A Blepharoplasty is a surgical procedure to remove excess skin and puffiness of
the upper, lower, or both upper and lower eyelid areas. Downward sagging of the
brow and redundant skin of the eyelids are some of the first signs of the aging
process. Later, fat from around the eyeball pushes forward into the eyelids, giving
them a "baggy" appearance.

What are the benefits of this surgery?

Since eye contact tends to be one of the major forms of human interaction a
blepharoplasty can make a dramatic improvement in restoring a more youthful
appearance of the aging face. Additional benefits can be a reduction in the
feeling of heaviness of the eyelids, and elimination of skin of the upper eyelids
overhanging the upper and outer portion of the eye obstructing vision. A
blepharoplasty may be performed as an isolated procedure or in conjunction with
a facelift or brow procedure.

How is Blepharoplasty performed?

Usually local anaesthesia with sedation is used. Surgery of the upper eyelid
involves making an incision along the crease of the upper eyelid. The incisions
are extended out past the corner of the eye into the region of the "crow's feet"
wrinkles. The excess skin, fat and muscle above the crease are removed, and
the incisions are closed with sutures.

On the lower eyelid an exterior incision just below the eyelash margin in the
lower eyelid can be used to remove excess skin and fat.

Alternatively the lower eyelid can be pulled downward and an internal incision
(transconjunctival blepharoplasty) on the eyelid can be performed to remove the
fat from the inside leaving no external scars. This also has the advantage of a
faster recovery and is ideal in patients where the puffiness of the lower eyelid is
the main issue. The lower eyelid skin can be re-surfaced if necessary with a
laser, Visage, or chemical peel to help smooth the skin.

What about the scars?

Scar tissue is the normal product of the body's healing process, so surgery is
not possible without scars. The incisions are carefully designed so they will
inconspicuously lie in normal skin folds and at facial borders minimizing the
visibility of the scar. Post operative activity and wound care instructions must be
followed to promote optimal healing. Individual natural genetic healing
characteristics are the main factors in determining scar appearance.

After eye surgery there is generally significant discoloration and swelling around
the area for several weeks. The scars generally slightly raised and pink for a
period of several months, but then tend to flatten and fade into the normal skin
lines that surround the eye.

What are the more common complications?

Although most patients encounter no problems with this operation, like any
operation an element of risk exists and complications may occur. The
complications of anaesthesia, whether local (freezing) or general, are part of the
risk of even minor surgery.

The basic mechanisms of prolonged swelling and bruising, subscleral bruising
(the white area of the eye), bleeding, hematoma (collection of blood beneath the
eyelid skin), and infection are potential problems of any surgery. Rarely poor
scar formation results. Occasionally as the scar heals small cysts (milia) can
form. Minor asymmetries of the scar placement or of the amount of skin and fat
removed are not infrequent. The lower eyelid incision adjacent to the eyelash
margin can rarely result in alteration or loss of the eyelashes.

The possibility of excess tightening of the lid skin or scar may make it difficult to
close the eyelids. Occasionally the scarring of the lower eyelid can pull the
eyelid down and away from the eyeball (ectropian). This usually resolves itself
with time and exercise, but may on occasion benefit from a touch up operation.
Older patients with poor muscle and tissue tone in the lower eyelids are more
prone to the above problem.

An excess or decrease in the tear production is seen in some patients, giving
the eye a watery or dry sensation. This is usually temporary and may require the
use of eyedrops. Eyelids that are pigmented before surgery do not lose their
pigment, and may in fact become darker after the operation. Although cases of
blindness have been noted following blepharoplasty, this has been extremely
rare, and to date the cause and effect relationship between the two has not been
established.

What is the Cost of the Operation?

This surgery may be performed for functional or cosmetic reasons. If the upper
eyelid skin is so redundant that it obscures the vision it is a functional problem
and may be covered by the medical plan. To be covered the British Columbia
Medical Plan requires a severe restriction on the Visual Fields eye exam. Lower
lid surgery is not normally covered. For cosmetic surgery this is not a benefit of
the plan and the patient is responsible for the facility fees, surgical fees, and
anaesthetic fees if required.