Face

Blepharoplasty

Blepharoplasty is performed on patients who have upper or lower eyelids which are sagging, wrinkled, bulging, or interfering with vision. These are common changes which occur with age.

Some patients develop weakness of the levator muscle attachment to the upper lid, which results in inability to fully open the eyelid (eyelid ptosis). This condition can also be corrected surgically.

Dr. Casso often performs upper lid blepharoplasty surgery in his office under local anesthesia and light oral sedation. Dr. Casso may also perform ptosis correction in the office under local anesthesia. Because of the importance of keeping patients comfortable, lower lid blepharoplasty is performed in the operating room at Houston Methodist St. John Hospital under general anesthesia.

Upper lid surgery typically involves removing excess fat and skin. An incision is made within the natural crease in the upper lids. The excess fat and skin are removed. The wounds are carefully repaired, leaving scars which often nearly disappear over time.

For patients desiring lower lid surgery, incisions used depend on the problem being addressed. Relatively young patients who have good skin tone, but have bulging of fat may undergo surgery through an incision within the inner lining of the lower lid (transconjunctival approach). In this procedure, fat is removed from inside the lower lid, avoiding external scars. Sometimes, Dr. Casso moves some of this fat into the hollow below the eyelid (tear trough deformity), to improve the contour of the lid.

For patients who have skin laxity alone in the lower eyelids, tightening is accomplished through an incision just below the lower eyelashes (sub-ciliary). Excess skin is removed, and the wound carefully closed. Often, stabilization of the lower lid is accomplished with a suture which secures the outer corner of the eyelid to the orbital bone (lateral canthopexy), thus preventing undesirable distortion of the lower lid (lower lid malposition).

Patients who have both skin laxity and fat bulges are treated with both a conjunctival incision (inside the eyelid) and a subciliary (below the eyelashes) incision.

Eyelid ptosis, if present, may be corrected with sutures placed in the upper lids which reattach the levator muscle to the upper lid tarsal plate.

After surgery, patients are advised to keep the head of the bed elevated, and avoid any bending, stooping straining or exertion. Ice packs help to keep bruising and swelling to a minimum. Arnica tablets may help to minimize bruising.

Pain is generally minimal, and often well controlled with Tylenol or Ibuprofen.

Patients may shower the day after surgery and apply antibiotic ointment on the suture lines daily.

The sutures are removed within three to five days. Bruising will last about two weeks, while swelling will disappear over several weeks. When extensive lower lid surgery is performed, recovery may take a bit longer.

Eye makeup is permitted shortly after removing the sutures, and contacts may be worn when comfortable, usually between seven and 10 days. Patients may return to light activities within a week or two. More vigorous exercise is permitted in about a month.

Some temporary visual changes are common within the healing period, but vision quickly returns to normal in most all patients.

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