Blepharoplasty

Blepharoplasty is eyelid surgery. It removes or repositions excess skin, muscle and fat from the upper eyelids, lower eyelids or both, to rejuvenate the eyes and, in some cases, improve the field of vision. It is one of the most common facial cosmetic operations and, thanks to its short recovery, one with the best balance between result and downtime.

History

The term was coined by the German surgeon Karl Ferdinand von Graefe in 1818 to describe eyelid reconstruction. Over the 20th century the technique evolved from repairing defects into a routine cosmetic operation. A key advance was the transconjunctival approach to the lower eyelid, which treats bags without an external scar. Today the trend is to preserve and reposition fat rather than remove it, to avoid a hollow look.

Indications

• Excess upper eyelid skin (dermatochalasis), which gives a tired look and, when significant, can block part of the field of vision.
• Lower eyelid bags caused by protrusion of the fat around the eye.
• Hollowing between the eyelid and cheek, which can be corrected by repositioning that same fat.

Dermatochalasis must be distinguished from eyelid ptosis (drooping of the lid margin due to a weak lifting muscle) and from brow descent, because they are treated differently and often coexist.

Techniques

• Upper blepharoplasty: incision in the natural eyelid crease, where the scar is hidden. Excess skin and, if needed, some muscle and fat are removed.
• Transcutaneous lower blepharoplasty: incision just below the lashes. Also allows excess skin to be treated.
• Transconjunctival blepharoplasty: incision inside the lower eyelid, with no visible scar. Indicated for bags with little excess skin.

On the lower eyelid, a canthal support technique is often added to maintain the eyelid position.

Risks and complications

The most common are swelling, bruising and temporary dry eye. Less frequent are difficulty closing the eye fully, retraction or eversion of the lower eyelid (ectropion), asymmetry and excessive fat removal. A haematoma behind the eye is a very rare but serious complication, so patients are monitored closely in the first hours.

Recovery and results

Swelling and bruising last one to two weeks. Stitches come out after a few days and most patients return to social life in about ten days. The result is long-lasting, especially on the lower eyelid; on the upper lid the skin may relax again over the years.