Dr. De Fazio Plastic Surgeon :: Procedures :: Face :: Blepharoplasty, canthoplasty e canthopexy

Blepharoplasty (Eyelid Surgery)


Blepharoplasty is performed to reduce excess eyelid skin and/or excess fatty deposits that appear as puffiness in the eyelids. Not all patients need to remove both the excess skin and the excess fat. Often only one of them is necessary. Not all wrinkles and skin folds around the eyes can be removed with the procedure. It is very important that the surgeon makes an accurate assessment of how much excess skin can be removed without undesired consequences, in order to get the best result.

local + sedation
1 hour
outpatient / day surgery
1 - 2 weeks
The procedure

The result of a plastic surgery operation is depending on many variable factors. In the case of blepharoplasty, these factors are the physical condition of the face, the presence of excess fat or not, the relative age of the skin, quantity and quality of wrinkles, the underlying bone structure and hormonal influences.
The length of the operation is different from patient to patient. In many cases the excess fatty deposits that appear as puffiness in the lower eyelids are not coming back, but, with aging, the skin gets more loose and redundant and, as a consequence, it could be necessary to undergo a further reduction of the skin in 5 to 10 years time after the surgery.

The procedure can be performed both with local anesthesia and with both local anesthesia and sedation. The type of anesthesia might also depend on both the patient's wishes and the surgeon's assessment.

The local anesthesia consists on sedation by intravenous injection before the operation and, if necessary, also during the operation. The area to be treated is injected with small quantities of local anesthetic.

The procedure takes about 2 hours.

The lower eyelid: the incision is performed on the lower eyelid at about 2 mm from the ciliary margin and parallel to the eyelid margin and continues over the external corner going around and into some wrinkles for about 1 cm. The skin is detached gently from the underlying tissues. The appropriate quantity of excessive peribulbar fat is removed; if necessary, excessive skin is also removed and, then, the skin is sutured with very thin sutures. In some cases, a sterile medicated patch is applied to the outside corner of the incision.

The upper eyelid: before performing the incisions, the surgeon must assess and draw the excess skin to be removed. The drawing must be done in a way that the final scar will be inside a normal skin fold when the eye is open. In the external corner area, the incision slightly turns upwards. The appropriate quantity of excess skin is removed. The appropriate quantity of excess fat is removed and the skin is stitched with very thin sutures.

Preoperative Preparation

The patient will be asked to stop taking aspirin or other drugs containing it 2 weeks before and 2 weeks after surgery. Aspirin can cause bleeding and, as a consequence, increase the risk of complications. No make-up product should be used on the day of surgery.
It is recommended to female patients taking oral contraceptives to stop taking them one month before surgery.

After the procedure

This kind of surgery causes minimal pain, which can be kept under control by painkillers. Edema (swelling), ecchymosis (bruises) and discoloration (redness and variations in skin color): these three possible consequences are different from patient to patient and can be either small ore more significant. Most of the edema and ecchymosis subsides within 5 to 10 days after surgery, but it is not unusual that discoloration takes a bit longer to disappear. During this time, the eyelids could look swollen, irregular and asymmetric.

Dislocation of the lower eyelid: the lower eyelid could be slightly stretched downwards or upwards. This can be caused by the edema and disappears as soon as the swelling is reduced. As a consequence, increased tearing might occur.

Conjunctival hyperemia (red eye): it might appear as a consequence of swelling and ecchymosis of the eyelid tissues. It is neither painful nor dangerous.
The stitches will be removed within 4-6 days after surgery.

Possible complications

Complications are rare. Occasionally, hematoma might occur (swelling due to an accumulation of blood under a wound). In some cases, it could be necessary to remove the blood clots in order to make the healing faster.
Infections are very rare. Occasionally, the eyelid could be slightly stretched away from the eyeball. An abnormal healing of deep wounds could cause this complication. This is, anyhow, a temporary problem, but it could be corrected with further surgery if necessary. Some tumescence along the incision lines which might arise 2-3 weeks after surgery. It can consist of blocked cysts or sweat glands. As a rule, it disappears by itself, but occasionally it can be necessary to open it. Anyhow, we are talking about a minor outpatient treatment.

Recovery time (back to social life)

Driving can be resumed one day after surgery; sports can be started again two weeks after surgery; make-up can be used again 1 week after surgery.
Sun exposure of the eyelids should be avoided for at least 3 months.
Work and social life should be reduced for at least 10-15 days after surgery.