What is eyelid surgery?

Blepharoplasties are the cosmetic surgery of the eyelids which aim to remove certain flaws, whether hereditary or due to age.

  • They can correct some effects of aging on the eyes such as drooping eyelids, bags under the eyes, etc...
  • They may concern only the upper or lower eyelid, or the four eyelids at once.
  • A blepharoplasty can be performed alone or combined with another intervention of plastic surgery of the face (forehead lift, cervicofacial lift).
  • Some medical procedures are sometimes used to complete the blepharoplasty, including some to treat fine lines and wrinkles that can not be treated with facelifts.
  • These include peels, dermabrasion (laser, chemical or mechanical), injections of fillers, botulinum toxin, etc...
  • These acts may be performed during the same intervention or during a second operation.

Why have eyelid surgery?

The first signs of facial aging frequently affect the area around the eyes:

  • On the upper eyelids, the skin folds and falls until touching the lashes or obstruct the field of view! Sometimes fat pockets become visible, especially in the inner part of the eyelids, making the eyes seem “puffy”.
  • On the lower eyelids, the skin falls and makes eyes seem “hollow”. The fat pockets may appear on the eyelids or lower on the cheekbones. Finally, the eye can become rounder, and the edge of the lower eyelid can come off of the cornea.
  • Wrinkles appear on the outer part of the eye (wrinkles of the crow's feet). Fine lines can mark all around the eyes. Forehead wrinkles usually accompany the alterations of the upper eyelids.
  • Finally, the eyebrows fall frequently, especially at their outer part, leaving an excess of skin in the outer part of the upper eyelids.

Blepharoplasty proposes to correct the signs of aging present in the eyelids and replace the "tired" appearance of the eye with a more rested and relaxed look.

The consultation

During the consultation, the areas affected by aging and their importance are specified.

  • An asymmetry exists frequently before the intervention: it is then noted and a correction thereof is discussed.
  • The location of future scars is shown: in the skin crease for the upper lid below the eyelashes (external scar) or the inside of the eyelid (internal scar) for the lower eyelid
  • Preoperative ophthalmologic consultation is prescribed to search for counter-indications to the intervention (Graves' disease, dry eyes…)
  • Finally, certain ophtalmologic risk factors are screened for (hypertension, diabetes, etc...)

It is later decided with the patient whether to involve other surgical procedures or cosmetic medicine, to preserve the harmony of the face.

  • This is for example performed at the same time as a brow lift, to enhance the eyebrow, or lipofilling in the case of an additional cosmetic surgery.
  • As regards to aesthetic medicine, it may include fillers to restore little volume in certain parts of the face (for example under the eyelids).

What happens during a blepharoplasty?

Duration of the intervention: 30 min to 1 hour and a half,  depending on whether the procedure is done on 2 or 4 eyelids, and whether other surgical procedures are necessary or not.

  • It may include a lipofilling (fat removal from the knees, thighs, etc...) which will be re-injected into some hollow areas (under the lower eyelids, or in some folds).
  • It is also sometimes includes external canthopexy, to tighten the lower eyelid or change its shape.

Hospitalization time: The procedure can take place with no hospitalisation, or in a outpatient clinic depending whether the procedure is done on 2 or 4 eyelids.

Type of anesthesia: The procedure is performed under local and potentialized anesthesia for single upper or lower eyelids and under potentialized or general anesthesia for upper and lower eyelids.

Some medications that favor bleeding should not be taken during the 10 days preceding the intervention: aspirin, anti-inflammatory, anti-clotting... Some drugs can be taken before surgery to reduce swelling and postoperative bruising.

What follows a blepharoplasty?

  • There are usually some bruises and edema (swelling) of the eyelids that disappear in 1-2 weeks. The head should be elevated (put two pillows on the bed) for a few days to decrease the swelling faster. Right after surgery, put cold compresses on the eyelids to reduce the bruising.
  • Watery eyes, and a sensitivity to light and a slightly blurred vision may occur for a few days after the operation: this disappears in a short time either spontaneously or with suitable eye drops.
  • During this period, it is best to wear sunglasses. Contact lenses are banned for two weeks after surgery.
  • A few days of rest are recommended after surgery, and violent efforts should be avoided for a month. You can start covering the bruising with makeup after 1 week.
  • The procedure is not painful. There may be a feeling of tightness of the eyelids, and eye irritation: eye drops will be prescribed to reduce these feelings.
  • Lymphatic drainage sessions of the eyelids may be necessary one month after the intervention.
  • The scars should not be exposed to sunlight for 6 months after surgery.

The risks of blepharoplasty

  • Epidermal cysts can sometimes appear on the scars (white dots). They are easily removed during a consulting.
  • Eye irritation can sometimes occur after surgery.
  • The round eye or ectropion (eversion) of the lower lid should be avoided by screening for risk factors before surgery.
  • Small asymmetries can sometimes require further surgery for correction, several months after the first.

The scars of a blepharoplasty

The position of the scars of a blepharoplasty will be determined during the consultation.

They are generally external scars: under the lashes for the lower lid, and the lid crease for the upper eyelid; and internal scars under the lower eyelid.

After a blepharoplasty

  • The results are even more durable than other facial interventions.
  • The rejuvenation that results is visible for many years before the facial aging resumes.

Information Sheet SoFCPRE (Société Française de Chirurgie Plastique Reconstructrice et Esthétique)

Last update of this page : 06-06-2019

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