Blepharoplasty, or an eyelid tuck operation, is a commonly performed operation to improve the aesthetics of the eyelid area giving a more youthful, awake appearance! It can involve the upper eyelids, the lower eyelids (bags), or both, and can be done as a single procedure, or combined with other facial rejuvenation techniques, like facelifts, neck liposuction etc.
Both upper and lower eyelids consist of 3 layers: Skin on the outside, muscle in the middle, and fatty tissue on the inside. Surgery is tailored to the specific needs of the individual, and would typically involve modifying some or all of these layers.
Often the ‘first sign of ageing’, upper eyelid surgery is simple to perform, and the results are generally good to excellent. The major problem in most people presenting for this surgery is skin excess, which hangs onto the lid margin, and gives a tired appearance.
The surgery is done under local anaesthetic with oral sedation, and a strip of skin is removed from the upper eyelid. This leaves a thin, fine scar in the upper eyelid crease, which fades over a few months to become barely perceptible. Often, some fatty tissue is removed at the same time, but little or no muscle (middle layer) is removed. The incision is closed with stitches which are removed at 5 days to a week post op. Bruising and swelling are variable, but usually minor – most important is to avoid aspirin or medication containing aspirin for about 2 weeks prior to the surgery – see under advice.
These are somewhat more tricky surgically, since most of the cheek fat is suspended just below the lower eyelids, and hence has a tendency to pull the lower eyelid down after surgery. Patients usually complain about eyelid bags, which bulge under the eye, and are often hereditary. The main problem in the lower eyelid is usually fat excess, or apparent fat excess, occasionally with some skin excess.
The “conventional” way of performing surgery on lower eyelids is to cut through the skin, through the muscle, and then remove some fat, and often a bit of skin and muscle too. More recently, there has been a shift in thinking in this regard – surgeons (like myself) believe that the middle layer (muscle) should not be injured or operated in most cases, and hence we do a transconjunctival approach to the fatty pockets. In essence, what this means, is that the fatty tissue is removed using a direct approach with a small incision on the inside of the eyelid (leaving no external scar). In younger patients (and often in older ones too!) this is all that is necessary, as the skin on the front of the eye often retracts once the fat is removed. In patients in whom there appears to be a true skin excess in the lower eyelids, this can be dealt with either by a concomitant light acid peel (to tighten the skin and minimise the ‘crepey’ lines) or surgically by using a ‘skin pinch’ – a small amount of excess skin is removed at the time of surgery (in front of the muscle). Hence – fat is taken from behind the muscle, and skin may be taken from in front of the muscle, but the muscle itself is not injured / operated upon. More often than not, fat micro-grafts are then placed along the eyelid-cheek junction to blend this area, and fill the tear trough. These grafts may also be used to plump out the cheekbone area to better support the lower lid.
Because the lower blepharoplasty involves surgery very close to the eyeball itself, I prefer to do this under a light general anaesthetic to ensure patient safety. In addition, a special corneal protector is used to shield the eyeball.