What is an eyelid correction?

A blepharoplasty is a surgical procedure to remove skin and to add fat to or remove fat from the eyelids.

Upper eyelid surgery uses a skin incision to allow for removal of skin and sometimes fat. A thin stitch then brings the skin together and allows for the creation of an eyelid crease.

Lower eyelid surgery can involve skin incisions directly below the lash line or an incision on the inside of the eyelid, called a transconjunctival approach. The transconjunctival approach allows for access to the eyelid fat without visible incisions which makes this technique perfect for patients who need fat removed or added.

What can a blepharoplasty do for you?

Excess skin and fat of the upper eyelid can cause a heavy looking eyelid, aged appearance, puffiness and sometimes blocked vision. Upper blepharoplasty is performed to remove excess skin and fat and may improve the patient’s vision.

Lower blepharoplasty is performed to remove excess skin, reduce wrinkles and improve the shape of the lower eyelid by removing skin and fat. Sometimes tightening the eyelid is needed to correct droopiness or sagging. Fat is added to improve a “hollowed” appearance.

Who is a good candidate for a blepharoplasty?

People with realistic expectations who are in good health are suitable for eyelid surgery.

How to prepare for a blepharoplasty?

There is no special preparation for this procedure.

How is a blepharoplasty performed?

As a stand-alone procedure, a blepharoplasty will be performed under local anaesthesia. The typical incisions are shown below.

Upper eyelid

In the upper eyelid, it is important that enough skin is left between the brow and the eyelid rim to ensure easy closure of the eyes. In women, the distance between the eyelashes and the lowest incision should be a few mm’s more than in men.

After the skin incisions have been made, the redundant skin is removed using fine scissors. A small strip of muscle sometimes is removed to avoid bulging. If some fat herniation is present close to the inner corner of the eye, a little bit of orbital fat can be removed. The skin will then be closed using one long nylon suture that needs to be removed six days after the surgery.

Lower eyelid

First, it needs to be determined if skin will be removed.

Transconjunctival blepharoplasty

If this is not the case, an incision on the inside of the eyelid is preferable as the scar will then be totally invisible. This procedure is called a transconjunctival blepharoplasty.

To fill up the tear, some fat from the inside of the orbit will be mobilised and sutured downwards into a pocket that has been created in between the bone and the periosteum. Sometimes this can be followed by some lipofilling.

No sutures are necessary as the incision will close spontaneously within a few days.

If there is redundant skin in the lower eyelid that needs to be removed, an incision is made just under the eyelashes extending about one cm laterally to the corners of the eyes. Fat repositioning as described above is performed.

To avoid an ectropion (outward rolling of the lower eyelid), a thin nylon suture is pulled through the outer corner of the eye and fixated to the periosteum (soft tissue layer that covers the bone) of the orbital rim. This will stretch the lower eyelid and add tension to the lower lid.

The redundant skin is removed conservatively. The skin is then closed using nylon sutures that need to be removed six days after the surgery.

What to expect and do during the recovery period after a blepharoplasty?

  • The day of the procedure: there will be some bruising and swelling. Pain is not really an issue and very well manageable with ordinary pain killers
  • Most people return to their normal activities after seven to ten days following the blepharoplasty. Two weeks after eyelid surgery, most of the bruising and swelling will resolve.

What are the risks of a blepharoplasty?

  • Ectropion, an outward rolling of the eyelid (lower lid only). This may improve spontaneously but corrective surgery might be necessary.
  • Difficulty closing your eyes resulting in dryness of the eyes. This may improve spontaneously but corrective surgery might be necessary.

How long can I expect the results of a blepharoplasty to last?

It is likely that the normal aging process will continue and that the eyelids slowly start sagging again. However, we also expect that the difference made by the surgery will last very long, if not forever.

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