Family doctor

What is cosmetic surgery of the eyelids?

Cosmetic surgery of the eyelids is generally directed towards the improvement of age-related changes to the tissues about the eye, although in some people these changes occur prematurely or may be the result of a medical condition.

"Cosmetic surgery" is a poor term as it has connotations of self indulgent or unnecessary surgery while in reality all eyelid surgery has a cosmetic aspect whether it be for reconstruction following excision of an eyelid tumour or the excision of excess skin.

There is often a functional reason for removing excess upper lid skin which occludes part of the visual field. Cosmesis is particularly important around the eye as this is the area concentrated on when recognising or conversing with another person.

Tissue changes

Skin - Changes to the elastin in skin reduces the tone of the tissue resulting in drooping of the eyebrows and redundant skin in the upper and lower eyelids.

Tendons - Laxity of the tendons causes a slackening of the eyelid support structures which can lead to malposition of the eyelids.

Fat - Atrophy of orbital fat may give a sunken appearance to the eye.

Fascia (connective tissue) - A weakness of this plane of tissue in the eyelid may allow orbital fat to escape forward and particularly in the lower lid causes the appearance of "bags" under the eyes.

While these changes most commonly occur with age, they may be seen in the relatively young, or with medical conditions such as dysthyroid eye disease. Facial nerve palsy may cause eyebrow droop and poor eyelid closure with sagging of the lower lid from loss of nerve supply to the eyelid and forehead muscles.

Surgery

The most commonly performed surgical procedures are the eyebrow lift and the upper and lower lid blepharoplasty. In a blepharoplasty, excess or redundant skin, muscle, fat or a combination of these can be removed via incisions which are hidden in natural skin lines.

Close attention is paid to the position and symmetry of the upper lid skin creases as well as the height of the upper lids.

There is a racial difference between the upper lids in Europeans and Chinese with the latter having very low or absent skin creases. In a "Westernisation procedure" a skin crease is formed in the oriental upper eyelid.

Common questions about cosmetic surgery

How long is the recovery period after surgery?

The surgery can be performed under local or general anaesthesia (more commonly local) and post-operatively the eyelids take only a few days to settle. Bruising and swelling is minimised by firm patching initially and the regular use of ice pads for 48-72 hours after the surgery.

Is cosmetic surgery covered by medical insurance?

Most insurance policies exclude "cosmetic surgery" as a rule but will accept the costs if there is a functional reason for the surgery (i.e. improving the field of vision) or if the problem is caused by a medical condition such as thyroid eye disease. Surgery for eyelid malpositions such as ptosis or ectropion is not considered cosmetic and is covered by medical insurance.

Can it affect my eyesight?

There have been reported cases of loss of vision with lower lid blepharoplasty although this is very rare and is estimated at only one per 40,000 cases. This exceedingly rare complication does not appear to occur with upper lid blepharoplasty.

Can blepharoplasty be performed with laser?

In eyelid surgery, a laser can be used to cut and diathermy tissue but there are a number of other instruments which can perform the same task. Irrespective of equipment or techniques used, it is important that procedures such as blepharoplasty are performed by a surgeon experienced in eyelid surgery.

The main function of the eyelids is to protect the eye and it is therefore imperative that the eye is thoroughly examined pre-operatively to rule out any condition for which surgery may be contraindicated.