Blepharoplasty for removal of excess skin from the upper eyelids
What problems can excess skin of the upper eyelids cause
Excess skin of the upper eyelids (dermatochalasis) occurs in most people with age. It is due to a combination of factors, including loss of elasticity in the skin, redundancy of skin, thinning of the outer layer of the skin and drooping of the eyebrows above.
The excess skin hangs in folds in the upper eyelid, particularly in the middle and outer aspect of the eyelid. This will mask the natural crease of the eyelid, and may often hang onto the eyelashes themselves. It is often accompanied by excess muscle in the eyelid, as well as herniation (bulge) of fat behind the upper eyelids, which appear as little bags/swellings in the hollow crease of the brow ridge.
It can cause multiple problems including:
- Loss of the upper and outer field of vision as the excess skin hangs down. This may lead to problems with driving or reading
- Irritation of the eyes, as excess skin pushes the eyelashes and eyelid margin onto the surface of the eye
- Heavy tired feeling in the eyes, especially toward the end of the day
- Frontal headache, as compensatory lifting of the brows is used to try and lift the excess skin off the eyelids
- Unsatisfactory tired and aged look to the face
Dermatochalasis is often accompanied by other problems, in particular drooping of the eyelids themselves (blepharoptosis), and drop of the eyebrows (brow ptosis). For the best surgical result to improve function and appearance, these conditions may need to be treated at the same time as the dermatochalasis.
Important things to know before your blepharoplasty surgery
Different patients will undergo blepharoplasty surgery for different reasons. For many, it will be to improve vision or comfort, and for others, it will be a mostly cosmetic procedure to improve appearance.
Dr Then will carefully examine your eyelids and eyes, and will then thoroughly discuss the best treatment options for you, to help you achieve the goals that you have in mind. It is important that expectations are realistic about what blepharoplasty surgery can achieve for your face. Age, skin type, structure of underlying bones and soft tissue, and any other associated problems, will all influence the results of your blepharoplasty surgery.
As with any surgery, knowing what you want to achieve, and whether these expectations can be met, are crucial.
How is blepharoplasty surgery performed
Blepharoplasty surgery aims to remove the excess skin to improve both the function and appearance of the upper eyelids. The overall effect, however, is actually to rejuvenate the whole face, often giving a marked improvement in the youthful appearance of the face.
Surgery is usually performed under local anaesthetic, and as a day case procedure.
First, Dr Then will mark your natural skin crease in the upper eyelid, and then make further markings to map out the degree and contour of excess skin to be removed.
An injection of local anaesthetic is then given beneath the skin of the upper eyelid to completely numb the area.
An incision is made with a blade into the natural crease of the eyelid, which will minimise the visibility of any future scarring. The marked area of excess skin is then removed. If necessary, any excess muscle and bulging fat is also removed at this time, and if a eyelid lift (ptosis repair) needs to be performed, this will also be done now.
Finally, the skin wound is carefully closed with fine self-absorbing sutures, which will also minimise the risk of significant scarring in the natural skin crease.
After surgery, the eye may be padded for 24 hours, to help reduce any post-operative swelling and bruising.
What other procedures may also be performed at the time of blepharoplasty surgery.
Whilst blepharoplasty surgery may be performed alone, this is uncommon. Most times, patients will also undergo eyelid lift surgery (ptosis surgery, see separate information sheet) and/or brow lift surgery. Reformation of a good-looking upper eyelid skin crease is also an important part of blepharoplasty surgery, and the technique used to do this will depend on your age, sex, ethnicity, and the presence and contour of your natural crease.
Dr Then will discuss with you if these procedures are appropriate for you, to achieve the best functional and cosmetic result for your face.
What are the benefits of blepharoplasty surgery
The benefits of blepharoplasty surgery include:
- Improvement in upper and outer field of vision
- Improvement in comfort of the eyes
- Elimination of forehead headaches from compensatory brow overaction
- Improved and more youthful appearance to the eyelids
What are the risks of blepharoplasty surgery
Most patients do not experience significant complications with blepharoplasty surgery.
However, the risks of blepharoplasty surgery include:
- Bleeding and bruising
- Overcorrection or undercorrection of skin removal
- Asymmetry of skin removal between the left and right eyelids
- Dry eye
- Poor eyelid closure
- Unsatisfactory scarring, or cysts/whiteheads along the suture line
- Temporary patches of numbness in the eyelid
- Persistent eyelid swelling
- Bleeding in the orbit of the eye, leading to loss of vision
Many patients are concerned that they will be left with a “surprised” or “operated-on” look after blepharoplasty surgery. If performed properly, this is very unlikely, and Dr Then is careful to remove only as much skin as is required. The removal of too much skin not only leads to an unsatisfactory appearance, but also the risk of not being able to close the eyes properly, which leads to dry and uncomfortable eyes.
Many patients will experience temporary dry eyes after the surgery, which can be easily treated with artificial tears. However, if you suffer with dry eyes prior to surgery, surgery may worsen your dry eyes, but again, symptoms can be easily treated with tear drops.
Unsightly scarring and persistent eyelid swelling are rare complications. Early bruising and swelling usually significantly resolves within 2 weeks, and many patients are back to work within 7-10 days, depending on the type of work that they do. However, it is important to remember that it can take up to 6 months from the time of surgery, for the skin crease wound and eyelid to settle to its final shape and appearance.
Loss of vision is a very rare complication, and only occurs when orbital fat is removed at the time of blepharoplasty surgery. Every precaution is taken during surgery to minimise this rare risk.