Blepharoplasty Surgery in Sydney

Indications

• Excess Skin: Excess skin that affects the natural contour of the upper eyelid or creates folds.
• Fat swellings: Fat deposits that create fullness in either the upper or lower eyelids.
• Impaired Vision: Overhanging skin that obstructs peripheral vision.
• Wrinkles and Fine Lines: Excess skin and fine wrinkles on the lower eyelids.
• Functional and Aesthetic Improvement: Desire to change the appearance and function of the eyelids.

Preoperative Assessment

1. Consultation:
   • Detailed discussion of the patient’s goals and expectations.
   • Comprehensive medical history review, including any previous eye surgeries, medical conditions, medications, and allergies.
   • Physical examination of the eyes and eyelids, assessing skin quality, muscle tone, and fat deposits.
   • Evaluation of tear production and eye health to rule out conditions like dry eye.
2. Photography:
   • Preoperative photographs are taken for surgical planning and comparison of postoperative results.
3. Discussion of Risks and Benefits:
   • Explanation of potential risks, benefits, and realistic outcomes of the surgery.
   • Review of the patient’s medical history and discussion of any specific concerns

Surgical Procedure

Upper eyelid blepharoplasty

In the upper eyelids this excess tissue can cause hooding over the eyelids which can eventually interfere with vision. In some instances it is actually the eyebrow or forehead skin which is drooping down into the eyes. In that situation a browlift / forehead lift would be necessary to reposition this.

1. Marking the Incision:
   • The surgeon marks the natural crease of the upper eyelid to determine the incision line. This ensures that the scar will be hidden within the natural fold of the eyelid. Dr Roth uses a calliper and fine tipped marking pen.
2. Making the Incision:
   • An incision is made along the marked lines in the natural crease of the upper eyelid, extending slightly beyond the outer corner if needed to address any lateral hooding.
   • This approach minimises visible scarring.
3. Removal of Excess Tissue:
   • Skin: Excess skin is excised being careful to allow comfortable eye closure.
   • Muscle: A strip of the underlying orbicularis oculi muscle may be removed to enhance the eyelid contour.
   • Fat: Protruding fat pockets, often found in the inner part of the upper eyelid, may be removed or repositioned.
4. Repositioning:
   • In some cases, fat may be repositioned rather than removed to avoid a hollowed appearance and to re-distribute volume.
5. Closure:
   • The incision is closed with fine sutures, usually 6-0 or 7-0 nylon or absorbable sutures.

Lower eyelid blepharoplasty

In the lower eyelids there is often prolapse (prominence) of fat. This bulging accentuates the appearance of the bony rim of the eyelid and creates an unnatural shape. The eyelid muscle can also descend and elongate with age forming what is called a festoon. Some people unfortunately develop recurrent swelling of the lower eyelids from conditions such as allergic rhinitis. This condition generally persists despite surgery.

Lower eyelid blepharoplasty can be performed in a number of ways. Traditionally, a small incision was made under the eyelid and skin and muscle was removed externally. More recently the technique of transconjunctival lower eyelid blepharoplasty was developed. This involves making small hidden incisions just inside the eyelid to access the tissues. Dr Roth generally recommends the transconjunctival blepharoplasty technique with an external skin pinch removal for most patients.

1. Approaches:
   • Transconjunctival Approach: Incision is made on the inside of the lower eyelid (conjunctiva), leaving no visible external scar. Ideal for younger patients with good skin elasticity and primarily fat-related issues.
   • Transcutaneous Approach: Incision is made just below the lower lash line, extending slightly beyond the outer corner. Preferred when there is significant excess skin or muscle laxity.
2. Fat Removal or Repositioning:
   • Fat Removal: Excess fat that causes is carefully removed.
   • Fat Repositioning: Fat may be redistributed to fill hollow areas and create a smoother contour, reducing the appearance of tear troughs and hollow eyes.
3. Skin and Muscle Modification:
   • Excess Skin Removal: Loose or sagging skin is excised.
   • Muscle Tightening: Orbicularis oculi muscle may be tightened or repositioned to improve support and contour.
4. Re-draping and Closure:
   • Re-draping: Skin and tissues are gently re-draped appropriately.
   • Closure: Incisions are closed with fine sutures. For the transcutaneous approach, sutures are typically placed just below the lash line to minimize visible scarring.
5. Additional Techniques:
   • Laser Resurfacing or Chemical Peels: Sometimes used in conjunction to improve skin texture and reduce fine wrinkles.
   • Canthopexy or Canthoplasty: Procedures to tighten and support the outer corner of the eyelid if needed.

Postoperative Care

1. Immediate Postoperative Care:
   • The patient is monitored in the recovery area until the effects of anaesthesia wear off.
   • Cold compresses are applied to reduce swelling and bruising.
2. Instructions:
   • Detailed postoperative care instructions are provided, including how to clean the eyes, apply prescribed ointments, and manage pain with medications.
   • Avoiding strenuous activities, heavy lifting, and bending over for at least a week.
   • Keeping the head elevated to minimise swelling.
3. Follow-Up Visits:
   • Scheduled follow-up appointments to monitor healing, remove sutures (if non-absorbable sutures are used), and address any complications.
4. Recovery Timeline:
   • Initial swelling and bruising typically subside within 1-2 weeks.
   • Most patients can return to normal activities within 7-10 days, but should avoid strenuous activities and contact lenses for a few weeks.

Expected Results

1. Immediate Effects:
   • Initial results are visible once swelling and bruising diminish, usually within a few weeks.
2. Final Outcome:
   • Full results become more apparent after a few months as tissues settle and incision lines fade.

Potential Risks and Complications

1. Common Risks:
   • Swelling and bruising
   • Temporary discomfort and dry eyes
   • Itching or sensitivity to light
2. Rare Complications:
   • Infection
   • Bleeding
   • Scarring
   • Asymmetry
   • Changes in sensation
   • Ectropion (outward turning of the eyelid)
   • Difficulty closing the eyes (lagophthalmos)
3. Managing Complications:
   • Most complications can be managed with appropriate medical care and follow-up visits.
   • Severe complications are rare but may require additional surgical intervention.