Blepharoplasty: Before, During, and After the Surgery

Blepharoplasty is a type of oculoplastic surgery that is done to repair droopy eyelids. Drooping of the upper eyelid, also known as ptosis (pronounced TOE-sis), may affect one or both eyes.

Although ptosis may be present at birth, in most cases it is the result of aging. In rare cases ptosis is caused by complications resulting from cataract surgery.

In some patients, blepharoplasty may be medically necessary to improve vision, eye comfort, and eye health—although some patients wish to have blepharoplasty for cosmetic reasons, in order to minimize the signs of aging. The majority of people who undergo blepharoplasty are between 35 and 64 years of age.

Blepharoplasty is the most common type of eyelid surgery. According to the American Society of Plastic Surgeons, it is one of the top five cosmetic plastic procedures performed in the United States.

Before you undergo blepharoplasty, your surgeon will check with your insurance company to determine whether it is covered.

This procedure is usually performed by an oculoplastic surgeon, an ophthalmologist who has completed additional training that focuses on the management of eyelid abnormalities, tearing problems, and orbital disease.

Blepharoplasty is typically an outpatient procedure, and most patients experience little discomfort, few complications, and a rapid recovery.

Medically Necessary Blepharoplasty, and What it Means to You

Different insurance companies will have different criteria for reimbursement of blepharoplasty. The most common reason to perform medically necessary reconstructive functional blepharoplasty is to correct diminished peripheral vision caused by the weight of excess upper eyelid tissue.

When the edge of the eyelid falls too low and covers part of the pupil, it can block the upper part of your field of vision.

Functional blepharoplasty may be performed to treat many eyelid conditions, including:

• Ptosis
• Eyelid lesions
• Inflammation caused by Grave’s disease
• Blepharochalasis (hypertrophy and loss of elasticity of the skin of the upper eyelid)
• Floppy eyelid syndrome
• Trauma to the eyelids
• Entropion (inversion) of the edge of the eyelid
• Ectropion (eversion) of the edge of the eyelid
• Trichiasis (the eyelashes grow inwardly against the cornea)

For blepharoplasty of the upper eyelid to be covered by insurance, you must have a functional complaint and a supporting visual field examination performed in an ophthalmology office. The visual field examination should demonstrate a 25 to 30 percent blockage of the visual field.

Insurance companies may also require documentation of visual improvement when the upper eyelid is taped, or a preoperative photograph of your face showing the degree to which the drooping eyelid covers the pupil.

Are You a Candidate for Blepharoplasty?

If you have one of the eyelid conditions listed above, you may be a good candidate for functional blepharoplasty. If you don’t have a medical reason for undergoing blepharoplasty, you may want to consider cosmetic eyelid surgery.

Surgical risk factors that may eliminate you as a candidate for blepharoplasty include dry eye problems, thyroid eye disease, and diabetes.

Your doctor will evaluate your medical history, clinical symptoms, and the severity and number of health problems you have to determine whether you are a good candidate for surgery.

In some people of Asian descent, cosmetic eyelid surgery may not be appropriate because of the unique structure of this ethnic group’s eyelids, which can be damaged by surgery.

How to Prepare for Blepharoplasty Surgery

According to the American Society of Ophthalmic Plastic and Reconstructive Surgery, you should take the following steps to prepare for your surgery:

• See your primary care physician or internist before your surgery for standard preoperative clearance. Patients who are taking daily doses of aspirin and warfarin under the care of a cardiologist may need to see their specialist in addition to seeing their regular primary-care doctor.
• Avoid certain medications (such as non-steroidal anti-inflammatory agents and warfarin) and over-the-counter supplements per your surgeon’s instructions.
• Schedule a preoperative visit with the surgeon. This is separate from your initial consultation with the surgeon and is scheduled after your primary doctor clears you for surgery.
• Don’t eat or drink anything on the morning before your surgery, and don’t wear any make-up on your face.
• Make arrangements for someone to pick you up the day of your surgery and stay with you for at least the first eight hours.

The Blepharoplasty Procedure

Functional blepharoplasty is generally performed on the upper eyelid, although blepharoplasty of the lower eyelids may be required for medical reasons. In some cases, both the upper and lower eyelids can be treated at the same time.

The surgery is done through incisions made in the natural folds of the eyelid, in the crease of the upper eyelid and just beneath the lashes or behind the lower eyelid. Your surgeon will mark the skin to designate where excess skin, fat, and muscle need to be removed.

Scalpels, surgical scissors, radio-frequency cutting devices, and sometimes cutting lasers are used to remove the excess tissue. Your surgeon will decide how much tissue to remove during the procedure. Sutures are carefully placed to reconfigure the eyebrows and eyelids.

If the procedure is cosmetic, a carbon dioxide laser is often used to resurface the skin and smooth out any remaining wrinkles in the eyelid and eyebrow area. In some cases, a brow lift is also performed.

After the Blepharoplasty Procedure

A topical antibiotic may be applied to the eye after surgery. You will be provided with instructions to follow at home. These will be explained to you and whoever accompanies you to your surgery.

Your surgeon will ask you to take it easy and apply cool compresses on your eyelids for the first few days after surgery. Minimal activity is usually recommended to help minimize any swelling, bruising, discomfort, and postoperative complications.

After the first 48 hours, you can get up and move around, but exercising or heavy lifting should be avoided for at least one week after surgery, and in some patients for up to two weeks after surgery. The sutures used during the procedure will dissolve within a few days. Non-dissolving sutures are removed in the office one to two weeks after surgery.

You will probably feel some mild discomfort immediately after surgery. The area around your eyes may appear swollen and bruised, and your eyes may appear bloodshot. This should resolve within a few weeks. Over-the-counter acetaminophen is usually recommended for any discomfort.

Risks of Blepharoplasty — Are You Susceptible?

Blepharoplasty, whether medically necessary or cosmetic, can alter your appearance significantly. There is the risk that you may not be happy with the results. It is the responsibility of your ophthalmologist to fully explain the surgery’s potential complications.

Those individuals undergoing blepharoplasty for cosmetic reasons need to have realistic expectations about the benefits of the surgery — and be willing to accept the potential consequences.

Complications of blepharoplasty range from minor to severe, and some cases may require additional surgical intervention. Superficial bruising, asymmetry, scarring, overcorrection, wound dehiscence, ptosis, ocular discomfort, and blink dysfunction are some of the more commonly reported complications.

Diplopia, ocular injury, and orbital hemorrhage and vision loss can also occur, but fortunately these complications of blepharoplasty are rare.