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Blepharoplasty Washington DC

The eyes are an incredibly important facial feature.  When we approach someone, the first thing we do is make eye contact.  If a person has excess upper eyelid skin or puffiness of the lower eyelids, they can be misinterpreted as tired, angry, or sad.  Eyelid surgery typically addresses 3 components: excess skin, protruding fat, and lax muscle tone. 

In upper eyelid surgery, removing the excess skin and fat, while redefining the fold above the lashes gives patients a more youthful, rested appearance. In lower eyelid surgery, there may also be extra skin, puffiness due to protruding fat, and decreased tone of the lower eyelid. In the past, surgeons were very aggressive with fat removal, generating a flat lower eyelid, but accentuating the bony orbital rim. This made the patient appear less tired, but also less youthful and gaunt. The goal today in lower eyelid surgery is to preserve fat to minimize this transition. If a distinct valley exists between the eye and cheek, this is called a tear trough deformity. There are several methods currently available to address this deformity.  They include a tear trough implant, fat injection, or a midface lift.

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Midface Lift

There is a triangle on the cheek bounded by the lower eyelid above, the nasolabial fold, and cheek bone called the midface. If there is a tear trough deformity, a prominent nasolabial fold and deficiency of the cheek bone, the patient may benefit by a procedure called a midface lift. 

To determine whether a patient may be a candidate for this procedure, one can place his/her index finger on the cheek bone and push in a vertical (straight up) direction. This simulates the effect of a midface lift.  The midface is approached as an extension of the lower lid using an incision that extends outside the corner of the eye. A tunnel is created along the orbital rim and then extending behind the soft tissue of the cheek. These tissues are then advanced in a vertical direction and attached to the deeper layers for support. The excess skin is then conservatively removed below the lash line. The results are quite dramatic, but swelling can last for 4-6 weeks. A canthopexy is commonly performed at the same time which not only lifts but, tightens the outer corner of the eye.  This is always over-corrected as it will also settle over 4-6 weeks.

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Eyelid Surgery

The procedure is performed on an outpatient basis either under local anesthesia with sedation or general anesthesia. Upper eyelids are approached through an incision in the natural crease above the lashes. This offers the opportunity to remove the excess skin and fat if present and redefine the fold if indicated. Lower eyelids may be approached in several ways. If there is puffiness due to excess fat, but minimal to no extra skin, the fat can be approached through a transconjunctival incision on the inside of the eyelid, which avoids an external scar. The lower eyelid skin is then addressed with laser resurfacing, which will provide an improvement in texture as well as a small amount of skin tightening. If there is excess skin (with or without excess fat), an external subciliary incision is made just below the lash line. The lower eyelid skin is then elevated and redraped, the excess fat removed, and the redundant skin trimmed. 

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Recovery from Blepharoplasty (Eyelid Surgery)

The patient is instructed to sleep with his/her head elevated on two pillows and rest his/her eyes. Cold compresses are applied for 24 hours followed by warm compresses. The following day, the patient is seen for a postoperative visit, and the sutures are removed around the fourth postoperative day. The swelling and bruising typically resolves over 1-2 weeks. If a canthopexy or midface lift is performed, this will delay the recovery slightly. The skin of the eyelids will be numb for a period of months. The feeling comes back gradually over time, although not 100%. The patient is asked to limit his/her activity for the first 2 weeks from the day of surgery. At that time, he/she can gradually start resuming his/her usual level of activity with the expectation of being back to normal at approximately 3-4 weeks.

Blepharoplasty (Eyelid Surgery) Risks and Complications

Risks and complications are uncommon, but may occur. They include, but are not limited to: infection, bleeding, scars, sensory changes of the overlying skin, lid malposition, blindness (extremely rare), and need for revision in the future.

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