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- BLEPHAROPLASTY
- HOW IS THE OPERATION DONE?
- The principle of a blepharoplasty is simple. The excess skin of the upper and lower eyelids is excised and at the same time fat, which causes bagginess, is removed.The operation begins by marking the excess skin. On the upper lid t
 his is done by finding the edge of the tarsal cartilage, the supporting cartilage of the upper eyelid, about 9-10 mm from the eyelashes. A line is then drawn to identify the lower edge of the skin which will be removed. This line will eventually become the scar that remains on the eyelid. The excess skin of the upper eyelid lid then marked out. On the lower eyelid the incision is drawn in the crow's feet so that the scar will replace an already existing crease. The incision may then be marked just below the lashes of the lower lid.
On the upper lid the area marked out in this way is then removed The fat pads are identified by applying gentle pressure to the lower eyelid and making small "stab" incisions through the circular muscle which surrounds the eye (orbicularis muscle). On the upper lid there are usually two pads of fat. These are carefully cauterized (sealed), usually with heat, to avoid any bleeding behind the eye when they retract to their normal position.. The upper eyelid incision is then closed with stitches. It is common to use a single long stitch , called a running stitch, on the upper eyelid.
On the lower eyelid the skin is dissected away from the underlying muscle. The fat pouches are identified by applying some pressure to the upper lid and then removed using the "stab" technique mentioned above. On the lower eyelid there are usually three pads of fat. Again they are cauterized at their bases to avoid bleeding.
The surgeon must then assess how much skin is to be removed. This is always a delicate part of the operation because removal of too much skin will cause a pulling down of the lower lid, called an ectropion. On the other hand if too little is removed the patent will feel unhappy with the result. One method used if the patient is awake is to ask them to look up and open their mouth at the same time. This puts the ski of the lower eyelid on stretch so the surgeon avoids removing too much.
The skin is then repaired with delicate stitches most commonly these are single or interrupted stitches.
- In both the upper and lower eyelid there are a number of stitches used. Some surgeons prefer to use stitches that dissolve. These are often fast absorbing catgut stitches. Other surgeons prefer stitches that have to be taken out. On the lower eyelid these are often made of silk and on the upper lid of nylon or prolene. All, surgeons use slightly different methods and usually found a method which works best for them.
- On the lower eyelid there are two modifications which may be made. The first is the use of a skin-muscle flap. Instead of going underneath the skin the surgeon goes beneath the skin and the orbicularis
 muscle. This gives direct access to the fat pads and provide a thicker layer to the skin. It is used most often in younger patients who do not have a great deal of loose skin.
- Another method of removing excess fat ,but not skin, from the lower lid is the transconjunctival blepharoplasty (seen at the left). In this operation the incision is placed on the inside surface (the conjunctiva) of the lower lid. This avoids a visible scar.
- The operation is done under either local anesthetic (you are awake) or general anesthetic (you are asleep). It is a day surgery operation which means that if you have the operation in the morning you can often be home by lunchtime. It is common to combine the procedure with other operations such as a facelift.
- After surgery some surgeons apply a light compression bandage while others prefer to use no bandage at all.
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