like our body, our eyes also go through an ageing
process. Many of those who want a facial uplift
also seek a cosmetic correction of their tired
and ageing eyes. Cosmetic blepharoplasty is a surgical
procedure for enhancing the look of the eye. Performed
on the upper and lower eyelid, this cosmetic therapy
is highly popular for its short recovery span and
instant results. It is also favored for its ability
to be performed under an outpatient ambience under
local anesthesia (oral sedation), making it a comfortable
and speedy process.
Upper eyelid blepharoplasty
Patients, who want to bring back the youthfulness
to their drooping and haggard upper eyelids,
choose to undergo upper eyelid blepharoplasty.
The skin of the eyelids becomes redundant and
flabby as a part of the natural ageing process.
This sagging skin is called ‘blepharochalasia’.
This occurs when the skin of the upper eyelid
loses its innate elasticity and suppleness, which
also causes the skin and associated form of the
forehead to deteriorate. Hence, the eyebrow drops
over the orbital rim and sags on the upper eyelid.
A few other causes of drooping eyelids are hypertrophic
orbicularis muscle, protuberant adipose tissue
from the upper fat pads or a rarer factor of
lateral fullness caused by a ptotic lacrimal
gland. It is vital to pinpoint the causes leading
to these upper eyelid syndromes in order to get
optimal results from upper eyelid blepharoplasty.
Generally, it is performed on patients with either
one or a combination of all these conditions.
After the identification of the indications,
there are a few other procedures before the surgery
takes places. They are:
A routine medical history overview: This includes
a mandatory inspection for a history of Graves’ disease,
connective tissue diseases associated with a
clinical or subclinical sicca syndrome or a history
of a bleeding problem.
Physical check-up: A detailed physical examination
and standardized photography to evaluate any
existing asymmetry is also vital. An up-to-date
and total visual investigation is also required
in order to trace chances of glaucoma or macular
disease. This visual examination also reviews
the features and competence of the tear film.
An instructive session: Patients must also be
given some idea about the procedure they would
undergo. This should include a discussion with
the patient on their outlook about the extent
of skin removal and the associated structuring
of the crease etc. A detailed discussion of the
complications of this process is also essential.
The patient must also be told that they cannot
use lenses during the postoperative period.
Next comes a few surgical assessments like the
condition of the redundant tissues of the forehead
and the eyelids, an evaluation of the patient
based on gender (since the anatomy of a male
and female eyebrow differs), the need for a brow
lift, forehead correction, evaluation of the
condition of the skin tissues etc.
Preoperative marking of eyelids: This is a technical
process that involves the marking of the surgical
incision on the eyelids. This is crucial and
must be done accurately to ensure conformity
in the distance of the incisions on both eyelids.
The surgical procedure
The surgical process consists of three steps
- Lifting the myocutaneous flap
of surplus fat (optional, depending on patient
- Sealing of the wound
Lower eyelid blepharoplasty
Those with the common complaint of “bags
under the eye” often seek lower eyelid
blepharoplasty. These bags are medically defined
as ‘herniated retro-orbital fat that is
protruding anteriorly’. This also gives
a haggard and aged look to the face. Gentle palpation
often gives temporary relief from these 'bags'
by a slight lifting of the globe and palpebral
conjunctiva of the eye. Lower eyelid blepharoplasty
is the best way to remove this sagging fat and
correct this facial defect.
Lower eyelid blepharoplasty can be performed
following two common approaches: the transcutaneous
or subciliary approach and the transconjunctival
The latter is generally the preferred mode because
it helps conceal and fade out the surgical scars
better. The subciliary approach also has its
advantage in its ability to remove the redundant
infraorbital skin during the sealing of the incision.
However, this skin elimination process involves
the risk of scar contraction followed by a condition
termed as ectropion. Elderly patients, who have
a more sagging lower eyelid, are more vulnerable
to this. Moreover, this scar contracture and
ectropion cannot be easily corrected.
Surgical and pre-surgical steps
The subciliary or transcutaneous approach consists
of the following steps:
- Preoperative markings
- Surgical procedure
- Removal of surplus skin
- Sealing of the
The transconjunctival approach involves the
- Preoperative markings
- Operative process
- Postoperative wound care
with the use of ophthalmic ointment and artificial
Both these procedures also involve a crucial
correction of the tear trough deformity.