With age, drooping folds of skin and eyebags appear above and below the eyes. A blepharoplasty is either a rejuvenating (cosmetic) or functional surgical procedure, depending on whether the excess tissue poses a cosmetic problem or interferes with the patient’s visual function. The purpose of the blepharoplasty is to correct excess folds of skin (dermatochalasis) and eyebags or to reduce lower lid festoons.
The festoons are those folds of skin and muscle that look like a drape that is hung from one corner of the eye to the other in the lower lids.
Upper eyelid blepharoplasty
This is eyelid lifting surgery to remove excess upper eyelid skin, which makes the eyelids droop.
We will typically make incisions in the upper eyelid skin crease, where they heal best and will remain well hidden.
We make the incision along the natural eyelid skin crease a few millimetres above the eyelashes. The height of this varies between six and eight millimetres and is commonly lower in Asian blepharoplasty patients who have a naturally low skin crease unless they are comfortable with a result that changes slightly the appearance of the eye to one that is more western.
We then remove an elliptical piece of skin and muscle using a blade and a colorado needle (ultra-sharp microdissection needle designed for precision cutting and coagulation), which greatly reduces bleeding and helps keep the surgery very neat. We then close the skin incision using delicate sutures (stitch) and /or Tisseel fibrin adhesive.
It is also possible that we remove underlying fatty material during the process to get rid of upper bulges (called the medial fat bags), particularly at the inner corner of the upper eyelid.
Lower eyelid blepharoplasty
Patients with only mild eyebags or mild lower lid skin laxity, fine lines, and discolouration may not require a blepharoplasty.
If there are deep tear trough hollows (orbito-malar groove) or hollowing at the orbital rim and upper cheek (orbital rim and zygomatic hollow), we may use an injection of hyaluronic acid filler such as Restylane® or Juvéderm® in the periocular region to increase the soft tissue volume. Once the hyaluronic acid has reabsorbed after several months, we can offer a further injection. Some patients can proceed with an autologous fat transfer (also known as a coleman fat transfer).
If blepharoplasty is required, we make the incision from the inside of the lower eyelid, which causes little swelling and leaves no scar visible on the outside. This is known as a transconjunctival blepharoplasty. The transconjunctival route is used if we remove a small amount of fat, and reposition it into the tear trough.
If we are removing skin from the lower eyelids themselves during blepharoplasty, we’ll make a fine incision (known as an infra-lash incision) close to the eyelashes. At the same time, we can tighten the eyelid, and stabilise it using an orbicularis muscle flap. We often do a lateral canthal canthopexy at the lateral corner of the eye to strengthen and sharpen the lateral angle of the eyelids. We use discreet absorbable sutures to close the skin incision, which heals well, usually leaving no visible scars.