Blepharoplasty is a surgical procedure designed to rejuvenate the appearance of the eyes by correcting age-related changes like sagging skin, puffiness, and bags. Often called eyelid surgery, it is divided into upper and lower components, which target separate anatomical structures. While both procedures aim to refresh the eye area, the techniques and specific problems they solve are different. The decision to perform an upper, a lower, or a combined blepharoplasty depends on the individual’s specific needs and the location of the tissue changes.
Upper Blepharoplasty: Addressing Eyelid Hooding and Functional Issues
Upper blepharoplasty focuses on correcting skin and tissue changes of the upper eyelid. With age, the skin loses elasticity, leading to dermatochalasis, or excess, drooping skin. This excess skin causes the eyelid to look heavy or hooded.
The drooping skin can impair peripheral vision, making the procedure functional as well as aesthetic. The surgeon makes the incision along the natural crease of the upper eyelid, concealing any resulting scar. The procedure primarily involves removing the redundant skin and, often, a strip of the underlying orbicularis oculi muscle to reduce bulk.
Surgeons may also address small pockets of fat that have begun to protrude from the orbit into the upper eyelid area. Some techniques now focus on repositioning this fat instead of removing it to preserve volume, especially if the eyelid has become hollowed. By adjusting the excess skin and fat, the upper eyelid is smoothed, revealing the eyelid platform and creating a more open appearance.
Lower Blepharoplasty: Correcting Bags and Puffiness
Lower blepharoplasty rejuvenates the area beneath the eye, addressing under-eye bags, puffiness, and skin laxity. These bags are caused by the weakening of the orbital septum, which allows fat pads to bulge forward, creating a shadow and a tired appearance. The goal is to smooth the contour between the lower eyelid and the cheek, which is often disrupted by the protruding fat.
There are two main surgical approaches for the lower eyelid, selected based on the patient’s specific needs. The transconjunctival approach involves an incision made on the inside of the lower eyelid through the conjunctiva, leaving no visible external scar. This internal technique is preferred when the primary issue is fat protrusion and the patient has good skin elasticity. It provides direct access to the orbital fat pads, allowing the surgeon to remove or reposition the fat to fill the hollow area over the cheekbone.
Conversely, the transcutaneous approach involves an external incision placed just below the lash line. This technique is used when significant skin laxity requires removal, allowing the surgeon to tighten the skin and address the underlying muscle. While this approach manages both skin and fat, it carries a slightly higher risk of temporary lower eyelid position changes compared to the internal approach. The incision is placed in a natural crease so that it heals discreetly.
The Combined Surgical Experience and Recovery Timeline
Blepharoplasty is typically performed as an outpatient procedure, allowing the patient to return home the same day. The surgery is often carried out under local anesthesia combined with intravenous sedation, though general anesthesia may be used depending on complexity. The total duration varies; an upper blepharoplasty takes around 45 minutes to an hour, while a lower or combined procedure can take up to two hours.
Swelling and bruising around the eyes are expected in the post-operative period, often peaking around the third or fourth day. Patients should keep their head elevated, even while sleeping, and use cold compresses to minimize swelling and discoloration. Discomfort is usually manageable with over-the-counter pain medication.
Sutures, if non-dissolvable, are typically removed within five to seven days after the operation during a follow-up appointment. Most patients return to work or light activities within one week to ten days. Major bruising and swelling subside over the next two to four weeks, but residual swelling can take several months to fully resolve. Strenuous exercise should be avoided for at least two to four weeks to prevent complications.