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Blepharoplasty (Eyelid Rejuvenation)

What is Blepharoplasty?

Blepharoplasty is a surgical procedure that rejuvenates aging changes that develop around the eyes.  These aging changes include:  wrinkled extra skin in the eyelids, droopy eyelids, loss of the make-up platform in the upper eyelid, fat bulges in the upper eyelids, wrinkled skin in the lower eyelid and bulging fat or bags in the lower eyelids.  The goal of blepharoplasty is to open up the appearance of the eye and restore a youthful and rested appearance.  Blepharoplasty should be customized for each individual to reverse the unique aging features that have developed.

The Aging Eye

 The 3 D’s of facial aging are:  DESCENT, DEFLATION, AND DETERIORATION.   DESCENT occurs due to the loss of tissue strength and elasticity which results in sagging due to the downward pull of gravity over many years..  In the upper eyelid, DESCENT shows up as drooping skin which hides the makeup platform and results in “hooding” of the eye, especially noticeable over the outside corner.  In the lower eyelid, sagging can produce laxity and excessive show of the white portion of the eye, also known as “scleral show” or a “hound dog” appearance.  Fat, muscle or tissue fluid can protrude and descend over time resulting in bags or pouches around the eyes and loss of the normal smooth contours.  DEFLATION around the eyes results in loss of fat below the lower eyelid producing a hollow area known as the nasojugal groove.  Skin DETERIORATION produces wrinkling and color changes in the eyelids.  The overall effect of aging around the eyes is a tired or angry look.  Blepharoplasty is primarily aimed at reversing the changes associated with tissue DESCENT or sagging.

What Can a Blepharoplasty Do and Not Do?

·         BLEPHAROPLASTY will reverse the aging eye changes associated with tissue DESCENT.

·         Eyelid rejuvenation surgery, when properly performed, will result in a more youthful and revitalized look.

·         Successful blepharoplasty will eliminate the tired or angry look that commonly accompanies advanced aging around the eyes.

·         The goal is to achieve a rejuvenated appearance without distorting or creating a different and unnatural or “operated” look.  

·         A good result should turn the clock back 8 – 10 years.

·         Blepharoplasty will not stop the aging process and after the procedure the clock will begin ticking again.

How Is Blepharoplasty Performed?

Blepharoplasty can be performed using either intravenous conscious sedation as an isolated procedure or general anesthesia, if it is being combined with other procedures.  The surgical technique may vary somewhat but in general the following principles apply.

Upper Eyelid: An incision is placed along the natural lid crease.  The predetermined amount of excess skin to be removed is excised.  Dissection then proceeds deeper into the eyelids to remove any protruding fat pockets.  Caution should be exercised when performing fat removal to prevent an unnatural hollowing or a ‘ghostly’ look following surgery. 

Lower Eyelid: Lower blepharoplasty can be performed with either an external or an internal eyelid approach depending on the nature of the aging changes being corrected.

·         Transconjunctival  Approach:  This approach is best suited for cases where fat bulges are present with little to no excessive skin or wrinkling.  An internal incision is placed along the inside of the lower eyelid.  Dissection then proceeds down to the bulging fat pads that are either repositioned or removed.  Small amounts of excess skin can be removed using a so-called pinch excision if necessary. 

·         Transcutaneous Approach:  This approach is best suited for cases with more severe signs of aging.  Such individuals demonstrate excessive skin wrinkling, large bulges and bags and severe drooping or laxity in the lower lids.  An external incision is placed just under the lash line that extends to the outer corner of the eye.  Dissection then proceeds to remove bulging fat.  Excess skin is removed and the corner of the eyelid is resuspended to restore tightness to the lower lid.

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