Eyelid Surgery Mobile, AL

Blepharoplasty

Blepharoplasty is a procedure that I frequently perform as a board certified plastic surgeon. Blepharoplasty just means eyelift and the term is used both for upper as well as lower eyelids. For upper blepharoplasty or surgery on the upper eyelids, usually an incision is made on the outside of the skin where the excess skin and fat is removed at which point the incision is closed with a small suture. The sutures are removed in approximately 5 days.

Who is a good candidate for an upper blepharoplasty?

I tend to see two different groups of patients. Those who are younger, in the 30-40 year old range who have a family predisposition for redundant skin in the upper eyelid, and then those who are older, who have undergone relaxation of the skin and have fullness or in extreme cases, excess skin which hangs down onto the upper eyelids and actually can obstruct some of their vision. For patients with a large amount of redundant skin that obstructs their vision, insurance will often pay for the surgery if they meet a certain percentage of decreased vision. The patient has to have a test called a peripheral field test, which is usually done by an optometrist, and if the obstruction is more than a certain percentage (depending on the criteria set by the insurance company) frequently the insurance will pay for this. Unfortunately, Medicare and some other insurance will not tell you ahead of time whether or not they going to pay for it, even with a significant decrease in vision. The best we can do is perform the surgery as if it was a cosmetic procedure and then bill Medicare or other insurance after the fact.

An upper blepharoplasty can be done as an “awake” procedure with sedation. It usually takes 30-40 minutes to do. A light layer of antibiotic ointment is applied to the area and usually we do not use any dressings except for some cold, light compresses over the eyes to add soothing sensations and help decrease some of the swelling.

Good candidates for lower eyelid blepharoplasty are people who have redundant or excesses skin or who have baggy and/or tired eyelids. The lower blepharoplasty can be done with a couple of different techniques. One is the traditional technique, which uses an incision just below the lash line and elevates the skin and muscle of the eyelid to remove the excess fat. Frequently those people with eyes that have not only bags but also hollowness under them can be remedied by transposing the fat, instead of completely removing it, so it fills in the hollowness under the eyes. Once the fat is either removed or transposed then the excess skin is removed and the incisions closed with a fine suture. These sutures are taken out at approximately 5 days. The other technique, which is more modern, is to do what is called a transconjunctival lower blepharoplasty. This involves making the incision on the inside of the lower eyelid. The nice thing about this is that it does not violate the eyelid itself and reduces the risk of scarring and pulling of the eyelid down after the surgery. The fat is removed through this incision. No sutures are used. Frequently if there is some crepiness or aged skin, this can be treated with either a laser or chemical peel on the outside of the skin. The chemical peel or laser is used to tighten the loose skin.

Frequently in older patients the eyelid becomes lax with age and needs to be tightened somewhat. It is not uncommon to do a blepharoplasty in the lower eyelid and to tighten the eyelid so it does not pull down with scarring. I like to do this through an incision in the lateral aspect of the upper eyelid. This only adds 5-10 minutes to the procedure and is a nice adjunct and helps to create a youthful appearance to the eyes. After the surgery, strenuous activity should be curtailed for 3 weeks. The patient is, however, able to do normal things around the house for at least a week. This procedure rarely causes pain requiring pain relievers.

The patient can expect to have a more youthful appearance and to appear more rested.