Eyelift or Blepharoplasty
An eye lift is one of the oldest procedures that provides a more youthful appearance to patients. Though the procedure dates back to the 10th and 11th centuries, the protocol in use today has been utilized since the 1950’s. An eye lift is relatively safe and produces remarkable results, turning back the clock for patients with drooping upper eyelids or bags on the lower lids.
Generally a cosmetic procedure, an eye lift aims to offer patients a more youthful look by reducing the bagginess under the eye and raising drooping upper eyelids. The procedure offers permanent results and involves the removal of excess skin, muscle and fat tissue, as necessary to accomplish the goal of providing patients with a younger and healthier look. Some doctors use a scalpel, also known as “cold steel”, while others prefer to use laser technology to cauterize the incisions as they are being made in the eyelids.
An eye lift can make patients look better rested and healthier by providing a lift to heavy eyelids or by removing bags under the eyes. In some instances, doctors also inject fatty tissues from another area of the body into the area just beneath the eyebrow to provide more volume. This procedure involves the use of liposuction to harvest fat cells from the body before injecting them into the eyelid.
Eye lift surgery is most commonly performed to fulfill cosmetic desires, instead of correcting functional issues with the eyelids. However, there are situations that warrant the use of an eye lift in order to help the eyelids function better. For example, a lot of excess skin in the upper eyelids may reduce peripheral vision, warranting removal of the extra skin to make it easier for the patient to see. Also, some eye diseases can be partially treated by doing a lower blepharoplasty to improve the functionality of the lower eyelid.
Eye Lift – Blepharoplasty
The Aging Process
As the face ages, changes take place that affect the bone, muscle, skin, and fat tissues. Though changes in the skin may be the first and most noticeable alteration brought on by advancing age, bone tissues slowly degenerate as well, creating marked effects. Bone is lost around the eye sockets, which can cause the eyes to appear “sunken”. This is precisely the reason why most patients elect to have an eye lift and other related cosmetic procedures. Bone is also lost in the jaw and checks. Loss of bone in the jaw is often the culprit behind the initial development of jowls, for example.
The muscles that attach to these bones can become slack as less bone tissue is available for attachment. The result is a drooping, sagging look, especially in the jowls. A corresponding loss of fat in the cheeks and eye region can simply add to a patient’s aged appearance. Addressing these underlying issues by opting for an eye lift can have an obvious and rejuvenating effect on the face.
Despite the underlying changes going on under the skin, dermal thinning is perhaps the most noticeable change to patients along with an increase in pigmented spots and problems like wrinkles. Though the skin may seem to be the whole problem on the surface, a qualified plastic surgeon can analyze a patient’s face in terms of the different tissue layers. Based on this analysis a treatment plan can be developed to address the various issues that go beyond the problems that are only skin deep.
Aging of the Eye (Periorbital) Region
There are a number of changes that take place in the periorbital region that contribute to an aged appearance. The tissues around the eyes slowly weaken as the years pass, which can lead to bulging of fat above and below the eye. The fat pad that creates rounding and softness in the cheeks just below the eyes slowly starts to descend over time, hence the need for an eye lift. Moreover, the orbicularis oculi muscle begins to sag and droop. This can cause the bony part of the eye to become more noticeable, a telltale sign of an aging face.
Other gravity-related changes can affect the lower eyelid and the area where the cheek and the lower eyelid meet. Some patients notice that their eyelids appear more “sunken” or that they look tired all the time. These changes mostly pertain to the muscle, fat, and skin tissues that are susceptible to the pull of gravity. The problem is the result of having a deficiency of tissue in the region and doctors typically treat the problem by performing eye lift surgery.
Examining the Brow
The artistic ability of the surgeon is of primary importance in any eye lift surgery. A good surgeon should have a firm grasp of the aesthetic relationship between the upper eyelid, the eyebrow, and the function of the bone that surrounds the upper eye in order to properly advise the patient on the best course of action when aging eyes become an issue.
Though the upper eyelids may be sagging, the correct course of action is not always an eye lift to correct the problem. Sometimes, surgeons are able to raise the eyebrows, which gives the patient a more wakeful and youthful appearance, while simultaneously lifting the skin of the upper eyelid such that it no longer sags or droops.
In some instances, doctors will recommend raising the eyebrows and also removing a bit of excess skin from the upper eyelid in a single treatment session. By raising the eyebrows first, the amount of skin that needs to be removed through an eye lift can be significantly reduced.
By treating upper eyelid problems, patients often experience a corresponding impact on the wrinkles in their forehead. Patients with the habit of raising their eyebrows using the muscle in the forehead will notice that it has a stretching effect on the skin of their eyes. They can be pleasantly surprised on how an eye lift can solve the negative effects of such mannerism.
The forehead muscles and the eyebrows are affected by gravitational pull as well as the pull of muscles on the lower part of the face that exert a downward force against these tissues in the upper part of the face. The downward pull of muscles are somewhat offset by the contraction of the muscles in the forehead that raise the eyebrows. Over time, the back and forth tug-of-war between the upper muscles and lower muscles of the face causes wrinkles as well as the gradual displacement of the eyelids and eyebrows.
Gender-Specific Brow Lift Approaches
Raising a sagging brow can be accomplished using a variety of different techniques. But skilled surgeons do more than just lift the eyebrow. They realized that the end result is not just about lifting the brow on the face, but also contouring the shape of the brow. In the end, the contour of the brow needs to be consistent with the patient’s gender as the shape of the eyebrow greatly affects the femininity or masculinity of the face.
Women typically benefit from having the outer portion of the eyebrow lifted to restore the original arch that is so depictive of a feminine face. Men, in contrast, tend to have eyebrows that are situated lower on the face that are straight rather than arched. Lifting the eyebrow for both men and women needs to take these features into consideration.
Lid Evaluation
The way the upper eyelid is treated will depend on a number of different factors related to the age of the patient, skin type, and the anatomical issues of the eye that must be addressed. The doctor may feel that it is necessary to excise skin as well redundant muscle tissue. Fat tissues may need to be resectioned under certain conditions as well.
The plastic surgeon will need to determine the location of the eyelid crease and examine the location of the upper lid and lacrimal glands. Patients may be able to see the approximate results of a conservative muscle resection and skin excision by having the doctor roll the redundant skin away from the eye using a Q-tip.
A variety of different eye lift techniques and procedures may be implemented to create a more youthful appearance by altering the soft tissues surrounding the eyes. Because each situation is unique, the procedures and techniques that are appropriate in any given situation will differ. Patients should expect to see the clock turn back by at least 10 years with the help of a skilled plastic surgeon who can expertly perform an eye lift surgery.
Before Surgery Considerations
Your doctor should discuss healthful recommendations with you prior to performing an eye lift. The procedure itself and the risks and complications associated with it should also be addressed. The following are some important pre-surgical considerations:
- Avoid aspirin, ibuprophen, and other non-steroidal anti-inflammatory products as well as vitamin E, which can all thin the blood and cause excessive bleeding during surgery or the presence of a very large bruise on the treated area after the procedure.
- Avoid alcohol, especially right before surgery as it can cause tissue swelling. In the weeks leading to your eye lift surgery, the anti-coagulant effect of alcohol can lead to problems similar to those encountered with aspirin and other blood-thinning products.
- Patients should be aware that exercise and other physical activities may need to be postponed for a specified period after surgery.
- Patients should consider putting off travel until recovery is complete.
- Patients should fully understand financing options for the surgery.
Blepharoplasty Costs
The cost of blepharoplasty varies significantly from patient to patient depending on a number of different factors:
- Geographic location where the surgery will be performed
- Fees charged by the plastic surgeon to perform the surgery
- Skills, experience, and training of the plastic surgeon performing the procedure
- Fees charged by the hospital, clinic, or outpatient facility where the surgery is performed
- Cost of anesthesia
- The amount of tissue to be excised and the complexity of the procedure
- Whether you will be getting an upper or lower blepharoplasty or both
Though you may be looking for an affordable blepharoplasty, the cost is not the only factor to consider when shopping for the right plastic surgeon to perform your procedure. Because highly skilled and well-trained surgeon tends to charge higher fees, shopping around for a more affordable surgeon isn’t a wise approach for saving money on this procedure. Blepharoplasty is a delicate procedure that requires a steady, skillful hand. If you’re trying to find a more affordable blepharoplasty procedure, try shopping for surgeons in areas outside of major cities to find equally skilled physicians in an area where blepharoplasty is not in as high demand.
The cost of traditional blepharoplasty treatment can range between $1500 and $10,000 depending on the various factors mentioned above. Upper and lower blepharoplasty fees are similar.
Laser blepharoplasty also varies from one physician to another but ranges between $2000 and $6000. In laser eyelid surgery, lower eyelids may be less expensive to treat than the upper ones.
Insurance
Sometimes insurance will cover eyelid surgery depending on the reasons for having the surgery. In particular, insurance companies will be more likely to cover the cost of surgery if it is deemed medically necessary. In other words, if the eyelids are interfering with the functioning of the eyes or contributing to a disease state in some ways, patients may be able to get coverage.
In most instances, blepharoplasty is performed for cosmetic purposes, to enhance the youthfulness of the eyes. Insurance companies rarely cover the costs of cosmetic procedures and blepharoplasty is no exception. However, you can contact your insurance company to find out about their policies and regulations regarding eyelid surgery to find out more.
Upper Eyelid Lift
The upper eyelids function both as aesthetic and functional parts of the face. It is nearly impossible to overlook the upper eyelids and it would be equally impossible to do without them. Technically, they form the lower border of the forehead, separated from it only by the eyebrows. Plastic surgeons who are evaluating patients to determine the proper approach for correcting upper eyelid problems need to consider the laxity of the eyebrows first. Function should also come before aesthetics when trying to determine which eye lift technique will most successfully address the presenting issues.
Evaluating the Patient
When the plastic surgeon evaluates the patient, he or she must consider the various layers that affect the upper eyelid: bone, skin, fat, and muscle. These layers play various roles in the development of aging issues associated with the eye.
The skin in the upper eyelid is quite thin, allowing it to stretch and droop over time. Though the droopiness may have an impact on the aesthetics of the eye, the most important consideration for the plastic surgeon is knowing precisely how much skin is needed in order for the eyelids to function properly. If the surgeon removes too much skin, the eyelid won’t be able to close properly, though it may have an aesthetically pleasing appearance when the lid is open.
An eye lift is not a technically challenging surgery in itself; however, it is often combined with other treatments such as the addition of volume, brow lifting or stabilizing, the creation of an upper eyelid crease, the repositioning of the lacrimal glands, and repair of droopiness around the eye. A highly qualified plastic surgeon will be able to determine what eye lift procedures are necessary to achieve optimal results.
Anesthesia
An eye lift or upper blepharoplasty can easily be performed with local anesthesia. Using local anesthesia diminishes the risks associated with surgery considerably. Doctors will also give patients a sedative such as diazepam as necessary to help them relax during the procedure.
Marking Incision Points
It is important for the plastic surgeon to properly mark the eyelid prior to the surgery. These markings will guide the surgeon during the procedure when making incisions in the proper location to achieve the desired effects. The surgeon will first determine where the eyelid crease is located using light and a magnifying glass.
The plastic surgeon will note the position of the eyebrows before having the patient lie down. Then, once the patient is supine, the surgeon will move the eyebrow into the position it was in while the patient was seated or standing. Once the eyebrow is in position, the surgeon will determine how much excess skin is on the upper eyelid. This excess skin will be gently grasped between a set of forceps to check and make sure that the eyelids will close properly after the excess skin has been removed. The surgeon will grasp the skin that the line of the natural eyelid crease is under one side of the forceps and the lines where the skin should be cut to perform the remainder of the excision is beneath the other side of the forceps.
The markings on the eyelid will follow the natural line of the eyelid crease. The shape of the skin excision above the eye will depend on many factors. The surgeon will excise skin in such a way as to prevent ‘hooding’.
Differences between Men and Women
Eye lift surgery in men is different from that performed in women. One reason for this is the fact that women can easily cover up some of the scarring left from the procedure using make-up while men generally are not willing to wear make-up and more readily object to having a scar from the procedure.
The depth of the eyelid crease in men and women needs to be carefully considered by the plastic surgeon. The location of a deep eyelid crease can have a feminizing affect that is undesirable for most men. Rather, men tend to look better with a bit of skin redundancy in the upper eyelid and a lid crease that is only a few millimeters above the margin of the lid.
Post-Operative Recovery
After an eye lift surgery, the patient should go home and take it easy for the remainder of the day. Doctors recommend that patients lie down with two pillows propping them up for support. An ophthalmic ointment should be applied several times throughout the day along with an ice compress. Acetaminophen is used to control the pain. Watching television and reading is usually not recommended for at least 24 hours following the surgery. Physical exercise is also not recommended.
Silk sutures should be removed within 24 hours after the surgery. Prolene sutures, on the other hand, can be removed four days after the procedure. Nylon should be removed within 3 days. In some instances, the plastic surgeon may decide to put in another set of sutures, usually to promote a more aesthetically pleasing outcome, though this isn’t always necessary. Sometimes doctors are able to simply use surgical tape or surgical glue to help provide the eyelid with the support it needs while the tissues are still healing.
Patients may return to mild physical activity within 10 days after their eyelift surgery and a more strenuous exercise routine can be worked toward by the fourth week after the procedure. Direct, prolonged exposure to sunlight is not recommended for at least 6 weeks after the surgery.
Lower Eyelid Surgery
There are two basic approaches used for an eye lift involving the lower lids:
- A transconjunctival procedure which involves an incision made along the inner surface of the lower eyelid.
- A transcutaneous procedure which involves an incision made just beneath the eyelashes on the lower lid.
Despite the fact that transconjunctival lower blepharoplasty is associated with certain advantages, the procedure is not appropriate for everyone. The advantages of having a transconjunctival eye lift include:
- A lack of a visible scar following the procedure
- Diminished risk of reddening or bruising
- The orbital septum incision isn’t necessary
- Denervation of the orbicularis oculi muscle can be avoided
Transconjunctival lower blepharoplasty is unfortunately associated with a swelling of the conjunctiva and scarring on the inner eyelid. The procedure is not appropriate for patients with excess skin in their lower eyelid and must be modified for patients whose lids are sagging or drooping. Mid-face descent is also contraindicated for transconjunctival eyelift. It is best for young patients without mid-face descent who don’t have problems yet with eyelid laxity.
Patient Evaluation
As with an eye lift involving the upper eyelids, evaluating a patient requires a skillful examination and testing. Patients should have reasonable expectations about what an eye lift can accomplish and they should also be in reasonably good health. Patients taking blood-thinning medications or who have issues with blood clots or thin blood may not be good candidates for the procedure. It may not be safe or prudent to discontinue anti-coagulant use just to have an eye lift performed. Talk to your doctor about your options.
Hypertension or high blood pressure is another issue of concern when patients are considering eye lift surgery. Blood pressure should be mostly under control before the patient can be considered for the procedure.
An eye lift may be appropriately performed at the doctor’s office or in a hospital with a licensed anesthesiologist. Typically local anesthesia is recommended because general anesthesia is associated with problems like dilation of the blood vessels and increased risk of bleeding. Some patients with severe anxiety about the procedure, however, may require the use of general anesthesia.
The doctor should evaluate the anatomical eye features prior to surgery to come up with a plan of action during the procedure. Specifically, the amount of extra fat in the lower three eyelid fat pads should be considered. It may be necessary to reduce the amount of fat in any one or all of these fat pads to achieve the most aesthetically pleasing effects.
Lower Eye Lift (Transconjunctival Incision Approach)
Lower blepharoplasty can be performed by placing the incision inside the lower eyelid in the transconjunctival incision approach (which is also known as the posterior eye lift approach). The conjunctiva is a clear membrane that covers the inner surface of the lower eyelid and a small portion of the white of the eye as well. Incisions in the inner eyelid cut through this membrane by necessity in order to accomplish certain aesthetic goals.
Typically, bulging fat is a primary issue that is resolved using this particular eye lift procedure. The patient’s lower eyelids are pulled away from the eye and a plastic shield is used to protect the eyeball itself during the procedure. An electrocautery tool, scalpel, or a laser is used to make the incision through the conjunctiva along the entire length near the eyeball. The fat that needs to be removed becomes easily accessible. This fat is clamped, cut, and then cauterized to stop the bleeding.
The orbicularis muscle and canthal tendon may be optionally tightened during a lower transconjunctival eye lift procedure. Fat that is removed may also be used to fill in and volumize the upper cheek area, creating a more youthful appearance. The surgeon may occasionally stop the procedure and return the eyelid to its normal position to look at the results of his or her work, thereby accomplishing greater precision using this technique. At the end of the procedure, the plastic surgeon may use several sutures to close the incision or the incision may not be suture-closed.
Typically, patients recover quickly from the procedure with less swelling than what’s common with the transcutaneous approach. However, some swelling is to be expected and many patients report that the swelling that does occur using this approach can persist for several months following the procedure. Patients may see some blistering or temporary swelling of the conjunctiva of the eye after this procedure. This can persist for several weeks. The lower eyelid may also look somewhat hollowed after the surgery.
There are limitations associated with transconjunctival eye lift. Talk with your doctor about issues relating to excess skin in the lower lid. Using a skin pinch procedure, excess skin can be removed. However, in patients who don’t have excess skin, removal of extra fat can help the lower lid skin return to a more normal position.
The advantages of using transconjunctival eye lift include the fact that no visible scars remain after the procedure. The middle layers of the eyelid are not opened up during the procedure making it slightly less invasive. The lower eyelid is less likely to pull away from the eye using this procedure and the precision with which doctors can sculpt fat is enhanced through the location of the incision. Patients who use this procedure report less bruising and swelling and fewer complications associated with repeat surgical procedures performed on the lower lids.
Lower Eye Lift (Transcutaneous Incision Approach)
The transcutaneous incision approach is also known as the anterior approach or the lower eye lift surgery. The goals associated with the transcutaneous approach differ somewhat from the goals of the transconjunctival eye lift. Using the transcutaneous approach, doctors can easily remove excess skin and fat from the lower eyelid and correct droopiness of the orbicularis muscle. Other procedures may be implemented at the same time to compliment a transcutaneous incision blepharoplasty. In fact, it is rare for transcutaneous blepharoplasty to be performed without adjunctive procedures to help offset the potentially undesirable “surgical” look that some patients have reported in the past.
Patients are given local anesthesia and a sedative to numb the pain and help them relax during the procedure. By using local anesthesia, many of the risks and complications associated with general anesthesia can be bypassed.
During transcutaneous blepharoplasty, the eyelid is incised just below the eyelashes to expose the orbicularis muscle. The exposed muscle is also incised. Fat pockets are then exposed such that it can be clamped and removed with scissors. The fat is cauterized to prevent bleeding before it is allowed to retract back to its original position. Excess skin is removed and then the surgeon uses sutures to close up the wound.
Some doctors will use a slightly different placement of the incision to achieve desirable effects, or won’t penetrate as far into the various layers of the skin. The eyelift surgery can be varied somewhat from patient to patient in order to achieve the most aesthetically pleasing effects.
After the procedure is complete, the patients are moved into a recovery area. Recovery from transcutaneous blepharoplasty is usually swift. There is some risk that the skin will be positioned improperly creating an unnatural look following the procedure. Bruising and swelling should be expected and patients sometimes lose eyelashes as a result of the procedure. This procedure can alter the position of the eye-opening and create a lot of scar tissue due to its invasive nature, unfortunately. Some adjunctive procedures can be used to offset some of these limitations, but patients are urged to carefully consider the validity of the procedure before going under the knife.
One of the advantages of transcutaneous blepharoplasty is the surgeon’s ability to remove and reposition fat and remove skin and muscle tissue at the same time.
Laser Eye Lift
In a traditional eyelift utilizing a scalpel, a lot of bruising and swelling is to be expected due to the presence of abundant blood supply to the eyelids. The use of a CO2 laser, in contrast, can avoid much of the problem of bruising. A laser eye lift is mostly “bloodless” and any bruising is likely the result of the local anesthesia injection rather than the surgery itself.
There are a number of advantages to laser eyelift. Typically, patients recover more quickly and experience less swelling and edema. There are no stitches required for the procedure. Patients often report no pain and less retraction of the eyelid following laser eye lift. Alterations to the shape of the lower eyelid are also less likely using this procedure over a traditional scalpel eye lift.
Primary Precautions
There are some important precautions that need to be taken to ensure patient safety during laser eye lift. Safety of the staff helping with the procedure is also important. The surgical team is required to wear special wavelength-protective eyewear for safety purposes. And patients must wear specialized contact lenses made of surgical steel to protect their eyes from the laser during the treatment.
Topical tetracaine is applied to the eyes as an ophthalmic ointment on the inner surface of the metallic contact lenses used by the patient. This is a strong topical anesthetic. The contact lenses are designed such that they have an anti-reflective outer surface that makes it impossible for the laser to accidentally reflect off of them into unwanted areas. In some instances, patients may be having other procedures done at the same time as the eye lift. If the patient is having a chemical peel, the use of alcohol or acetone should be postponed until after the laser treatment is complete.
Patient Preparation
The patient is first brought to the operating room to make the markings for the incisions using a special surgical marker. Then, the incisions are checked using forceps to pinch the skin gently and make certain the eyelids will close properly following the excision of skin. Symmetry of the eyes is also double-checked at this time. Local anesthetic injections are then administered.
The patient is then prepared for laser eyelift surgery by applying metallic contact lenses to the eyes with the topical tetracaine in place on their undersurface. Though the patient may be given oxygen during preparation for the procedure, oxygen should be turned off when the laser treatment is started to avoid causing a fire or a build-up of oxygen in the patient’s body. The patient’s face is covered with moistened towels or gauze to help prevent unwanted burns from the laser on areas of the face not being treated.
A silk suture is made to keep the eyelids stabilized during the laser procedure. Typically the laser is pulsed and the incision is made in the areas that were previously marked and checked with the forceps. Though there may be some slight bleeding, usually this can be kept under control using the laser to coagulate the blood, which also diminishes bruising and swelling after the surgery.
The Procedure
The patient is first prepared for the procedure by having his or her eyelids clearly marked with a surgical marker. The incision markings are made in a manner similar to that of traditional eyelift. The surgeon sets up the laser machine near the patient’s head and the tetracaine is applied to the eyes along with the protective contact lenses.
Using a laser to perform an eye lift surgery means that the plastic surgeon must consider the potential for thermal damage throughout the procedure. The depth of the incision is related to the power setting of the laser and somewhat to the speed with which the surgeon makes the cut using the laser. The laser differs substantially from the scalpel as a tool for performing an eye lift and the major consideration pertains to burns rather than issues pertaining to bruising and swelling.
After the incisions have been made using the laser, the laser settings are changed and the skin and orbicularis muscles are removed from the orbital septum. The orbital septum itself may need to be cut in order to gain access to the fat pad behind it, which may need to be reduced. The laser can be used throughout the procedure to coagulate blood in vessels that are bleeding by merely defocusing it or moving it somewhat farther away from the treated area. Finally, the incisions are closed and the patient moved to recovery.
Advantages of Laser Eye Lift Surgery
There are a number of advantages to laser eyelift surgery including the following:
- Reduced bleeding associated with the procedure
- Reduced tissue distortion and drag
- Reduced risk of bruising and swelling
- Decreased time spent in surgery
- Increased sculpting abilities
- Keloid formation is non-existent
- Crease formation is arguably better using laser treatment
- Diminished risk of hemorrhage