Laser Blepharoplasty

1. What is Blepharoplasty?

2. Indications & Contraindications

3. Special Instructions

4. Surgery

5. Recovery and Combination Procedures

6. Results – Longevity and Limitations

What is Blepharoplasty?

Eyes are the main focal point of the face. They play a major role in the attractiveness of the face (at rest and in dynamic movement). Cosmetic eyelid surgery (Blepharoplasty) can remove excess eyelid skin, correct bagginess and puffiness of the eyelids.

Additional procedures like brow lift, eyelid lift, cheek lift and augmentation around the eyelids can further enhance the beauty of the face. Consideration of the relevant associated procedures if necessary is recommended for maximum results.

Blepharoplasty is usually considered after the age of 35, it might be considered earlier in those who demonstrate the inherited tendency towards the indications of surgery. The idea behind Blepharoplasty is fine tuning of the eyelids’ shape, size and enhancing the glow of the eyes. It is aesthetically pleasing when the eyelids blend in with the soft tissue and the bones around them and also the inside of the eyes (such as the iris and white eye). Ideally the upper lid should be just touching the upper part of the iris and the lower lid should be just touching the lower part of the iris without covering too much of the iris or exposing  too much of the same. Any deviation from the normal position of the eyelid could be due to the aging process, heredity, any birth deformity, smoking, sun damage, inflammation, infection or trauma.

Advantage of Laser Blepharoplasty over traditional scalpel method

The advantages of Laser Blepharoplasty over the traditional scalpel method are - in this method there is a lot less bleeding and bruising as the laser seals as it cuts and it is a quicker procedure as it is a cleaner operation site.

In Laser Blepharoplasty we can combine 2 functions of the laser to get the best results. The cutting laser is used to sculpt, to excise the extra skin in the upper eyelid and the fat from the upper and lower eyelids (even to minute amount with precision). The pulse mode laser is used to resurface the eyelid skin, to remove the fine wrinkles and to improve the texture and glow of the skin. The tissue can be tightened by defocusing the laser, especially the muscle.

What it can achieve

• The aim of upper Blepharoplasty is to reduce the amount of excess skin in the upper eyelid.
• The aim of Lower Blepharoplasty is to reduce the bulge of the fat pad in the lower eyelid.
• Both upper and lower Blepharoplasty, improve the quality and texture of the skin. The idea is to create a natural looking eyelid with fullness rather than radical operation with hollowness. (conservative approach is the best)

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Indications & Contraindications

Indications

• Always looking tired
• Baggy eyes
• Droopy upper eyelid
• Lustreless skin with wrinkles and creases around the eyes
• Puffiness around eyes

Contraindications

• Excessively droopy brow (requires brow lift at the time of blepharoplasty)
• Some existing eye conditions
• Bleeding disorders

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Special Instructions

Special instructions

A check up with a hospital ophthalmologist prior to surgery is a must to check the state of the eyes and ensure there are no contra indications.

It is essential that the surgeon identifies if the patient’s complaint stems from excess skin on the upper eyelid or brow droopiness at the time of consultation. An Upper eyelid surgery to remove excess eyelid skin will make the brow more hooded, making the brow droopiness more prominent. In cases where both conditions exist, it is recommended that a blepharoplasty is combined with a brow lift at the same time, for best results.

Types Of Blepharoplasty

• Scalpel Blepharoplasty
• Laser Blepharoplasty

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Surgery

Anaesthetic

Generally a combination of sedation and local anaesthetic is administered. In case of patient preference a combination of Local and General anaesthetic may be used.

Surgical procedure

Length of surgery – 30 mins to 90 mins. On an average upper and lower eyelid procedure together  takes about 45 mins

Upper Blepharoplasty – The marking are usually done pre-operatively in the sitting position to delineate the amount of excess skin for removal and the location of the fat bulge.  Before the surgery local anaesthetic is injected to reduce bleeding, numb the area and create a plane. Metal eye shields are inserted under the eyelid over the globe to protect it from laser. Using cutting laser excess skin will be removed, possibly with a little strip of muscle to tighten the lid. The fat pad and the inner corner of the eyes will be removed adequately. Bleeding will be stopped and the skin will be approximated and sutured with stitches. Peeling can be done with an ultra-pulse co2 laser. The shields are taken off, the eyes washed with saline and antibiotic ointment and artificial tear gel is applied in the eyes and cool packs are placed inside the eyes.

Lower Blepharoplasty – marking of the fat pad is done in sitting position. Local anaesthetic is then infiltrated around the lower eyelid, especially around the fat pad.

There are 2 approaches for the lower eyelid operation – one is transcutaneous (under the eyelash on the skin) and the other approach is via the inside of the eyelid, through the inner lining.  The advantage of the inner approach is avoidance of visible outside scar, lesser disturbance to the muscle and skin system and higher chance of preserving the initial eye shape and aperture. Using the cutting laser, the middle inner lining of the eyelid is incised; adequate fat pad is sculpted and repositioned. Conservative approach is the best to reduce hollowness and improve to create a uniformly fuller appearance. Defocused laser can tighten the soft tissue including the muscle from the back. There is no necessity for suturing, the stickiness of the lining will glue together.  Laser peeling is done on the lower eyelid skin and the metal shields are removed. A saline wash followed by antibiotic ointment and tear gel are applied to the eye.

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Recovery and Combination Procedures

Following the surgery you will be in the recovery room for 20 – 30 mins and transferred back into your room. Cool packs are placed around the eyes for 4 – 6 hours continuously to cool the eyes. Following this white aqueous cream is applied  to the lasered skin every hour and artificial tear gel is applied inside the eyes every 2 hours to avoid dryness. The surgery is generally performed as a day procedure not requiring over night stay if it is only one procedure that is undertaken (Upper or Lower Blepharoplasty) . The surgeon will see you before you are discharged. You will be given a course of antibiotics to be taken as prescribed and pain killers to be taken as necessary. Medication for itching and sleeping are given and creams and gels for application outside the skin and inside the eyes are also provided. Please have someone pick you up from the hospital and ensure you are wearing your protective wrap around sunglasses when you are leaving and for at least 4 weeks afterwards to prevent pollution and sun. Please visit the clinic in 5 days time for suture removal in the case of upper Blepharoplasty and a week’s time for follow-up in the case of lower blepharoplasty.

For the first few days, only minimal activity is recommended. You can return to work in approximately 10 days.  Eye make-up can be applied after 1 to 2 weeks, and contacts can be worn after 2 weeks. Glasses can be used immediately.

Be prepared for some stinging sensation, a pain like sunburn, this may persist for approximately 72 hours.  This can be controlled with simple painkillers like co-dydramol. The skin may become very itchy around the 4th or 5th day – avoid scratching.  Scratching will cause bleeding and scarring.  If persistent bleeding occurs, and does not stop, contact the surgeon immediately.  Anti-histamine such as Piriton will help the itching as will frequent application of the moisturizer on the healed skin.

If the cream gets dry or scabby do not wipe or apply force, as this will result in bleeding or scarring. Apply more aqueous cream to the cream you already have on, and wash off in the shower or with water spray, or very gently apply mild soap, such as Neutrogena or dove on top of the scab, wait for a few minutes then clean by gently rolling a cotton bud over. In the first few days, vision will be blurry and slowly recover as swelling subsides and dryness improves.

After healing a mild redness is indicative of the healing process – this usually persists for a few months with exposure to heat, drinking alcohol or sun exposure. The scar is a noticeable red/pink line, which fades into a white line and can easily be camouflaged in the case of upper Blepharoplasty.
Resurfacing wounds heal in 5-7 days – until then use the aqueous cream.  After 7 days, apply a simple moisturizer without alcohol or perfume around the healed skin with sun block on top.  Post operatively a powder based laser make up to conceal redness can be recommended

Follow-up after surgery

The recommended follow-ups are generally spaced 5 days, 2 weeks, 3 months, 6 months , 12 months and 18 months from surgery.

Usual combination procedures

• Expressional lines can be improved with botox.
• The quality of skin can be improved with laser or chemical peel.
• Ptosis can be improved by muscle repair.
• Tear trough can be improved by filler.
• Excessive fat bulge associated with over active thyroid which may need thyroid treatment to control the thyroid activeness.

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Results – Longevity and Limitations

Longevity of results

Depends upon lifestyle factors and heredity. Generally fat pad will recur. Fine wrinkles and lax skin can develop with aging.

Limitation of results

• Repeat procedure necessity : sometimes the fat pad may need further excision and the lax skin may need further removal.
• This procedure will not lift the brow, eyelid or cheek.
• This procedure does not augment or fill. May need filler for hollowness
• This procedure does not reduce dynamic line around the eyes.

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