty
Blepharoplasty or eyelid surgery, commonly known as an ‘eyelift’ surgery is done to reduce bagginess of lower eyelids and to remove excess skin and fat from the upper eyelids. A combined upper and lower eyelid blepharoplasty is done to tackle both problems together at the same sitting.
This surgery is usually done for cosmetic reasons or to improve sight in older people with obstructed visual axis due to loss of elasticity and sagging of the eyelids.
Indications for a Combined Blepharoplasty
Baggy or droopy eyelids
- Excess skin of upper eyelids blocking the visual axis
- Droopy lower eyelids
- Excess skin of the lower eyelids
- Bags under your eyes
Ideal Candidate for Combined Blepharoplasty
The ideal candidate for a combined upper and lower eyelid blepharoplasty is a patient with realistic expectations and one who is in pretty good physical and mental health. The candidate is usually 35 years or older, having baggy, tired-looking lower eyelids and droopy upper eyelids and one who is willing to go under the knife.
Combined Blepharoplasty Procedure
A combined blepharoplasty usually requires about 1 to 3 hours and could be done under local anaesthesia or under general anaesthesia.
A combined upper and lower eyelid blepharoplasty involves the following steps:
- Local Anaesthesia: The procedure is done under local or modified local anaesthesia and patient co-operation is of utmost importance in achieving a symmetrical surgical outcome.
- Making the Skin Incision: Incision lines are made in the natural creases of the upper eyelids such that any resultant scar is camouflaged. Incision lines are made below the lower eyelashes in a discreet manner such that the incision is hidden from plain view.
- Skin Excision: The skin is removed using Westcott scissors along the eyelid crease.
- Orbital Septum Excision: A strip of orbital septum is removed across the entire eyelid. This permits access to the eyelid fat pads beneath the orbital septum. Orbicularis muscle in the lower eyelid could or could not be removed depending on the desired end results.
- Fat Removal: The eyelid is then re-contoured by a graded removal of the eyelid fat pad from different regions. Fat could also be transferred just below the eyelids to provide it fullness and readjustment of contours in sunken eyes.
- Haemostasis: Aggressively control bleeding, particularly those arising from the orbicularis muscle as it could lead to loss of vision.
- Closure: The wound is closed using either absorbable or non-absorbable sutures. Sutures should be removed at 7 to 8 days following surgery.
Risks and Complications of Combined Upper and Lower Blepharoplasty
Orbital haemorrhage is the most dangerous complication when it comes to blepharoplasty and can cause loss of vision in rare cases. Other complications include lagophthalmos, dry eyes, pain, swelling and stiffness of the eyelids, scarring, ectropion, infection, excessive tearing, and excess removal of eyelid tissues.
Results of Combined Blepharoplasty Surgery
Combined blepharoplasty surgery can be one of the best decisions for a person with tired, droopy upper eyelids and saggy or puffy lower eyelids caused by the ageing process. It can produce a smooth, firm, younger-looking surface around the eyes by correcting puffiness in the upper eyelids and bagginess of the lower eyelids as obvious in the pictures given below.
It can also correct any visual field defect cause by droopy eyelids, giving rise to the commonly used misnomer, ‘eyelift’ for the procedure. The procedure actually does not lift the eye skin in any way.
A perfectly sculpted blepharoplasty does not show any visible scars and the aesthetic improvement achieved is dramatic and transforming for both the surgeon and the patient alike. The following figure shows the contrasting looks of the patient before and after a combined blepharoplasty procedure.
Immediately during the postoperative period, there will be pain, irritation, swelling and discomfort which gradually resolves over time. The final results could take months to consolidate after which the beneficial effects lasts for 5 to 7 years on average. In fact, the effects of a perfectly healed blepharoplasty could last a lifetime for some patients who will continue singing praises for this procedure.
Overall, combined blepharoplasty can be a very fulfilling experience in both aesthetic and psychological terms. But, it is always wise to consider all possible outcomes before the surgery with your surgeon to achieve the best possible result.