Cosmetic Eyelid Surgery

Brief overview:-

An individual’s eyes are a focal point of his/her facial features and are often first things people notice about each other. Unfortunately, as we age, our eyelid skin can loosen and sag and the fat pads deep within the eyelid bulge forward and become more prominent. The droopy and/or puffy appearance can make a person appear more tired or older than he/she actually is.

Blepharoplasty eyelid surgery can give a more youthful, refreshed appearance by removing the excess loose skin and sculpting the deep bulging eyelid tissues. Cosmetic blepharoplasty surgery can be performed on the upper and/or lower eyelids. This is one of the most common eyelid and cosmetic surgeries performed.

Listed below are the types of Cosmetic Eyelid Surgeries that can be carried out in order to give a fresh, youthful appearance to the face:

  1. Blepharoplasty
  2. Cosmetic Ptosis Surgery
  3. Double Eyelid Surgery (Asian Blepharoplasty)

Blepharoplasty:-

Blepharoplasty or Eyelid surgery is a type of plastic surgery which is done to correct deformities, defects and disfigurations of the eyelids; and also for modifying the orbital region, with a cosmetic perspective. The Blepharoplasty procedure includes the removal, excision or repositioning of the tissues on the eyelid, the skin and adipocyte fat, muscle and tissue augmentation. The procedure aims to fix the cosmetic and functional problems of the ‘periorbita’ which is the area extending from the eyebrow to the upper portion of the cheeks. 

Objectives:

  • Affected eyelids should be restored to their normal condition.
  • To restore the cosmetic and aesthetic aspects of the face.
  • Ocular muscles restoration.
  • To tighten the supporting structures.
  • To reposition the excess fat from the retroseptal area of the eye this produces a smooth skin area from lower eye to the cheeks.          

  Procedure:-

In a blepharoplasty procedure incisions are made externally along the natural crease lines in the upper and lower eyelids. These creases then conceal the surgical scars from view, especially when affected in the skin creases below the eyelashes of the lower eyelid.

According to the technique preferred by the oculoplastic surgeon, the incisions can be made from the conjunctiva, the interior surface of the lower eyelid, as in the case of a “Transconjunctival blepharoplasty”. Such a technique allows the excision (cutting and removal) of the lower-eyelid adipocyte fat without leaving a visible scar, but, this technique does not permit the removal of excess eyelid-skin. Time for completion of surgery requires 1-3 hours. The normal bruising and swelling associated with any surgical procedure subside completely within 1-2 weeks, with the final results generally coming in a few months after the procedure. 

Upper Eyelid Blepharoplasty:-

Upper eyelid dermatochalasis (extra loose skin and bulging fat) is addressed by blepharoplasty surgery. The Oculoplastic Surgeon will determine how much skin to remove and will contour the underlying fat through an incision which hides in the natural eyelid crease. The thin eyelid skin heals remarkably well and the incision is often hard to find after several months of healing.

Lower Eyelid Blepharoplasty:

Lower eyelid blepharoplasty surgery primarily involves removal or repositioning of the herniated fat (the cause of “eyelid bags”) through an incision hidden on the inside surface of the eyelid. The eyelid is also sometimes tightened horizontally at the outside corner of the eye to create a pleasing eyelid contour and reduce fine skin wrinkling. Finally, if extra skin can be safely removed, a separate incision is made just below the eyelashes and closed with fine sutures.

Cosmetic Ptosis Surgery:

To perform the Levator Palpebrae Superios (LPS) muscle Aponeurosis surgery, an incision is made in the crease of the lid and the levator tendon is located. The tendon is made tight with short-term stitches. The patient will be asked to open their eyes to assess the position of the stitches and to adjust them as required.  After ensuring that the stitches are correctly positioned, the skin incision is sutured, using absorbable stitches. The wound is concealed inside the natural crease of the eye and after the procedure a pad is placed over the eye.

For Muller’s muscle resection procedure, on the inside of the upper lid, an incision is made and the muscle is made short using non dissolving stitches which are placed along the natural crease of the skin. The surgery usually takes two-three hours and if both the eyes are affected because of the droopiness, they should be operated upon simultaneously to obtain symmetrical results.

Tarso Frontalis Sling Surgery: Tarso frontal sling surgery is generally advised in persons with severe blepharoptosis (drooping of the upper eyelid) and poor functioning levator muscle (muscle which raises the eyelid). With this surgery, the eyelid is connected to the brow using a sling material and the power of frontalis muscle is utilized for elevating the poor functioning eyelid.

In cases of Congenital Ptosis, it is proposed that the surgery be postponed until the patient is minimum 3 to 5 years old, most importantly to allow facial growth and maturation, and to fortify patient’s co-operation in the process of pre-operative evaluation and measurements.

In some elderly patients, surgery can be performed under local anesthesia, which permits a better intraoperative quantification and in return better output from the surgery. 

Procedure:-

Initially, multiple stab incisions, in the shape of a triangle, are made above the eyebrow.

Next, a sub-orbicularis tunnel is formed between the incisions.

The sling material is fixed to the tarsus, after which the eyelid crease is created.

The sling material is passed through the tunnel and fixed at the subcutaneous tissue of the eyebrow. This procedure allows a broad fixation of the sling material to the tarsus, thereby producing a natural upper eyelid curvature and an appropriate eyelid elevation with long-lasting stability. 

Double Eyelid Surgery (Asian Blepharoplasty):

Double eyelid surgery also known as East Asian Blepharoplasty is a type of cosmetic surgery in which recontouring of the skin around the eyes is done. This procedure creates a crease in the upper eyelid which creates ‘double eyelid”.

There are many approaches to perform this surgery, which includes a no-incision method, a partial incision method or a full incision method. Patients typically desire to look more bright-eyed and want to make applying eyeliner easier. Patients also seek to remove the puffy and tired look associated with a fatty upper lid

Surgical Procedure:-

2 categories of repair are possible- Open method & Suture method.

Suture/Semiopen method – indicated in patients with thin skin or Asian eyelid so thin that they fold spontaneously on an intermittent basis. If there is excess fat, this fat can be removed with the help of a small stab incision. The fat in the central part of the eyelid should be conserved, but that near the orbital rim may be removed for obtaining better definition.

Open technique – Indicated for patients with thicker skin, thick pretarsal orbicularis muscle, or excess skin.

Cosmetic Eyelid Surgery

The skin around the eyes is the first area where early signs of ageing appear. Barely half a millimetre in thickness, the skin around the eyes start showing dark circles, puffiness, fine lines and wrinkles as age progresses. Loosening and sagging of eyelids as well as bulging of under-eye fat pads are also signs of advancing age, which can drastically mar your aesthetic appearance. While there are several topical and non-invasive procedures available for cosmetic correction of the eyelid area, cosmetic eyelid surgery is the most effective one.

Cosmetic eyelid surgery involves correction of deformities or modifying the eyelid area for improving aesthetic appearance and eyelid function. There are primarily three types of cosmetic eyelid surgeries, which are –

  • Blepharoplasty: Cosmetic removal, excision or repositioning of tissue under the eyelids is called blepharoplasty. This procedure, doesn’t only work with the skin, but also modifies the fat tissue and muscles around the eyes. Both cosmetic and functional benefits can be achieved from blepharoplasty, if performed under the care of a trained oculoplastic surgeon.

Cosmetic blepharoplasty procedure can be performed with incisions made on the inner side of the lower eyelid or with incisions made in the natural crease of the upper eyelid. The cosmetic surgery can take 1-3 hours for completion and further requires 1-2 weeks for post-surgery swelling to subside. With minimal scarring, blepharoplasty is one of the best cosmetic surgeries available right now for eyelid modification.

  • Cosmetic Ptosis Surgery: One of the most sought out cosmetic correction is sagging or droopy eyelids. As we age, eye muscles and tendons also weaken, loosening up the eyelids. With cosmetic Ptosis surgical procedure, the Levator tendon or the Muller’s muscle is tightened using short term or non-dissolvable stitches. The incision is made in the natural eyelid crease and it take 2-3 hours for the surgery to complete. But the cosmetic effect is dramatic and aesthetic appeal as well as functionality of the eyelids is restored.
  • Double Eyelid Surgery: East Asians have single upper eyelids which give them the unique ethnic appearance. Many prefer to get a double eyelid surgery performed, which entails creation of a crease in the upper eyelids to form double eyelids. This cosmetic procedure can be performed with a full incision, with a partial incision or without any incision at all. The cosmetic improvement also reduces the upper eyelid puffiness thus restoring a youthful look.

Due to the specialized nature of these cosmetic procedures, it is important to get them done only by trained cosmetic surgeons. Dr. Debraj Shome specializes in cosmetic and corrective eyelid surgeries and is one of the best Oculoplastic surgeons in India. He currently practices in Mumbai, India, at The Esthetic Clinics.