IMPORTANT FACTS ABOUT EYELID SURGERY

Eyelid Surgery, otherwise known as Eyelid Reduction Surgery or Blepharoplasty is typically sought by those who notice a heavy, tired look to their eyelids.  It is a semi-cosmetic procedure that lifts the upper or lower eyelids, eliminating excess skin or under-eye puffiness to improve the overall symmetry and appearance of the eyes.  It involves the removal of skin, and sometimes the removal of muscle or fat. Modern techniques avoid removing too much fat and focus instead on contouring or repositioning fat to avoid a sunken, aged, skeletal appearance.

In some cases, people are physically aware of a pressing and heaviness upon their eyelids.  This can be pronounced when people are tired and do not use their eyebrow muscles to elevate their eyebrows and can sometimes can affect people’s superior or even central vision or cause headaches.

Closely related to such direct eyelid procedures is Ptosis Surgery, which is performed to correct a droopy eyelid.  This often occurs when the eyelid muscle is stretched due to age or trauma (such as contact lens use) and physically lowers the eyelid, creating asymmetry and potential obstruction to vision. 

A related cause of heavy upper eyelids can be brow ptosis, or mechanically dropped eyebrows. A procedure to lift the brow, ‘brow lift’ can correct this problem, rather than eyelid based surgery.

FINDING THE RIGHT SURGEON

Dr Freny Kalapesi, an Oculoplastic Surgeon with Personal Eyes, says that Blepharoplasty  Surgery is commonly performed by a wide variety of medical practitioners, including General Practitioners with a cosmetic interest,  Plastic Surgeons, Ear Nose and Throat surgeons and others.  This causes confusion about locating the best specialist for such eyelid procedures.  How do you know who the well-trained people in this area are?

The benefit of engaging an Oculoplastic Surgeon is that these professionals are trained Ophthalmologists (eye specialists) who undertake further fellowship surgical training specifically on eyelid and orbital eye anatomy.  Oculoplastic surgeons are better suited to address complaints and are trained to identify the many underlying causes of eyelid droopiness.  They can closely examine the anatomy to identify both causes of abnormalities and to prevent complications other surgeons may miss.  Look out for those who belong to the society of Oculoplastic Surgeons, the Australian and New Zealand Oculoplastic and Reconstructive Surgery (ANZOPRS).

There are many different potential diagnoses of droopy or asymmetrical eyelids, including allergies and inflammation behind the eyelids.  In some cases, the cause may be systematic muscle conditions where the eyelid muscles are weakened.  These can be treated by medications rather than surgery. It is also important to examine the pupil and eye movements to rule out aneurysms or a tumour as the root cause of the droopiness.  During the surgery itself, a surgeon must carefully delineate the planes of the eyelid, knowing that the orbital fat pads could potentially bleed and threaten vision.  This is again good reason to engage an eye specialist when considering surgery.

“The function of the eye, that is the ability to close the eyes properly always takes priority over achieving cosmetic symmetry of the eyelids, so it is important to have realistic expectations, particularly if pathology exists,” says Dr Kalapesi.

EYELID SKIN CREASING

The surgery is sometimes sought out by those who have excess skin as a result of age, or come from an Asian background with the aim of creating eyelid creases and show skin above the eye for cosmetic appearance and for some, the ability to apply eyelid makeup.   The surgeon must be highly trained and experienced in creating, contouring and positioning the creases to ensure the skin showing between the eyelashes and sub-brow area of the eyelid is well proportioned and looks natural. 

PREPARING FOR SURGERY

It is important that blood thinners not critical for health and herbal supplements are not taken prior to surgery as these can cause excess bleeding, and post-operative bruising and swelling.  A lot of swelling can effectively undo the effects of surgery, because it stretches the skin. 

So it is vital that patients are upfront with their doctor about existing use of blood thinners or herbal supplements such as Garlic, Ginger, Ginko Biloba, Echinacea, Turmeric, and Fish Oil.  Unless these are specifically prescribed by a doctor, they should stop being taken as soon as possible prior to surgery.

NON SURGICAL OPTIONS

There are also non-surgical options which may be of benefit when surgery is not desired or recommended for some reason. “ Botulinum Toxin injectables (such as Botox or Dysport) can achieve good effects, such as chemically lifting the brow and reducing upper eyelid heaviness,  albeit temporarily ”, says Dr Kalapesi.

Some people are happy to use Botulinum to help rejuvenate the periocular or eye region which can be used to even out wrinkles around the eyes as well as helping to even out eyelid asymmetry and improve the cosmetic effect.  Botulinum can also be used medically for functional reasons, for example to paralyse muscle twitches around the eyes (blepharospasm).  In this case, the injections are subsidised by Medicare. 

Botulinum toxin injections typically take one to two weeks to take effect, and generally last for a few months before needing repeat treatment.

Ultimately, electing to have Eyelid Surgery is a personal decision.  You are well advised to learn as much about the procedure as possible and ensure that you have researched the expertise of your surgeon.


Dr Freny Kalapesi is an Oculoplastic Surgeon