EYELID SURGERY

What is an Eyelid Lift (Blepharoplasty)?

Commonly known as an Eyelid Lift, blepharoplasty is surgery to restore youthful eyes, to look brighter and allow better function of the sight. It involves removing excess skin and addressing the change in fat distribution around the eye that happens with age. 

What Happens Around Our Eyes As We Age?

Upper eyelids– The “soft tissue” from the top of your scalp down through your your hairline, your forehead, your brow and upper eyelid gets pulled down with gravity over time.  This excess skin created begins to “hood” over your eyelids.

People often do not notice that their peripheral vision has diminished as these changes happen slowly overtime. They can’t see as well as they used to because the hooding obstructs peripheral vision.

As less light gets through to your eyes your brain detects this change and, without you being aware, causes you to open your eyes wider and raise your eyebrows to let in more light.  This can also have the effect of producing wrinkles on your forehead.

There are also two fat compartments in your upper eyelids that change over time, one becomes larger and bulges out,  the other recedes, making your eyes often look hollow and gaunt if extreme.

Lower eyelids– Bone structure also changes slowly over time and gravity causes soft tissue to migrate south.  As skin loses its elasticity this steady pull causes wrinkles around the eyes  and “bags” or “dark circles” can also develop below the eyes. A comment we often hear from patients who come in is “I look tired all the time”, “I hate these bags under my eyes”.

 

This loss of elasticity in your skin and stretching of the ligaments below your eyes  act much like a hammock that stretches and sags as it holds the fat that has migrate south.

How Does Blepharoplasty Correct These Changes?

If the changes are early, one may be able to tighten the skin without surgery. There are non surgical methods that may allow for less down time and less risk. Also if the skin quality is good we might use fillers to camouflage the changes  and give more youthful look.  However, beyond a certain level the upper eyelids and lower eyelids need to be addressed with specialized operations.

Upper Eyelid Revision– Our faces and bodies are asymmetrical (no two eyes, breast and ears are exactly the same)   Excess skin is precisely measured to allow for this asymmetry. Skin may be taken away with an incision and depending on the situation fat may be “reallocated”  Taking fat from an area that is bulging due to excess fat and using it to reverse this “gaunt look” can be very effective.  This re-balancing is crucial in restoring youthful volume to make you look brighter and eliminating the appearance of having had surgery.

Depending on what can be addressed, this procedure can be done under local anaesthetic in an office setting.  It is extremely rare for an upper eyelid incision to be noticeable- best part of the body to have a scar, no one sees it eventually provided recovery is uneventful.

 

Lower eyelids Revision  There are largely 2 ways.
   Scarless approach– incision is made inside your lower eyelid (it’s actually not as scary as it sounds!) so there is no scar on the outside. The fat below your eyelids are addressed  through this approach but this method does not address the skin- so this might be for someone who’s skin tone is good and little or no excess but the chief complaint is about the fat.

   Open approach– hairline incision is made below the eyelashes (scars around eyelids for some reason heals extremely well, so much so that months down the line it is almost imperceptible provided there were no complications) so that excess skin and fat are sorted.

As mentioned above, some times the loss of volume around the eyes are best addressed with right amount of additional volume. This can be temporary solution like a filler (An office based procedure, with no downtime, which if you don’t like can be left to disappear within 3-6 months) or permanent like a fat injection (sucking fat from an unwanted area and injecting it into places that need filling)..

Brow Lift - Why We Often Suggest This

Often patients come in wanting an eyelid lift but the bigger problem (apart from the eyelid) is the eye brow position. This is because the soft tissue migrating south from the top of your scalp down to your upper eyelid stretch due to gravity. You may already compensating for your blocked vision by unconsciously raising your eyebrows. This can be why some people have wrinkles on their forehead.

For most people the issue can be dealt with by addressing the eyelids. If the biggest problem you have is brow migrating south, doing your eyelids then will help make your brow relax, and your eyelids sit more naturally again. Patients are often surprised to find that their eyelid lift solve the eyebrow problem?

 What are different ways of changing the eye brow position?

   Endoscopic- A technique using a camera and sutures.

   Open incision technique- This is a more direct approach, and also the simplest, most direct way to change position of the eyebrows. 

   Limited incision technique- Which is a mix of the above two techniques

Can Eyelid Lifts Be Done Under Local Anesthetic

For selected cases, after examination and in depth discussion in person, will can determine whether this is appropriate for your situation.

This may be relevant if you are a self funded patient with no private health insurance coverage as the additional operating theater cost can be expensive.

Ask Us to see if you are suitable to have this done in an office setting with local anaesthetics.

Risks of Blepharoplasty

Any operation comes with risk. These risks will be discussed with you in detail at your consultation.  Thankfully these risks are extremely low but it is important that you understand them and accordingly follow all post operative care instructions completely.

Chemosis– This is the commonest complication after blepharoplasty. It is when swelling of the red mucosa inside of your eyelid persists after surgery.  The condition is usually temporary and is thought to be due to a blockage of the lymphatics.  If it does occur it can be treated effectively topical medications and rarely needs any other intervention.

Injury to the eyes– Eye protectors and lubricants are used to minimise this and incidents of injury to the eye are extremely rare.

Poor Scar Healing – Tissue around the eyes generally heals very well and noticeable scaring is extremely rare. Virtually unheard of if postoperative scar advice are followed closely.

Ectropion– This is a potential risk of lower lid surgery when the eyelid margin no longer sits on the eye itself.  To prevent this proper examination and discussion of tailored plan including manipulation of eyelids will take place.

Asymmetry– Because no two eyes are exactly the same existing difference between right and left may remain and in rare circumstances be exaggerated.

Infection– You will be covered with the right antibiotics and also provided with topical ointments and drops.  Following postoperative care procedures is the best way of avoiding this.

Close

What Happens Around Our Eyes As We Age?

Upper eyelids– The “soft tissue” from the top of your scalp down through your your hairline, your forehead, your brow and upper eyelid gets pulled down with gravity over time.  This excess skin created begins to “hood” over your eyelids.

People often do not notice that their peripheral vision has diminished as these changes happen slowly overtime. They can’t see as well as they used to because the hooding obstructs peripheral vision.

As less light gets through to your eyes your brain detects this change and, without you being aware, causes you to open your eyes wider and raise your eyebrows to let in more light.  This can also have the effect of producing wrinkles on your forehead.

There are also two fat compartments in your upper eyelids that change over time, one becomes larger and bulges out,  the other recedes, making your eyes often look hollow and gaunt if extreme.

Lower eyelids– Bone structure also changes slowly over time and gravity causes soft tissue to migrate south.  As skin loses its elasticity this steady pull causes wrinkles around the eyes  and “bags” or “dark circles” can also develop below the eyes. A comment we often hear from patients who come in is “I look tired all the time”, “I hate these bags under my eyes”.

 

This loss of elasticity in your skin and stretching of the ligaments below your eyes  act much like a hammock that stretches and sags as it holds the fat that has migrate south.

How Does Blepharoplasty Correct These Changes?

If the changes are early, one may be able to tighten the skin without surgery. There are non surgical methods that may allow for less down time and less risk. Also if the skin quality is good we might use fillers to camouflage the changes  and give more youthful look.  However, beyond a certain level the upper eyelids and lower eyelids need to be addressed with specialized operations.

Upper Eyelid Revision– Our faces and bodies are asymmetrical (no two eyes, breast and ears are exactly the same)   Excess skin is precisely measured to allow for this asymmetry. Skin may be taken away with an incision and depending on the situation fat may be “reallocated”  Taking fat from an area that is bulging due to excess fat and using it to reverse this “gaunt look” can be very effective.  This re-balancing is crucial in restoring youthful volume to make you look brighter and eliminating the appearance of having had surgery.

Depending on what can be addressed, this procedure can be done under local anaesthetic in an office setting.  It is extremely rare for an upper eyelid incision to be noticeable- best part of the body to have a scar, no one sees it eventually provided recovery is uneventful.

 

Lower eyelids Revision  There are largely 2 ways.
   Scarless approach– incision is made inside your lower eyelid (it’s actually not as scary as it sounds!) so there is no scar on the outside. The fat below your eyelids are addressed  through this approach but this method does not address the skin- so this might be for someone who’s skin tone is good and little or no excess but the chief complaint is about the fat.

   Open approach– hairline incision is made below the eyelashes (scars around eyelids for some reason heals extremely well, so much so that months down the line it is almost imperceptible provided there were no complications) so that excess skin and fat are sorted.

As mentioned above, some times the loss of volume around the eyes are best addressed with right amount of additional volume. This can be temporary solution like a filler (An office based procedure, with no downtime, which if you don’t like can be left to disappear within 3-6 months) or permanent like a fat injection (sucking fat from an unwanted area and injecting it into places that need filling)..

Brow Lift - Why We Often Suggest This

Often patients come in wanting an eyelid lift but the bigger problem (apart from the eyelid) is the eye brow position. This is because the soft tissue migrating south from the top of your scalp down to your upper eyelid stretch due to gravity. You may already compensating for your blocked vision by unconsciously raising your eyebrows. This can be why some people have wrinkles on their forehead.

For most people the issue can be dealt with by addressing the eyelids. If the biggest problem you have is brow migrating south, doing your eyelids then will help make your brow relax, and your eyelids sit more naturally again. Patients are often surprised to find that their eyelid lift solve the eyebrow problem?

 What are different ways of changing the eye brow position?

   Endoscopic- A technique using a camera and sutures.

   Open incision technique- This is a more direct approach, and also the simplest, most direct way to change position of the eyebrows. 

   Limited incision technique- Which is a mix of the above two techniques

Can Eyelid Lifts Be Done Under Local Anesthetic

For selected cases, after examination and in depth discussion in person, will can determine whether this is appropriate for your situation.

This may be relevant if you are a self funded patient with no private health insurance coverage as the additional operating theater cost can be expensive.

Ask Us to see if you are suitable to have this done in an office setting with local anaesthetics.

Risks of Blepharoplasty

Any operation comes with risk. These risks will be discussed with you in detail at your consultation.  Thankfully these risks are extremely low but it is important that you understand them and accordingly follow all post operative care instructions completely.

Chemosis– This is the commonest complication after blepharoplasty. It is when swelling of the red mucosa inside of your eyelid persists after surgery.  The condition is usually temporary and is thought to be due to a blockage of the lymphatics.  If it does occur it can be treated effectively topical medications and rarely needs any other intervention.

Injury to the eyes– Eye protectors and lubricants are used to minimise this and incidents of injury to the eye are extremely rare.

Poor Scar Healing – Tissue around the eyes generally heals very well and noticeable scaring is extremely rare. Virtually unheard of if postoperative scar advice are followed closely.

Ectropion– This is a potential risk of lower lid surgery when the eyelid margin no longer sits on the eye itself.  To prevent this proper examination and discussion of tailored plan including manipulation of eyelids will take place.

Asymmetry– Because no two eyes are exactly the same existing difference between right and left may remain and in rare circumstances be exaggerated.

Infection– You will be covered with the right antibiotics and also provided with topical ointments and drops.  Following postoperative care procedures is the best way of avoiding this.

Close

What is an Eyelid Lift (Blepharoplasty)?

Commonly known as an Eyelid Lift, blepharoplasty is surgery to restore youthful eyes, to look brighter and allow better function of the sight. It involves removing excess skin and addressing the change in fat distribution around the eye that happens with age.