Type of Surgery
Information
Last updated: 11/24/2009
There are several places around the eye that can be altered during eyelid surgery and several different procedures can be performed depending on the desired effect. For surgical alteration of the upper eyelid, the plastic surgeon will mark the...
area to be removed following the natural creases of the lid. These lines will dictate the location of the incisions so that when the eye is sutured (sewn together) the scars will fall within the folds. Usually two incisions are made and the skin between them is removed. Also, any fat that has collected in the lid is removed as well. The two incision lines are closed and, with the intervening skin removed, the eyelid rests much higher on the eye in its relaxed state.
area to be removed following the natural creases of the lid. These lines will dictate the location of the incisions so that when the eye is sutured (sewn together) the scars will fall within the folds. Usually two incisions are made and the skin between them is removed. Also, any fat that has collected in the lid is removed as well. The two incision lines are closed and, with the intervening skin removed, the eyelid rests much higher on the eye in its relaxed state.
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Most often, people have surgery to the lower eyelid in order to remove the “bags” from under the eyes. These “bags” are simply pockets of fat that serve no real purpose other than to make the person appear older and more tired. Small incisions are made along the lash line in the lower eyelid and the small pads of fat are extracted. Since the incisions are made in the lash line and the sutures are self-dissolving, the scar is completely invisible to the naked eye, under most circumstances.
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The placement of a pretarsal crease in Asian patients can be performed in one of several ways, but they all create a fold that is roughly parallel to the lash line of the patient’s upper eyelid. Regardless of the surgical approach, a sliver of fat is usually removed from the eyelid to create the fold. The procedure usually involves suturing a new fold into the eyelid that becomes permanent as the patient heals.
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Blepharoplasty in children is usually performed under general anesthesia (loss of consciousness), but adult patients have the option of having local anesthesia (anesthetic placed under the skin to completely numb sensation) instead. The advantage of local anesthesia is that the eyelid can be consciously held in place to determine ideal lid height. When local anesthesia is used, a sedative may also be given to relax the patient without putting them completely to sleep. There are also fewer side effects from local versus general anesthesia. Also ptosis (eyelid droop) can actually improve when a patient is under general anesthesia, thus the surgeon may underestimate the amount of eyelid to remove during the procedure.
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The entire procedure usually takes between one to three hours. Despite the fact that the surgery covers such a small area, the eyelids are extremely delicate structures and their alteration requires a slow, thoughtful technique. Achieving the desired aesthetic result takes a good deal of time. The surgeon must determine how much skin and fat to remove but also consider where the suture lines will fall. The sutures must be made very carefully and methodically to prevent visible scarring to the eyelids.
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A graphic animation of what causes fat and sagging eyelids. The video describes what takes place during eyelid surgery (blepharoplasty).
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Blepharoplasty can be both a functional and cosmetic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When an advanced amount of upper eyelid skin is present, the skin may hang over the eyelashes and cause a loss of peripheral vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision. Patients with a less severe amount of excess skin may have a similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve puffy lower eyelid "bags" and reduce the wrinkling of skin.
Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete.
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