Blepharoplasty or eyelid lift, improves the appearance of the eyes by removing excess skin or bulging fat. It can be done on the upper or lower lids. It is performed for cosmetic purposes, but is also used to restore peripheral vision that has been restricted by excess, overhanging upper lid skin.
Removal of heavy or loose upper lid skin results in a more energized and awake appearance. It creates a more visible upper lid margin and increases the aperture of the eye. The amount of excess skin is measured from the inside to the outside corners of the lid. The proper amount of skin removal is as much as can be taken without restricting eye closure. The exception is that in male patients it is better to leave a little more skin, especially along the lateral or outer area in order to avoid a feminine look. Most of the incision is made in the natural skin crease which camouflages any signs of surgery once healed. Sutures can be dissolvable or permanent depending on the thickness of the skin. Permanent sutures, if used, are removed at one week.
A lower blepharoplasty is performed to eliminate bulging or dark shadows along the lower lid. Typically skin and muscle are tightened as part of the procedure. There are two approaches to the lower lid. One is transcutaneous in which an incision is made just beneath and parallel to the eyelid margin. It extends from close to the inner corner of the eyelid to the outer corner and then beyond this for a short distance, usually stopping at the outer boney rim of the eye socket. This allows for good exposure of all of the fat compartments. After removal of excess fat the overlying muscle/skin layer is further tightened by tacking it to the outer boney rim of the eye socket. This also straightens the lid margin, which tends to start to droop as part of the aging process. External sutures for transcutanous lower blepharoplasty are typically disolvabe.
The other approach is transconjunctival. The lower lid is pulled down and the incision is made along the inside of the lid to expose the fat. There are no external sutures.
As with any surgical procedure, there may be bruising or swelling. If it occurs, it tends to be more apparent than other areas because the upper and lower lid skin is so thin and so loosely attached.