What is eyelid surgery (blepharoplasty)?
Eyelid surgery is a cosmetic change of upper and lower eyelids. Blepharoplasty solves mostly ptosis (drooping of eyelid), fat prolapses or combination of both defects. The surgeon removes excess skin and so-called fat bags (prolapses). If necessary he/she removes also some parts of increased oblique eye muscle. The patient can undergo the upper and lower eyelid surgery at the same time. If there are only fat bags in the lower eyelids and it is not necessary to remove excessive skin, the operation can be done from the inner-conjunctival side of the lid. This is called the transconjunctival version of the eyelid surgery.
If you have droopy or baggy lids, medical specialists recommend undergoing eyelid surgery as soon as possible. The results are then much better and will last longer. Usually, eyelid surgery is done for clients older than 35 years of age, but in some cases, it can be done earlier, usually because of a genetic predisposition of the client. In the case of younger clients, operation of the lower eyelids is done mostly from the inner–conjunctival side of the eye.
Eyelid surgery can improve your look, but do not expect people to treat you differently. It is therefore important to consider what your expectations are from eyelid surgery. Eyelid surgery can be done together with face-lift or browlift.
How is eyelid surgery done?
Before the surgery
First, the consultation with the eyelid surgeon is very important. It is necessary to speak openly about the reasons for the operation and to decide if it is desirable to operate on all four eyelids or just the upper or just the lower. The surgeon will explain the operational procedure and the process of anesthesia. Do not be afraid to ask questions, especially if you have any doubts or are unsure about something. You can also get more information in our blepharoplasty forum.
Avoid the use of medications such as Acylpiryn, Aspirin, Alnagon or Mironal before the eyelid surgery, as they can increase bleeding during and after the procedure.
Eyelid surgery can be only done if the patient is in a general state of good health. Your surgeon will define the extent of pre-operational examinations needed.
While making pre-operation preparations, be sure to arrange for someone to drive you home after your eyelid surgery and help out for a few days, if needed.
If you decide to undergo the surgery under local anesthesia, a presurgical internal examination is not necessary. You are sent to eye department, where quality and field of vision will be checked, pressure inside the eye will be measured and your eye will be examined microscopically with slit lamp (all these examinations are part of normal examination at ophthalmologist).
Blepharoplasty is not performed if your lacrimal aparat does not function sufficiently. Functional tests of lacrimation serve for evaluation (e.g. Schirmer’s test: A small piece of paper with high absorbable features is inserted on the edge of lower eyelid, distance of its moistening is read after certain time). Further the surgeon evaluates various eye parameters:
Size of palpebral fissure: It is a separation between central edge of upper eyelid and the edge of lower eyelid. The palpebral fissure is narrowed, if the distance is less than 10 mm.
MRD1: It is a separation between middle of pupil in the straight position and middle of upper eyelid.
MRD2: It is the same distance between pupil and lower eyelid. Both these distances should measure more than 4 mm.
Distance between eye fold and centre of pupil.
Exceptionally the surgeon requests CT to eliminate pathologic processes in the back part of eye socket.
On contrary functional tests of eyelid levator are common. The upper eyelid is turned and the patient is asked to look upwards. If the levator is in function the eyelid should turn back. The second test checks the elevation of eyelid by elimination of frontalis muscle out of function.
Eyelid surgery is usually performed under local anesthesia. However, the surgeon or patient may prefer to use general anesthesia. In case of general anesthesia, you will not be allowed to eat, drink and smoke for about six hours before the operation. If local anesthesia is used, the patient can leave for home after the surgery, however general anesthesia requires the patient to stay in hospital.
The patient can ask for reimbursement of the procedure if it is performed at the clinic that has closed contract with the insurance company. Unfortunately most of the surgeons don’t have that. Surgery of congenital ptosis of eyelids, skin prolapses and fat bags that limit vision are covered. Patient can undergo this covered procedure also at the eye department.
What results can you expect from eyelid surgery?
The scars, which are delicate and discrete, may be slightly pink during the initial weeks. Later, they fade and become almost invisible. Usually the eyelid surgery does not have to be repeated. Although the durability of the surgery is very individual, it depends on life style and quality f the skin. Sometimes after 8 to 10 years new fat prolapses occur and reoperation is necessary. The surgeon uses the same incisions; the procedure is simpler than the first surgery. Before and after photos of previous patient's eyelid surgery can be seen here.
This text has been created with kind assistance of Tomas Dolezal, M.D.