Primary goal: Removal of skin and/or fat to improve appearance
Anesthesia: Local anesthesia with oral sedation in an office operating room or intravenous sedation as an out-patient at a hospital or surgicenter.
Operation: Skin to be removed is outlined. The first incision is made along the length of the lid and extends slightly upward at the lateral canthus. A second incision is made above the first and determined the amount of skin to be removed. If the orbicularis muscle is thickened or stretched, a small strip may be excised.
The orbital septum is opened to expose the fat pockets overlying the levator aponeurosis. The “middle” pocket is thinned using a process of dissection, excision, and cauterization. The “nasal” pocket requires deeper dissection.
The skin edges are reunited with either dissolving or permanent sutures.
Laser-assisted blepharoplasty, in which the actions of the scalpel and scissors are undertaken with a laser, received widespread attention in times past. While some proponents claimed faster operating times from decreased bleeding, objective studies failed to demonstrate less bruising after surgey. External scars may be more irregular than those created by a scalpel and may take longer to strengthen.
A modification known as deep fixation may be utilized to deepen the eyelid crease and create a more stable platform of skin on which to apply cosmetics. During closure, the skin edges are lightly attached to the underlying levator aponeurosis (tendon) using sutures.
Advantages: Upper blepharoplasty may achieve anything from a subtle to dramatic improvement in a person’s appearance. Due to its relatively modest cost and quicker recovery, many patients choose eyelid surgery over full face lift.
Limitations: If performed aggressively, descent of a weak brow may occur. “Crow’s feet” are not addressed. If ptosis (a droopiness of the eyelid due to a defective levator muscle system), blepharoplasty will not correct the problem.
Functional blepharoplasty or blepharoplasty undertaken to increase the rnage of vision narrowed by overhanging skin, entails removal of skin only. The results may be cosmetically disappointing to a patient who was hoping to coax his or her insurance company into paying for eyelid rejuvenation.
