Blepharoplasty

Am I a good candidate for blepharoplasty?

Generally speaking, there are two types of blepharoplasty: cosmetic blepharoplasty and functional (medical) blepharoplasty.

Cosmetic blepharoplasty refers to eyelid surgery that is performed to improve the appearance of the eyes. In the younger East Asian patient, this usually means surgery to create a lid crease in the upper eyelid that previously did not have one. In the older patient, cosmetic upper blepharoplasty refers to the removal of excess skin and fat tissue from the upper eyelid to restore a more youthful appearance. It usually involves crease formation as well. Occasionally, where the patient is noted to have a droop of the upper eyelid in addition to excess skin and fat, cosmetic ptosis and upper blepharoplasty has to be performed simultaneously to achieve a good outcome. Lower blepharoplasty is performed to eliminate or reduce the appearance of eyebags which can present from the mid-thirties. Insurance and Medisave does not cover any form of cosmetic surgery.

Functional (medical) blepharoplasty is only performed for elderly patients with such an excess of upper eyelid skin that the skin fold begins to cover part of the pupil. There are stringent criteria to be met and both photographic and perimetric (visual field) evidence are required before one is allowed to claim insurance or use Medisave to pay for the surgery.

If one has a cosmetic issue with the eyelids or have such severe excess skin that it starts to affect the visual field, then one could consider blepharoplasty. A detailed examination and in-depth discussion with your oculoplastic surgeon will help to determine the type of blepharoplasty that is most appropriate for your eyelids.

What are the differences between a suture technique and an incisional technique for upper blepharoplasty?

There exists many suture techniques to create an upper eyelid crease without a long skin incision. The technique used for upper eyelid surgery is dependent on surgeon preference. Essentially, whichever suture technique is used, the aim is to place fine, permanent sutures in a specific manner through the upper eyelid so that a crease forms in eye opening. This procedure has the advantage of minimizing down time although significant bruising can occur on occasion. It is useful in the younger patient, especially those with thinner upper lid tissue. It is not as useful in the older patient or the patient with bulky upper eyelid tissue. There is also greater potential for crease loss over time although this is disputed by some surgeons who favour this technique.

The incisional technique for eye lift surgery involves skin incision and the formation of a fine surgical scar plane that allows a crease to form in eye opening. The advantage here is the ability to excise any excess skin, superficial muscle and fat that may contribute to the eyelid bulk. There is also the opportunity to add in a mini-lift and eyelash eversion for greater rejuvenation. In older individuals, the wound heals well after a few weeks and is often not visible after a few months. In younger patients, wound healing can be exuberant and the crease may be prominent for quite some months before it becomes less visible.

Both techniques can be performed alone or in combination with a medial epicanthoplasty to achieve a more parallel crease.

A good discussion with your oculoplastic surgeon will allow you to make the right decision in which technique is most appropriate for you, based on your preferences and the pre-operative eyelid features.

What are the differences between fat excision and fat preservation techniques in lower blepharoplasty?

In the 60’s to 80’s, the trend in lower blepharoplasty was lower eyelid surgery involving the removal of fat from the lower eyelid. It is now recognized that this was not the best approach as it often led to hollowing of the lower eyelid area, deeper eye sockets and darker eye circles which all had an aging effect.

For the past two decades, surgeons have preferred fat preservation techniques, aiming to expose, release and reposition the bulging fat over the bony inferior orbital rim, particularly into the tear trough area between the eye bag and the nose. This allows the marked reduction or elimination of the eyebag without risking an aging hollowing effect.

Is revision surgery a common occurrence?

Revision surgery is not often discussed in-depth in the exciting lead up to cosmetic surgery. But it is good to be aware that it is a reality that one might encounter when one decides to proceed with cosmetic surgery. It can be minimized by a detailed pre-operative discussion on what one prefers as well as the limitations of the technique chosen. With an experienced surgeon, the likelihood is markedly reduced, However, even the best cosmetic surgeons do perform revision surgeries on their patients as complications do arise in a small percentage of patients. It is good to know that a slight adjustment of upper eyelid height or contour or a refinement of the crease in the early post-operative period is not considered revision surgery but rather a fine-tuning of the main procedure.

How much down time will I encounter?

Most eyelid surgeries will heal within two weeks. Stitches are removed between one to two weeks. Some bruising may still be evident at the end of two weeks but is not a major concern. As patients show a variable rate of healing, it is best to dedicate two weeks of rest to allow for good post-operative care and optimal healing. Travel overseas is best avoided during the post-operative period as any troublesome problem, even if small, is best managed by your surgeon.

Find out more about about double eyelid surgery or droopy eyelid surgery.