Blepharoplasty

BLEPHAROPLASTY is the term for eyelid surgery, one of the most frequently performed cosmetic procedures. It comes from bleph, pertaining to the eyelids, and plasty, to mold. To mold the eyelids — a genteel way of describing the procedure. In reality, it amounts to surgically removing the excess skin on and about the lids and reducing fat pads, which cause baggy eyes.

As an antiaging surgical procedure, it is among the earliest performed, typically in one’s mid-to-late forties but increasingly earlier. That should come as no surprise, since the skin of the eyelids is the thinnest and most delicate of the face. The eyelids provide an actual mirror of the system and swell at the slightest provocation. Here one finds the first signs of allergy, illness, emotional distress, or the results of last night’s spicy food and alcohol. Repeated cycles of swelling — and the rubbing that unconsciously follows — take a toll on the elasticity of the eyelids. When the fine thin skin is subjected to regular abuse, there can be no surprise in its distortion and the breakdown of elasticity. Each smile helps etch lines on the outside corners of the eyes, as does each squint to block the sun or look off into the distance. We do squint, and we do like to smile and laugh, and the damage adds up.

With the natural loss of elasticity, the eyebrows drop a bit, adding excess tissue to the upper lids. The fat pads of the lower lids become more prominent, and bags develop. For some this is a congenital problem seen as early as the teen years; for most, it develops considerably later.

Incisions in the upper lids are made in a natural skin crease. Incisions in the lower lids, a wrinkle between the lashes. Sutures are removed in four days and patients return to work one week after surgery.

Clamping eyelid wrinkles

This simple procedure achieves a lot and is among the quickest fixes of all. It is directed at the patient with excess, wrinkled lower-eyelid skin and no bags under the eyes. Stand in front of the mirror and smile a few times. If the skin under your eyes doesn’t fall back in place but forms tiny folds and wrinkles, then you see the problem. This is primarily a condition of middle age, though young people with years of sun exposure also exhibit the signs. The small folds of skin are anesthetized and gently lifted away from the under-lying muscle. In proper candidates, this is easily done without distorting the eyelid. A fine clamp is then used to pinch the excess skin, which is then precisely excised. There is virtually no bleeding, and the incision is closed with skin glue, or fine sutures that are removed in four days. There is minimal postoperative swelling or discomfort, and by the end of the week there is little sign of surgery except for the absence of the excess skin.

Subconjunctival (transconjunctival) blepharoplasty

Another mouthful. This is an operation usually restricted to young adults. It treats puffy, baggy lower eyelids in people whose skin is still firm and elastic. That eliminates all but those in their twenties or thirties who have suffered through youth with people saying, “You look tired. Is anything wrong?” No, there’s nothing wrong. You look tired because you have inherited excess fat beneath the muscle of your lower lids. It’s a family trait. Have a look at the family album. It’s there — and it’s easy to get rid of.

The term subconjunctival, or transconjunctival, blepharoplasty means that the actual surgery is done through the inner lining of the eyelid and no visible skin incision is necessary. Under local anesthesia and sedation, the eyelid is held down and the cornea protected. An incision is made in the eyelid lining, or conjunctiva, in order to reach the fat pockets just deep to it, so the operation is sub, or deep to, the conjunctiva. After the fat is removed, some ointment may be put over the area, and the eye is allowed to close. No sutures are necessary, and healing is rapid.
Often some temporary bruising and discoloration result, but otherwise there are no scars and no sign of surgery.

The procedure is specifically designed for people with excess fatty bags but no loose skin or wrinkles. When the fat is removed, the skin becomes less tense, then contracts. If your skin is loose already or very inelastic, this may not be the procedure for you. In some cases laser resurfacing of the eyelid skin can be done at the same time. This tightens the lower-eyelid skin and removes blemishes and pigment.