What is blepharoplasty?

What is Blepharoplasty?

Blepharoplasty is a surgical procedure that modifies the contour and configuration of the eyelids by removing redundant skin, fat, and muscle to restore a more youthful appearance or improve visual function. 1

Surgical Approach and Technique

Blepharoplasty can be performed on both upper and lower eyelids, with distinct technical considerations for each:

Upper Eyelid Blepharoplasty

• Primarily involves removal of excess skin and aesthetic placement of the supratarsal crease, with selective contouring of the upper orbital sulcus when necessary 2
• Generally does not require fat removal and involves more superficial tissue manipulation 2
• Should be approached transcutaneously (through the skin) 2

Lower Eyelid Blepharoplasty

• Addresses the orbitomalar sulcus (lid-cheek junction and tear-trough abnormalities) and pseudoherniation of periorbital fat 2
• Based on selective removal and repositioning of fat rather than simple excision 2
• Can be safely performed through either a transconjunctival or transcutaneous incision 2
• Involves releasing deep structures, making it more complex than upper lid surgery 2

Indications

• Treatment of excess eyelid skin and/or orbital fat for cosmetic rejuvenation 3
• Functional improvement when redundant eyelid skin obscures the crease, touches lashes, or causes visual field constriction 4
• Supporting structures such as canthal tendons may be tightened during the procedure 1
• Concurrent conditions like ptosis, brow ptosis, entropion, ectropion, or eyelid retraction may need correction simultaneously to ensure optimal functional and aesthetic results 1

Potential Complications

Common but Mild Complications

• Hematomas and chemosis are the most common complications but are usually mild and transient 5
• Overall complication rates are low, with one series reporting 9.5% incidence 5

Serious Complications Requiring Awareness

Upper Lid Blepharoplasty:

• New-onset diplopia (double vision) can occur, sometimes associated with trochlear nerve damage 6, 7, 4
• Scarring, hemorrhage in adjacent tissue, or fat adherence are potential mechanisms of complications 6, 7, 4

Lower Lid Blepharoplasty:

• Damage to the inferior rectus muscle can occur 6
• Lower eyelid malposition including retraction (5 cases) and ectropion (1 case) in one series of 200 patients 5
• Lower blepharoplasty has potentially more serious complications compared to upper lid surgery 2

Rare but Severe Complications

• Blindness, though extremely rare, is a feared complication 5
• Some complications may require surgical revision 5

Preoperative Considerations

Critical preoperative assessment includes:

• Thorough medical and ophthalmic history 3
• Symptoms of preexisting dry eye should be specifically elicited, as they directly correlate with postoperative complications 3
• Physical examination must evaluate brow position, eyelid ptosis, lower eyelid position, and cheek projection 3
• A history of cosmetic blepharoplasty is important to obtain because increased surface exposure may increase tear evaporation 6

Anesthesia Options

• Can be performed under intravenous sedation or entirely with local anesthesia 2
• This makes it a relatively accessible procedure with shorter operative times 2

Patient Counseling

Patients must understand:

• The American Academy of Ophthalmology recommends counseling patients about potential complications including scarring, hemorrhage, fat adherence, and new-onset diplopia 7
• The procedure significantly enhances periorbital and midface aesthetics by improving the tired appearance 2
• High patient satisfaction rates are typical when properly indicated 5