Surgery in eyelids, technically known as blepharoplasty, is a surgical procedure aiming to eliminate excess skin from upper eyelids (upper blepharoplasty) and the fat pads from lower eyelids (lower blepharoplasty)
Intervention may be advised for eyelid aesthetic reasons or because, sometimes, excess skin in eyelids can push lashes on a vertical position and/or limit the field of vision.
By means of incisions performed in the crease of the eyelid, the excess skin is removed by pulling out a skin section and tightening part of the orbicular muscle located underneath. In case there is an excess of fat and the patient wants the problem to be fixed for aesthetic reasons, the fat can be removed.
The fat pads in lower eyelids may pose an aesthetic problem, but in no case will they cause health problems in the eye if they are not removed.
The removal of fat pads in eyelids can be performed through different ways:
– An intervention performed from an internal (transconjunctival) approach, consisting of the removal of the excess fat by means of an incision in the conjunctiva (inside the eyelid), in a way that no scars are left on the skin. They are usually performed this way those fat pads having small or medium size in patients with no excess skin added that we want to remove at the same time. Sometimes, this method is used for fat repositioning, rather than removal, in order to give a natural appearance to the lower eyelid.
– An intervention performed from an external approach, consisting of the performing of a small incision under the eyelids through which the fat pads are pulled out. The incision is closed by means of a stitch that also serves to tighten the skin. This surgery is recommended in patients with very large fat pads or having excess skin or lower eyelid laxity, as this allows us to remove and tighten skin at the same time.
Eyelid laxity comes with age, due to tendons holding the eyelid becoming increasingly lax, which makes the eyelids become loose as well. There are two techniques for these cases: the canthopexy and canthoplasty.
Skin wrinkles around the eyes do not disappear with blepharoplasty and they sometimes require additional treatments, such as botulinum toxin (for crow’s feet, wrinkles between eyebrows, or front wrinkles) or scrubs, depending on wrinkles type.
It is very important that an ophthalmologist specializing in oculoplastic surgery performs a preoperative assessment, as this will determine if the patient has any problem impeding surgery or the need to perform another procedure that does not damage the structure that eyelids aim to protect: the eye.