Blepharoplasty

File:Blepharoplasty_svg_hariadhi.svgThe thorough pre-operative medical and surgical histories, and the physical examination of the patient's periorbital area (eyebrow-to-cheek-to-nose), determine if the patient can safely undergo a blepharoplasty procedure to feasibly resolve (correct or modify, or both) the functional and aesthetic indications presented by the patient. Sequentially, lower eyelid blepharoplasty can successfully address the anatomic matters of excess eyelid skin, slackness of the eye-muscles and of the orbital septum (palpebral ligament), excess orbital fat, malposition of the lower eyelid, and prominence of the nasojugal groove, where the orbit (eye socket) meets the slope of the nose.{{Citation |last1=Rostami |first1=Soheila |title=Lower Eyelid Blepharoplasty |date=2022 |url=http://www.ncbi.nlm.nih.gov/books/NBK448181/ |work=StatPearls |place=Treasure Island (FL) |publisher=StatPearls Publishing |pmid=28846282 |access-date=2022-08-12 |last2=de la Torre |first2=Jorge I. |last3=Czyz |first3=Craig N.}}

Concerning the upper eyelid, a blepharoplasty procedure can resolve the loss of peripheral vision, caused by the slackness of the upper-eyelid skin draping over the eyelashes; the outer and the upper portions of the field of vision of the patient are affected and cause him or her difficulty in performing mundane activities such as driving an automobile and reading a book.

{{Main|East Asian blepharoplasty}}

In many East Asian countries, double-eyelid surgery is the most popular surgery, especially in South Korea. Depending on the methods, directing doctors' experience and the difficulty of the individual case, this surgery can cost between about US$2,000 to $4,000. The procedure is famous for producing double-eyelid for patients for the long term.{{cn|date=October 2023}} This kind of operation normally takes about thirty minutes to an hour, and patients are not required to stay hospitalized afterward. Stitches are removed five to seven days after surgery. Many foreigners go to South Korea each year for blepharoplasty.{{cite journal|last1=Holliday |first1=R. |last2=Bell |first2=D. |last3=Cheung |first3=O. |last4=Cho |first4=J.|date=August 2017|title=Trading Faces: The 'Korean Look' and Medical Nationalism in South Korean Cosmetic Surgery Tourism|journal=Asia Pacific Viewpoint|volume=58|issue=2|pages=190–202|doi=10.1111/apv.12154|url=http://eprints.whiterose.ac.uk/109548/1/Trading%20Faces%20FINAL%20DBell.pdf}}

File:Kami Parsa MD Cosmetic LowerEyelid Blepharoplasty.jpg

A blepharoplasty procedure usually is performed through external surgical incisions made along the natural skin lines (creases) of the upper and the lower eyelids, which then hide the surgical scars from view, especially when affected by the skin creases below the eyelashes of the lower eyelid. The incisions can also be made from the conjunctiva, the interior surface of the lower eyelid, as in the case of a transconjunctival blepharoplasty.{{Cite web|url=https://www.drberan.com/procedures/face/eyelid-surgery/|title=Eyelid Surgery NYC {{!}} Westchester NY Eyelid Surgery|website=www.drberan.com|date=11 March 2013 |language=en-US|access-date=2018-09-06}}

Transconjunctival lower blepharoplasty technique was pioneered by Clinical Professor of Surgery at the University of Chicago Medicine,{{cite web | title = Anthony J. Geroulis | publisher = University of Chicago Medicine | work = University of Chicago Medicine Physician Bios | date = 1998 | url = http://www.uchospitals.edu/physicians/anthony-geroulis.html }} Dr. Anthony J. Geroulis{{cite web | last = Geroulis | first = Anthony J. | name-list-style = vanc | title = Eyelid Surgery Chicago Transconjunctival Techniques | date = 1998 | url = https://cocoona.ae/en/departments/facial-plastic-surgery/eye-lift-blepharoplasty/ | access-date = 28 May 2015 | archive-url = https://web.archive.org/web/20150528094709/http://www.geroulis.com/cosmetic-procedures/facial-rejuvenation-plastic-surgery/lower-eyelid-surgery-eye-lift-blepharoplasty-chicago | archive-date = 28 May 2015 | url-status = dead }} and introduced to medical trial in 1998. Transconjunctival Technique has become the norm in the plastic surgery field with most surgeons preferring it over the external surgical incisions. This technique is particularly useful for patients with darker skin tones where standard external incision often leaves a visible white scar.

Transconjunctival blepharoplasty technique permits the excision (cutting and removal) of the lower-eyelid adipose tissue without leaving a visible scar, but the technique does not allow the removal of excess eyelid-skin.{{cite journal | first1 = Scott J | last1 = Rapp | first2 = Brian S | last2 = Pan | first3 = W John | last3 = Kitzmiller | name-list-style = vanc | title = Lower Lid Subciliary Blepharoplasty | date = 2006 | url = http://www.emedicine.com/plastic/topic4.htm | journal = Medscape }}File:Blepharoplasty 04.jpg

A blepharoplasty operation usually requires 1–3 hours to complete. Post-operatively, swelling and bruising is expected and will usually resolve without further intervention; application of cold compresses can help to reduce the duration and discomfort.{{Cite journal |last=Alghoul |first=Mohammed |date=2019-01-01 |title=Blepharoplasty: Anatomy, Planning, Techniques, and Safety |journal=Aesthetic Surgery Journal |volume=39 |issue=1 |pages=10–28 |doi=10.1093/asj/sjy034 |issn=1527-330X |pmid=29474509|doi-access=free }} There are no standardized outcome measures for upper or lower blepharoplasty. Blepharoplasty is generally a relatively safe surgery, but possible complications include hematoma/ecchymosis, lagophthalmos (incomplete or abnormal closure of the eyelids), ptosis (drooping of the upper eyelid), scarring, dry eyes, orbital hematoma/compartment syndrome, lymphedema, and ocular motility disorders.{{Cite journal |last1=Bhattacharjee |first1=Kasturi |last2=Misra |first2=Diva Kant |last3=Deori |first3=Nilutparna |date=July 2017 |title=Updates on upper eyelid blepharoplasty |journal=Indian Journal of Ophthalmology |volume=65 |issue=7 |pages=551–558 |doi=10.4103/ijo.IJO_540_17 |issn=1998-3689 |pmc=5549405 |pmid=28724810 |doi-access=free }}

After the procedure, a type of stitch known as a canthopexy is placed near the outer corner of the lower eyelid, which is inside the tissue. This allows the eyelid's position to remain fixed during the healing process. The canthopexy is dissolved after four to six weeks of use. For particular patients, a mid-face elevation may be required to rejuvenate the lower eyelid-cheek complex.

• Lower Blepharoplasty 3X Vector Suspension technique lifts and tightens the lower eyelid and mid face using sutures, ensuring a natural look. {{Cite web |last=Dubey |first=Punit |date=2024-03-16 |title=Blepharoplasty In Delhi |url=https://thefacialplasticsurgery.com/fa/eyes/blepharoplasty-in-delhi/ |access-date=2025-02-19 |website=Facial Plastic Surgery |language=en}}

File:Skin and fat from blepharoplasty.jpg

The anatomic condition of the eyelids, the "wear-and-tear" quality of the patient's skin, age, and the general condition of the adjacent tissues affect the functional and aesthetic results achieved. Additional to the anatomic conditions of the eye region of the patient, the possible occurrence of medical complications is determined by factors including:{{medcn|date=December 2013}}

• Dry-eye syndrome – which can become exacerbated by the disruption of the natural, lacrimal (tear) film of the eyes
• Palpebral skin laxity – looseness of the lower eyelid margin, which predisposes the lower eyelid to malposition
• Eyeball prominence – the protrusion of the eyeball in relation to the malar (cheek) complex, which predisposes the lower eyelid to malposition

File:Removal of fat from lower eyelid during blepharoplasty 1.jpg|Fat is removed from the lower eyelid by means of an incision to the inner surface of the eyelid. A surgical suture retains the inner tissue of the eyelid over the eyeball.

File:Removal of fat from lower eyelid during blepharoplasty 2.jpg|The fat is held with forceps (left), and clamped with a hemostat (right), while a small medical retractor keeps away the extra tissue, so that the surgeon can operate (bottom right).

File:Removal of fat from lower eyelid during blepharoplasty 3.jpg|The fat is excised (cut away) with surgical scissors.

As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Celsus, a first-century Roman, described making an excision in the skin to relax the eyelids in his book De Medicina.{{cite journal | vauthors = Lazzeri D, Agostini T, Figus M, Nardi M, Spinelli G, Pantaloni M, Lazzeri S | title = The contribution of Aulus Cornelius Celsus (25 B.C.-50 A.D.) to eyelid surgery | journal = Orbit (Amsterdam, Netherlands) | volume = 31 | issue = 3 | pages = 162–7 | date = June 2012 | pmid = 22551367 | doi = 10.3109/01676830.2011.648816 | s2cid = 20670884 }}

Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.{{cite journal | vauthors = Bhattacharjee K, Misra DK, Deori N | title = Updates on upper eyelid blepharoplasty | journal = Indian Journal of Ophthalmology | volume = 65 | issue = 7 | pages = 551–558 | date = July 2017 | pmid = 28724810 | pmc = 5549405 | doi = 10.4103/ijo.IJO_540_17 | doi-access = free }}{{cite book |last=Von Graefe |first=Karl Ferdinand|author-link= |date=1818 |title=De Rhinoplastice |url= |location=Berlin |publisher=Dietrich Reimer |page=13 |isbn=}}

Laser blepharoplasty is the performance of eyelid surgery using a laser instead of a scalpel. Laser blepharoplasty is often combined with laser eyelid rejuvenation, as the two procedures can be performed in conjunction.

A CO₂ laser blepharoplasty offers many benefits over a blepharoplasty performed using a scalpel. Some of these benefits include less bleeding, shortened surgical time, better intraoperative visibility, less bruising and swelling, less pain or discomfort, and smoother healing.{{Cite journal |last1=Morrow |first1=D. M. |last2=Morrow |first2=L. B. |date=April 1992 |title=CO2 laser blepharoplasty. A comparison with cold-steel surgery |url=https://pubmed.ncbi.nlm.nih.gov/1560155/ |journal=The Journal of Dermatologic Surgery and Oncology |volume=18 |issue=4 |pages=307–313 |doi=10.1111/j.1524-4725.1992.tb03676.x |issn=0148-0812 |pmid=1560155}}

Historically there has been some contention as to the categorization of laser treatment on upper or lower eyelids as blepharoplasty, which is itself by definition surgical. The statutory definition of surgery and that supported by the American College of Surgeons states that surgery is the "treatment ... by any instrument causing localized alteration or transportation of live human tissue, which include lasers...".{{cite journal | vauthors = Grill C | title = State of the states: defining surgery | journal = Bulletin of the American College of Surgeons | volume = 97 | issue = 5 | pages = 27–9 | date = May 2012 | pmid = 22590793 | url = https://www.facs.org/~/media/files/publications/bulletin/2012/2012%20may.ashx }}

While blepharoplasty provides a permanent solution for double eyelid creation, some individuals seek non-surgical alternatives that do not require invasive procedures.

Eyelid tapes and adhesives, such as D-UP Wonder Eyelid Tape, AB Mezical Fiber, and Optifold, offer a temporary or semi-permanent method for double eyelid formation. Unlike surgical intervention, these methods rely on skin adhesion or mechanical reinforcement to shape the eyelid fold.

The efficacy of these tapes varies based on eyelid thickness, skin elasticity, and consistent use. Some brands claim to provide long-term crease formation by training the skin to fold naturally over time, but scientific validation on permanent results is still limited.

{{Commons category|Blepharoplasty}}

• Eye surgery
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