Eyelid Surgery, which is technically referred to as a blepharoplasty, eliminates bags, wrinkles, and excess skin around the upper and lower eyelids. The eyes are often the most expressive feature of a person’s face and quickly define the facial expression and overall mood. Unfortunately, the eyelids are often the first area to show signs of aging with lower lid “bags” and hooding across the upper lids; they can be noticeable as early as the mid to late thirties. Subtle improvements can have a dramatic impact on the image you portray, particularly by appearing less tired and more alert. Some people have fullness to the lower eyelids that are an inherited characteristic and are eliminated in a similar surgical fashion.
Our facial expressions and emotions are often conveyed through the position of the eyebrows and eyes. As gravity slowly pulls the brow tissues down, the overall expression begins to change and take on a sad, tired, or even scowling look. A brow lift, or forehead lift as it is also known, lifts drooping eyebrows and smoothes the deeper furrows of the forehead.
Recreating the natural arch of the eyebrow and eliminating the lateral hooding can remove a fatigued appearance. This correction can be achieved through a number of ways, including an endoscopic technique that uses only small incisions placed back beyond the hairline.
Sagging brows are often overlooked and misinterpreted as excess skin of the upper eyelid. Identifying this problem is essential in order to avoid removing skin below the brows and exacerbating the preexistent droop. This procedure can often be performed in conjunction with a blepharoplasty.
Understanding the Procedure
Blepharoplasties, when performed alone, are usually done under local anesthesia with IV sedation. The eyelid skin can be completely anesthetized with small amounts of local anesthetic. The upper eyelid incision is usually within the natural crease of the eyelid and redundant skin carefully trimmed (Figure 1). On rare occasions, excess fat around the upper eyelids exists and requires excision.
The lower eyelid incision is typically located immediately below the eyelash for maximum concealment (Figure 1). The excess skin to the lower eyelid is also trimmed in this way. Often there is excessive fat to the lower eyelids that are responsible for the “bags” and can be directly excised in order to improve the contour of this area. In some younger people, the problem is primary the bulging fat of the lower eyelids and not excessive wrinkling or redundant skin. Under these circumstances, the surgeon may be able to make the incision along the inside of the eyelid in order to gain direct access to this fat (Figure 2). When performed this way, there is no skin incision made.
Both of the incisions are closed with small sutures that will dissolve by themselves. The incisions typically look somewhat red for the first couple of weeks although they are easily concealed with makeup.
Browlifts are performed through a number of approaches and the best method is a decision made by you and your surgeon. The primary difference between techniques is the location of the incision. Considerations for incision placement may be based on pre-existing forehead wrinkles, gender and hair loss, the frontal hairline position and hair styling habits. Incisions made behind the hairline are maximally camouflaged but have the disadvantage of elevating the hairline to some degree. The endoscopic approach uses small incisions within the hair and has a distinct advantage of creating less scalp numbness and a quicker recovery. For people with a pre-existing high hairline, a jagged incision at the hairline will lift the forehead and eyebrows without distorting hair position. In men, it is often advantageous to place the incision directly within a forehead wrinkle in anticipation of future hair loss or receding hairline.
Surgery can be done with either local anesthesia with IV sedation or general anesthesia. There is a circumferential head bandage that is applied immediately following surgery in order to maintain pressure along the forehead and scalp areas. This is an important part of this procedure in order to minimize the risk of subsequent bleeding and ensure good healing.
What to Expect After Surgery
Bruising and swelling frequently occur after surgery and can be minimized with diligent use of ice packs and head elevation. It is important to keep a moisturizing ointment directly on the incision in order to keep it clean. These incisions can get slightly wet after 48 hours, with water, soap and shampoo gently trickling over them. The incisions should not be directly scrubbed or irritated. You will need to see the surgeon a couple of times during the first few weeks in order to have the incision carefully cleaned and inspected.
The bandages are usually removed and/or changed the first day or two after surgery. The incisions, especially when not covered with hair, are best cared for with gentle cleaning and covering them with an antibiotic ointment. The wounds can get wet from bathing about 48 hours after surgery. There is usually some degree of swelling and bruising that occur along the upper eyelids. This can be minimized with ice and head elevation and usually take several days to spontaneously resolve. It is not uncommon to have some degree of temporary numbness along the forehead and frontal scalp areas following surgery. When incisions are located in front of the hairline, they are closed with small dissolvable sutures. Posterior scalp incisions are usually closed with staples that are removed 7-10 days after surgery.
Frequently Asked Questions?
Is there any potential danger to my vision with this type of procedure?
Any surgery in and around the eyes can potentially jeopardize vision. It is extremely unusual for any permanent change. On occasion, however, the swelling in this area can cause temporary changes in refraction. For this reason, it is recommended to delay having any prescription measurements made immediately after eyelid surgery. In addition, some of the ointment around the eye can cause some blurriness to your vision.
What are the possible complications?
Small changes in your eyelid shape can occur after the redundant skin and fat are removed. The lower eyelids, in particular, are subject to retraction inferiorly and can cause some rounding of the eyelid margin. Small changes of the lash line can also occur if the lid margin is rolled outward. Some people heal with scars that are more prominent and red. One can expect these to resolve with time.
Will this surgery remove all the wrinkles around my eyes and forehead?
A browlift can have a dramatic effect on the entire upper eyelid and temple areas. Lifting the eyebrow will also reduce the amount of excess skin to the upper eyelids in a natural fashion. Some wrinkles, especially those between the eyebrows and the corners of the eyes, may persist. Browlift surgery is not designed to have a direct impact to the lower eyelids or mid facial areas.
What are possible complications?
Bleeding and numbness are possible complications from this surgery. Sensory nerves to the forehead run vertically from above the eyes and these can be stretched and temporarily injured. A separate nerve is responsible for animation to the forehead and can also be compromised. Temporary numbness across the upper forehead or behind the hair is not uncommon. Permanent injury is extremely rare.
How long will it last?
Like facelift surgery, a browlift can create lasting effects, however, the forehead skin is still subject to the forces of gravity and gradual dropping can occur over the next ten years.
Will it leave me with a startled or unnatural appearance?
It is imperative that the final appearance is completely natural and not “operated on.” The brows are lifted to a specific height with respect to the upper eye bone, and no more. Maintaining the natural look may necessitate leaving a few wrinkles around the eyes but it remains a premium.
“I am very happy with the results. What impressed me about Dr. Park is his integrity and professionalism. His bedside manner is really great. He is very understanding, nurturing and develops a level of trust… He is very confident about what he does and puts me at ease… My eyes came out great and the scar has disappeared…”
“. . .He is very very good. I work out and I want to look as good as I can. . . My eyes look like they did 20 years ago, but still perfectly natural…You gotta have that connection, surgery is very scary and he takes the time to make me feel comfortable. . .”