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Blepharoplasty - Eyelid Surgery Methods

 

                                eyelid surgery or blepharoplasty surgical methods

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Upper Eyelid Blepharoplasty

Different types of Upper Blepharoplasty:

 

This method is the most commonly used  - with the incision in the natural crease of the upper eyelid area. Varying amount of skin and muscle are removed, however as a general rule a conservative amount is removed. If the patient has excess fat in the upper lid, then the fat is removed to prevent any excess puffiness.

 

 

 

This technique is designed to create a crease in the upper lid between the eye-shadow space and the eyebrow.  This is performed on Asian patients with almond shaped eyes who might have minimal upper lid folds, and they are desiring a double fold. This procedure is also performed on patients who have had prior blepharoplasty surgery which resulted in an uneven crease.

 

 

 

This technique combines the upper blepharoplasty with elevation of the temporal area through the upper blepharoplasty incision. This method is used for patients with an unstable brow that could be pulled down with the upper blepharoplasty procedure - to give a slight brow-lift.

PROS: 

  • It attempts to stabilize the eyebrow to prevent addition drooping without the need for additional incision lines.

CONS: 

  • This procedure does not give much of a lifting effect.

 

 

 

Sagging brows can contribute to a tired or sad appearance. Sometimes if upper eyelid surger is done alone it can actually make the problem worse, not better. In these cases, this technique in which combines the upper blepharoplasty procedure with an endoscopic brow lift to improve the appearance of the eyelids, forehead and eyebrows will be beneficial. The endoscopic brow lift is performed through tiny incisions hidden above in the hairline of the patient. 

PROS: 

  • This procedures not only lifts the brow but the frown lines in the glabellar region are improved.

CONS:

  • This approach might actually take longer to complete than a Coronal Brow Lift

  • Endoscopic surgeon needs to be fully trained and experienced to perform the surgery

  • Endoscopic brow lifts do not last as long as a Coronal Brow Lift.

 

 

 

Ptosis is a condition where the eyelid does not fully open. This technique combines an upper blepharoplasty with tightening of the loose levator muscle in which the muscle's tendon is repaired or shortened in order to restore the balance of the eyelids. Sometimes in extreme cases a sling might be needed to help prop up the eyelids. 

PROS: 

  • Not a cosmetic procedure, more a functional / medical procedure. Patients who have excess fat or skin in the upper eyelids - a cosmetic blepharoplasty may be considered at the same time. Main goal of the surgery is to allow the eye to open fully and vision to be restored.

Read more about Brow Ptosis

 

 

                               surgical markings before a blepharoplasty is performed

 

 

Lower Lid Blepharoplasty

There are two main types of blepharoplasty:

 

 

 

This technique hides the scar inside the lower eyelid. This procedure is designed to remove the fat from the three fat pads under the lower eyelid. 

 

PROS: 

  • Scars are hidden and the risk of changing the shape of the eyelid is reduced, almost no possibility of scar-related lower eyelid retraction


CONS: 

  • Excess skin and muscle underneath the eyelids cannot be tightened, requires increased technical skill, the eyelid can be "hollowed".

 

 

 

                                            transconjunctival blepharoplasty incision

 

                                     Copyright 2010 ASAPS - Used with permission

                       

                                        Transconjunctival Blepharoplasty

 

 

This technique combines the transconjunctival removal of fat with laser resurfacing with CO2, Erbium, or other types of skin tightening lasers under the eye area.

 

PROS:   

  • Improvement of lines under the eyelids and also the "crows feet" area

 

CONS:  

  • Healing time is longer due to prolonged redness from the laser, scarring from the laser, and possibly changing the shape of the eyelids, excess skin and muscle underneath the eyelids cannot be tightened, requires increased technical skill, and the eyelid can be "hollowed".

 

 

 

This technique combines transconjunctival blepharoplasty with the use of a chemical peel around the eyes (TCA - Trichloroacetic Acid)

PROS:   

  • Improvement of lines under the eyelids and also the "crows feet" area

CONS:  

  • Healing time is longer due to prolonged redness from the chemical peel, scarring from the chemical peel, and possibly changing the shape of the eyelids. Excess skin and muscle underneath the eyelids cannot be tightened, requires increased technical skill, the eyelid can be "hollowed".

 

 

 

Traditional Lower Lid Blepharoplasty

This technique hides the scar just under the eyelashes. The lower blepharoplasty is designed to remove fat from underneath the eyelids and tighten loose skin and muscles.

PROS: 

  • Longer lasting result allowing sculpting of the fat which reduces a possible "hollow appearance" after surgery.

CONS: 

  • Eyelids might change shape to more round - possible scleral show (white of the eye) and or ectropion (drooping of the lower lid), scars might be more visible. 

 

 

                                         incision location for traditional blepharoplasty

                                            Copyright 2010 - Abridged version from

                        'Eyelid Surgery' pamphlet Mi-Tec Medical Publication & ASPS Plastic Surgery

                            Incision location for traditional blepharoplasty

 

 

This technique is similar to a standard blepharoplasty with use of a flap of excess skin which is tightened while preserving the muscle. Skin Flap Lower Blepharoplasty was at one time considered the "gold standard" form of cosmetic lower eyelid surgery. It is the easiest form of lower blepharoplasty. The complication of eyelid retraction is known with this type of surgery.

The incision is made along the lower lash line and skin is lifted away from the lower eyelid muscle.  The fat pads are accessed through the muscular and fibrous layers of the lower eyelids and trimmed. The lower lid (skin flap) is then re-shaped and the excess is trimmed down and then the incisions are sutured.

PROS: 

  • Addresses lower eyelid fat, the surgeon can reposition the fat (or spread it out evenly) with this method.

CONS: 

  • This method does not remove lower eyelid wrinkles, retraction of the lower lid or ectropion can occur.

 

 

 

Skin muscle flap lower blepharoplasty is also the another form of the "gold standard" for lower eyelid surgery. 

The approach consists of:

  • incision made underneath the lower eyelash line

  • the skin and the underlying muscle layer are lifted away from the orbital septum

  • lower eyelid fat pads are trimmed

  • incision line is closed with sutures

PROS:

  • Addresses lower eyelid fat, the surgeon can reposition the fat (or spread it out evenly) with this method.  Complications are less with skin muscle flaps than with skin flaps.

CONS:

  • This method does not remove lower eyelid wrinkles.

 

 

 

Standard blepharoplasty with repositioning of the fat pads to fill in areas of hollowness under the eyes.

PROS: 

  • Less wrinkles will appear when fat is repositioned along the lower lid to fill out any hollows.

CONS:  

  • Technique is important to make sure the fat is evenly distributed.

 

 

 

Canthopexy: is a technique that uses a permanent internal suture to secure tendons of the outside corner of the “lateral canthus”, to the bony rim of the eye socket at their existing level. Canthopexy is primarily used a preventative step to prevent sagging of this area with the healing process.

PROS:

  • Allows tightening of the eyelid to avoid changing shape.

 

Canthoplasty: is different than canthopexy - as it the main goal is to free up and reposition a lateral canthus that is too low.  The tendons of the outside corner of the eye are separated from their attachments to the outside rim of the eye socket, and secure the tendons in a higher position. A conservative canthoplasty can restore a youthful look in carefully selected patients, while an overdone canthoplasty can create a cat-like eye shape.

PROS: 

  • Correct lower lid mal-position

 

 

 

This technique is performed through the lower blepharoplasty incision to improve the appearance of the eyelids and the cheeks by lifting the fat pad above the cheekbone.

PROS: 

  • Blepharoplasty is easily done at the same time as a mid-face lift

CONS: 

  • When the mid-face lift is performed through the eyelid incision - this lift can possibly make the lower eye lid unstable.  A lateral canthoplasty is sometime necessary to prevent the lid from pulling away from the eyeball (eyelid retraction). This incision method at one time was the most common, however; it is now not normally considered due to the post-operative distortion at the canthus and the risk of lower eyelid retraction.

 

 

 

 

 

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