The most common eyelid surgery performed in the United States is a plastic surgery procedure known as blepharoplasty. During the procedure, excess skin and fat from the upper and/or lower eyelids is removed. Both men and women can benefit from this type of surgery.
Many blepharoplasties are done for aesthetic or cosmetic reasons and are normally not covered through insurance plans. Fees for elective surgery are paid prior to procedures. Reconstructive blepharoplasties, however, are done to correct conditions that impair normal vision; for example, when the excess skin on the upper eyelids is severe enough to partially obstruct vision. If surgery is felt necessary to correct a condition that impairs normal vision the surgeon’s fee and other costs may be partially or fully paid by your insurance carrier.
Prior to undergoing eyelid surgery a complete eye examination should be performed. Certain eye conditions may need to be treated prior to surgery, or the surgery may need to be modified to avoid post-surgery complications. Dry eyes and skin conditions such as rosacea and other eye surface issues need to be evaluated and treated before surgery. This is why an ophthalmologist with advanced training in eyelid surgery, a type of oculoplastic surgery, is uniquely qualified both to perform the procedure and address the effects of the surgery on the eyeball itself.
Eyelid surgery is performed in a physician’s office or in an outpatient surgery center. Local anesthesia with sedation to relieve anxiety is often used. For the upper eyelids, excess skin and underlying compartments of fat are usually removed while in the lower eyelids, fat sculpturing with skin tightening and little or no skin removal is the objective. A new technique in lower eyelid surgery called transconjunctival blepharoplasty allows removal of fat from the lower eyelids without a skin incision. This technique is most useful in patients who have minimal looseness of their lower eyelid skin. In the upper eyelids the incisions are made in the eyelid creases and are barely visible within six months. Depending on the amount of surgery, the procedure requires 45 to 90 minutes to perform.
Other types of eyelid surgery are commonly performed to correct faulty or malposition of the eyelids such as ptosis (drooping of the upper eyelid) or entropion and ectropion (turning in or out of the eyelid). These conditions almost always interfere with normal visual function and therefore should be partially or fully covered by your insurance carrier. Ptosis, or droopy eyelid, is caused by a weakness in one or both of the upper eyelid muscles. This can occur as a result of aging, previous eye surgery, neurologic disease or diabetes. In children and some adults, the cause is often congenital or present at birth. Ptosis surgery involves tightening the upper eyelid muscle to raise the eyelid and can also be performed with a blepharoplasty if there is excess skin present.
Surgical outcome depends on skin structure and the healing process. Post-surgery pain is usually minimal and ice compresses are used to reduce swelling. The removal of excess skin and fatty tissue around the eyes results in a younger more rested appearance. Blepharoplasty will also improve, but not remove, fine wrinkling. To permit proper healing, the eyes should be shielded from the wind and sun for about three weeks. You may be asked to use ointment or eye drops during the recovery phase. As with any surgical procedure complications, although rare, can occur. In eyelid surgery, the risk of excess bleeding, infections or poor wound healing can be minimized by avoiding exertion and using cold compresses for the immediate period following surgery.
To discuss eyelid surgery or to make an appointment, use our Patient Portal or call 704-365-0555 Monday-Friday, 8 a.m. to 5 p.m.
By Mark Malton, M.D.