Your eyes are often the first thing people notice about you and are an important aspect of your overall appearance. As we age, the tone and shape of our eyelids can loosen and sag. Heredity and sun exposure also contribute to this process. This excess, puffy or lax skin can make you appear more tired or older. An oculoplastic procedure is a type of surgery done around the eyes. One may have this procedure to correct a medical condition or for cosmetic purposes.
Blepharoplasty (Eyelid Surgery)
Eyelid surgery or blepharoplasty (pronounced “blef-a-ro-plasty”) can give the eyes a more youthful look by removing excess skin, bulging fat, and lax muscle from the upper or lower eyelids. If the sagging upper eyelid skin obstructs peripheral vision, blepharoplasty can eliminate the obstruction and expand the visual field.
Upper Blepharoplasty: For the upper eyelids, excess skin and fat are removed through an incision hidden in the natural eyelid crease. If the lid is droopy, the muscle that raises the upper lid can be tightened. The incision is then closed with fine sutures.
Lower Blepharoplasty: Fat in the lower eyelids can be removed or repositioned through an incision hidden on the inner surface of the eyelid. Laser resurfacing or a chemical peel can be performed at the same time if desired, to smooth and tighten the lower lid skin. If there is excessive skin in the lower lid, the incision is made just below the lashes. Fat can be removed or repositioned through this incision, and the excess skin removed. The incision is then closed with fine sutures
You will be given specific instructions that may include how to care for your eyes, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your overall health, and when to follow-up with your ophthalmologist.
The results of eyelid surgery will be long-lasting. While there usually is little pain involved in this surgery, there can be swelling or bruising. Most patients are presentable to the public in 10-14 days. However, it may take a few months before final healing is completed.
Entropion is a condition in which the eyelid is rolled inward toward the eye. It can occur as a result of advancing age and the weakening of certain eyelid muscles. Entropion may also occur as a result of trauma, scarring, or previous surgeries.
A turned in eyelid rubs against the eye, making it red, irritated, painful, and sensitive to light and wind. If it is not treated the condition can lead to excessive tearing, mucous discharge, and scratching or scarring of the cornea. A chronically turned in the eyelid can result in acute sensitivity to light and may lead to eye infections, corneal abrasions, or corneal ulcers. If entropion exists, it is important to have a doctor repair the condition before permanent damage to the eye occurs.
There are a number of surgical techniques for successfully treating entropion. The most common surgical treatment involves tightening of the eyelid and its attachments to restore the lid to its normal position. The surgery to repair entropion is usually performed as an outpatient procedure under local anesthesia. Patients recover quickly using an antibiotic ointment for about one week after surgery. Most patients experience immediate resolution of the problem following surgery.
Ectropion is when the lower eyelid droops down and outward. Ectropion can happen naturally due to age, disease, or an injury to the eyelid. If ectropion is not treated, the condition can lead to chronic tearing, eye irritation, redness, pain, a gritty feeling, crusting of the eyelid, mucous discharge, and breakdown of the cornea due to exposure.
The irritation can be temporarily relieved with artificial tears and ointments to lubricate the eye. Surgical treatment for an ectropion often depends on the underlying cause. In the type of ectropion associated with aging, most surgeons elect to shorten and tighten the lower lid. This typically is completed with an incision of the skin at the outside corner of the eyelid and reattachment of the eyelid to underlying tissues and the upper eyelid. Sometimes, there are scars from chronic sun exposure, following trauma, or the surgical removal of skin cancers. Your surgeon might need to use a skin graft taken from the upper eyelid or from behind the ear to repair the ectropion. Both the donor site for the graft and the surgical site will usually heal nicely within a few weeks following the surgery.
Ptosis (pronounced “toe-sis”) is the medical term for drooping of the upper eyelid. This lowering of the upper eyelid margin may cause a reduction in the field of vision when the eyelid either partially or completely obstructs the pupil. Patients with ptosis often have difficulty keeping their eyelids open. To compensate, they will often arch their eyebrows in an effort to raise the drooping eyelids. In severe cases, people with ptosis may need to lift their eyelids with their fingers in order to see. Children with ptosis may develop amblyopia (“lazy eye”) or developmental delay from the limitation of their vision.
There are many causes of ptosis including age-related weakening of the muscle, congenital weakness, trauma, or sometimes neurologic disease. As we age, the tendon that attaches to the levator muscle, the major muscle that lifts the eyelid can stretch and cause the eyelid to fall. This represents the most common cause of a droopy eyelid. Ptosis may also occur following routine LASIK or cataract surgery due to stretching of the muscle or tendon. Children may be born with ptosis or may acquire it due to trauma or neurologic reasons.
Ptosis can be corrected surgically and usually involves tightening the levator muscle to elevate the eyelid. In severe ptosis, when the levator muscle is extremely weak, a “sling” operation may be performed, enabling the forehead muscles to elevate the eyelid(s). Other types of repair may include surgery on the muscle on the inside of the lid in cases of small amounts of ptosis. The surgeon will perform testing to determine the best form of correction for the individual patient. The goal is to elevate the eyelid to permit a full field of vision and to achieve symmetry with the opposite upper eyelid.
Risk of Surgery
Possible risks of eyelid surgery include:
- Infection and bleeding
- Dry, irritated eyes
- Difficulty closing your eyes or other eyelid problems
- Noticeable scarring
- Injury to eye muscles
- Skin discoloration
- The need for a follow-up surgery
- Temporarily blurred vision or, rarely, loss of eyesight
- Risks associated with surgery in general, including reaction to anesthesia and blood clots
Talk to your doctor about how surgical risks apply to you. Understanding what's involved in blepharoplasty and weighing the benefits and risks can help you decide if this procedure is a good option.
For most procedures, you will be able to go home the same day you have surgery. Your procedure may take place in a hospital, an outpatient facility, or the provider's office.
Depending on your surgery, you may have local anesthesia or general anesthesia. Local anesthesia numbs the surgical area so you do not feel any pain. General anesthesia puts you to sleep during surgery.
During the procedure, your surgeon may place special contact lenses on your eyes. These lenses help protect your eyes and shield them from the bright lights of the surgical room.
Do not wear any eye makeup or artificial eyelashes on the eye to be operated on for 1 week prior to surgery.
Please let your doctors know if you are taking any medicines for diabetes or high blood pressure (especially angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers). Your doctors may want you to hold these 24 hours before surgery.
Please let your doctors know if you have a pacemaker.
Do not eat or drink anything at least 6 hours before your check-in time for surgery. This means no coffee, milk, or unnecessary water. You can take tiny sips of water with your pills.
You will most likely be able to go home or to a hotel after your surgery is done. You will need someone to take you home or to a hotel after your surgery.
You may have some pain, bruising, or swelling after surgery. Place cold packs over the area to reduce swelling and bruising. To protect your eyes and skin, wrap the cold pack in a towel before applying it.
You may need to avoid activities that raise your blood pressure for about 3 weeks. This includes things such as exercise and lifting heavy objects. Your provider will tell you when it is safe to begin these activities again. It is ok to shower after surgery but avoid getting tap water in the area that had surgery.
In most cases, you will see an eye doctor for postoperative visits one day, one week, and 4-6 weeks after your surgery, depending on your eye doctor. Some eye doctors forgo the one week visit.
If you develop severe eye pain or severe vision decrease after surgery, please call or see your eye doctor immediately. The phone number for the Loma Linda University Eye Institute is 909-558-EYES or 909-558-4000.