Surgery to reduce the amount of excess tissue around the eyes (blepharoplasty) may be performed in conjunction with a face-lift operation or, more frequently, as a separate procedure. When a patient wants both a face-lift and a blepharoplasty, the operations may be performed together or in stages, according to the patient's personal preferences or financial considerations.
In most cases the right and left eyelids are operated on at the same time. However, it is not uncommon to do only the upper eyelids or the lower eyelids, as the patient wishes.
To remove excess skin and other tissue from the upper eyelids, incisions are made in the eyelid fold and extended laterally toward the smile lines. Fatty tissue from the lower eyelids may be removed either through an incision in the skin (just below the eyelashes) or through an incision in the back surface of the eyelid (the transconjunctival approach). Some patients have droopy lids from a weak eyelid muscle (with or without excess eyelid skin and fat). If this problem, which is called blepharoptosis, is diagnosed, it often is amenable to surgical correction.
The operation takes from 30 minutes to two hours and usually is performed using local anesthesia. Intravenous sedation may be given if the patient wishes. General anesthesia often is used if blepharoplasty is performed at the same time as a face-lift.
Sutures typically are removed four to seven days after surgery. Although discoloration around the eyes usually resolves in one to three weeks, swelling (edema) may persist for several weeks. The skin scars heal as inconspicuous thin lines in nearly all patients within a few weeks to months.
Some patients may experience dryness of the eyes after surgery. This symptom may be caused by incomplete closure of the eyelids during the healing phase and usually resolves within a few weeks. In the interim, the eyes may be soothed by using artificial tear drops and ointments. Because people who have dry eyes before surgery have a greater chance of experiencing this problem postoperatively, we recommend an examination by an ophthalmologist before blepharoplasty is performed.
Rarely, there may be other problems after surgery such as persistent drooping or retraction of the eyelids or darkening of the lids because of permanent retention of blood pigments in the skin. These undesirable side effects frequently can be treated satisfactorily.
Complete loss of vision in an eye is an extremely rare complication of blepharoplasty. Temporary visual blurriness occasionally may occur after surgery because of alterations of the tears, but the problem typically is short-lived.
Most patients indicate that their eyes look and feel more rested and youthful after blepharoplasty. In general, it is a relatively safe and straightforward operation.
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