Types of Blepharoplasty

Blepharoplasty is a rejuvenative surgery of the upper and/or lower eyelids that includes:

• Upper blepharoplasty which rejuvenates the upper eyelids
• Lower blepharoplasty which rejuvenates the lower eyelids.

Out of the two eyelid surgeries, upper blepharoplasty is probably a little more common than lower blepharoplasty because it can easily be done under local anesthesia whereas the lower eyelids are usually done with some form of systemic anesthesia (either iv sedation or general).  Furthermore, there are no fillers that can replicate the removal of excess upper eyelid skin therefore the upper blepharoplasty is the only option for this problem whereas, fillers to the lower eyelid region can improve the appearance of that region and can be considered a temporary alternative to surgery for some people.

DIFFERENT UPPER BLEPHAROPLASTY TECHNIQUES

The staple for upper blepharoplasty is removing the extra skin that hangs over the upper eyelids. There are different variations on how this is accomplished. Some doctors remove only the skin and some doctors remove the extra skin as well as some of the muscles that live just beneath the skin. Other doctors remove the extra skin, the extra muscle, and some of the deeper fat. It really depends on the anatomy of the patient to determine which technique is the most appropriate in any given situation.

Asian blepharoplasty is a lot different than the standard rejuvenative upper blepharoplasty. Many Asian people have that classic Asian look where they do not have an eyelid fold and/or have the epicanthal fold which is the web of tissue that extends from the middle of the upper eyelid towards the lateral aspect of the bridge of the nose.  Many Asians want to have a westernized looking eyelid in which case the surgeon creates an upper eyelid fold and/or removes the epicanthal fold. This is a different technique than the standard rejuvenative blepharoplasty.

DIFFERENT LOWER BLEPHAROPLASTY TECHNIQUES

There are different techniques for a lower blepharoplasty. The standard old school lower blepharoplasty is designed to remove the fat that lives there as well as remove the excess lower lid skin. Fat removal can be done in the form of an incision inside the lower eyelid which is called a transconjunctival lower blepharoplasty. This technique removes the fat from an incision inside the eyelid so there is no visible scar. Transconjuctival lower blepharoplasty is a more up to date method to remove the fat versus the older school method of making an incision on the lower eyelid and going through the external incision to remove the lower fat. There are many benefits to the transconjunctival approach including no visible scar as well preservation of the underlying muscle and septum which essentially eliminates any risk of the lower eyelid pulling down.

The most up to date way to do a lower blepharoplasty is to not even remove the fat. Instead, the surgeon repositions the fat. Removing the fat from the lower eyelid can create a hollow appearance so we try to preserve that fat whenever possible. The fat is moved from where it causes the puffiness (or bags) and then folded down onto the upper cheek so that the bags disappear and the hollow ridge is corrected at the same time. There are a lot of benefits to this technique, but it takes longer to do and there is a longer healing period. This procedure is called a transconjunctival lower blepharoplasty with fat repositioning.

SKIN PINCH FOR LOWER BLEPHAROPLASTY

The skin pinch for lower blepharoplasty involves taking out a little bit of the skin just beneath the eyelashes. This procedure yields a very mild result. The procedure is not strong enough to significantly tighten the lower eyelid skin. It can give a little improvement to the excess wrinkles on the lower eyelid skin, but it is a very minor technique that does not remove fat.

NON-SURGICAL APPROACHES

There are not any non-surgical approaches to upper blepharoplasty. A doctor can do a little bit of Botox underneath the eyebrows to create a brow lift effect with Botox. When the brows are lifted, the upper eyelids can tighten up a bit. It gives a very small and temporary correction to the upper eyelids for some people. It is not a good alternative to an upper blepharoplasty although it can give a little bit of relief with some of the heaviness in the upper eyelids.

For the lower eyelid, doctors can use fillers in the region just beneath the bags. By putting filler under the bag, it raises the level of the skin closer to the height of the bag thereby making it less noticeable.

Using fillers only gives temporary improvement which can be very aesthetically pleasing. This procedure requires a very conservative and artisitic touch.  Even in the most experienced and skilled hands a person can see some mild prolonged swelling due to obstruction of the lymphatic drainage system caused by the filler compressing the vessels and patients need to be made aware of this possible sequelae.

IDEAL CANDIDATES

For an upper blepharoplasty, somebody with excess skin that looks like they have skin folding over their upper eyelids is a good candidate. For example, a woman would not be able to see her eye shadow because the extra skin folds over that platform. For a man, somebody with extra skin that hangs over and gives a very tired and sleepy appearance. A good candidate is anybody with upper eyelids that gives them an older, mad, and/or tired appearance.

For the lower eyelids, anybody who has bags and puffiness that makes them look older and tired is a great candidate for a lower blepharoplasty. If there is wrinkled skin on the lower eyelids then a skin pinch to the lower eyelid would be appropriate at the same time as the lower blepharoplasty.

RISKS

In skilled hands, upper and lower blepharoplasties are extremely safe procedures. If it is not done skillfully or appropriately, a bad complication would be too much skin removed from the upper eyelid. This would make a person unable to close their eyes. That complication would be due to a lack of judgment and experience.

With the lower eyelid, if too much skin was removed during a skin pinch, it could pull the lower eyelid down and give a sad, unhappy and non-aesthetic appearance. Again, that would be due to a lack of experience, skill and judgment. Thankfully, those risks are very rare.

RECOVERY

The recovery time varies depending on the type of procedure.

For an upper eyelid, regardless of the technique, the recovery time is five days. It is very fast and very mild.

For the lower eyelid, if it is only fat removal, the recovery time is five to seven days. It is also very fast. If the doctor repositions the fat, that takes longer because it is a longer surgery and requires more dissection and more work. The recovery can be up to ten days to two weeks with this procedure.

Most people resume normal activities in about two weeks.

RESULTS

The results from an upper blepharoplasty are immediate. The results for the lower blepharoplasty probably take about a week to see. Both procedures have long lasting results of at least 10 years and possibly up to 15.

Revisions are possible if somebody is not happy with the results. If too little skin was removed from the upper eyelid and the patient still feels like they look heavy or tired, the doctor can always go back and take more out.

With the lower eyelid, if it is only fat that is removed and the patient still feels like they have got bags present, the surgeon can always go back in and take more fat out. If too much skin was removed from the upper eyelids, it is a fairly unfixable problem. It is not easy to go back in and add skin. A surgeon can take skin from behind the ear and add it into the upper eyelid but it does not leave a good aesthetic appearance. Too much fat taken out of the lower eyelid creates a hollow look in the area. The surgeon can re-inject fat back in but that involves another surgery.

FINAL THOUGHTS

Patients who have extra skin that hangs over the eyelids or extra fat under the eyelids can benefit from blepharoplasty. Since there are a variety of techniques that can be used to take care of the extra skin or fat, it is recommended that a patient schedule a consultation with a doctor before making a final decision on which procedure to undergo.

Written by Cosmetic town Editorial Team- MA

Based on an exclusive interview with Jason Diamond, MD in Beverly Hills, CA