Blepharoplasty is a surgical procedure whose aim is to eliminate the excess of skin and fat of the eyelids. Blepharoplasty can enhance the flaccid skin and the bags under the eyes, and can help to improve vision in elder people who present an important excess of skin on the upper eyelid (blepharochalasis), even covering the pupil. Despite it can cause a fold in the upper eyelid of an Asian-like eye, blepharoplasty cannot erase any racial or ethnic characteristic features. Blepharoplasty does not eliminate the " crow's-feet " nor the expression wrinkles nor dark rings under the eyes. It cannot deal with drooping eyebrows either. The eyebrows ptosis is addressed with other operation (see lifting).

Blepharoplasty is designed individually for each patient, depending on its particular needs. It can be performed independently for upper, lower or both eyelids, or in combination with other surgical procedures on eyes, face, eyebrows or nose. Surgery for the eyelids cannot stop the ageing process. However, it can significantly improve the sad or tired looks. Other types of surgery of the eyelids can be necessary if alterations that affect the function of the eyelids, like the malfunction of the elevator muscle (palpebral ptosis), or lack of contact between the eyelid and the ocular globe exist (ectropion). The smaller cutaneous wrinkles can be improved by means of laser or peeling.

ANAESTHESIA

It is an intervention that can be made with local anesthesia, local anesthesia plus sedation or general anaesthesia.

TECHNIQUE

In the upper eyelids the skin to be removed is drawn in such way that the scar would lie in the palpebral fold. This drawing is done with the patient standing up and arching the eyebrows. It must be taken into account that drooping eyebrows can only be fixed with frontal lifting. After removing the excess of skin and muscle, the central and medial fat bags are partially removed (only the herniated part of them). Through this incision it is also possible to remove the corrugator muscles responsible for the wrinkles between the eyebrows (frowning) and even use a piece of them as fillers for such wrinkles.

In the lower eyelid there are several possibilities:

• The classic tecnique consists of making the incision right under the eyelashes so that the scar is soon hidden. A skin-muscle flap is raised and the excess of the three fat bags are removed. I do not remove much skin since this is very thin, it will contract and if much skin is excised the lower eyelid will fall and the result would be a round eye with scleral show.
• More often, we carry out the fat removal through an incision within the eyelid (transconjunctival), so that there is no visible scar outside and we do not injure the orbicular muscle (it is left completely undisturbed).
• In those cases with a deep dark line in the lower limit of the eyelid (tear through deformity) we perform a filling with fat (Coleman technique).
• In almost all cases we tighten the lower eyelid (canthopexia). Normally the lateral cantus is 1-2 mm above the medial one. This procedure allows to give a more youthful shape and contour to the eyelid and to keep it in its place, avoiding retraction or malposition (" round eye " or scleral show).
• From this incision we can lift the sub orbital fat pad and improve the contour of the malar area.

POST OPERATION

Hematoma is much reduced by usin cool packs or ice about 2-3 hours after the operation. Stitches are removed 4-5 days after the operation and then I always recommend to proceed with massages (drainage) to reduce edema and to give elasticity to the skin.