Eyelid lift or repair

Alternative names
Blepharoplasty

Definition
Eyelid lift surgery, also called blepharoplasty, is done to repair sagging or drooping upper eyelids (ptosis).

Description
Sagging or drooping eyelids occur naturally with increasing age. However, some people are born with it or develop diseases (such as myasthenia gravis) that cause eyelid drooping. Most blepharoplasties are done to improve appearance, but some people have excessive eyelid drooping that actually interferes with vision. For these people blepharoplasty is required to improve eyesight.

Eyelid repair is usually optional (elective) cosmetic surgery. It is usually done while the patient is awake or sleepy (sedated) but under local anesthesia. The incisions are made in the natural creases or folds of the eyelids. Loose skin and extra fat tissue is removed. The eyelid muscles are tightened and the incision is stitched closed.

Eyelid repair surgery rarely requires hospitalization. The surgery is done in a surgeon’s office or as outpatient surgery in a hospital or surgical center.

Indications
Eyelid surgery is used to correct drooping upper lids that make the patient look older or tired or that interferes with vision. Eyelid repair (blepharoplasty) is sometimes done alone or with other facial surgery such as a browlift or facelift. Eyelid surgery will not remove wrinkles around the eyes, lift sagging eyebrows, or eliminate dark circles under the eyes.

Medical conditions that make blepharoplasty more risky are:

     
  • thyroid problems such as hypothyroidism and Graves’ disease  
  • dry eye or lack of sufficient tears  
  • high blood pressure or other circulatory disorders  
  • heart disease or disorders of the blood vessels  
  • diabetes  
  • retinal detachment  
  • glaucoma

Risks
The risks for any anesthesia are:

     
  • reactions to medications  
  • problems breathing

The risks for any surgery are:

     
  • bleeding  
  • infection

Additional risks of eyelid repair include:

     
  • double or blurred vision  
  • temporary swelling of the eyelids  
  • uneven healing or scarring  
  • tiny whiteheads (milia) after removal of the stitches  
  • difficulty closing the eyes while sleeping; rarely permanent  
  • slowness in healing

Expectations after surgery
Scars may remain slightly pink for 6 months or more after surgery. They will fade eventually to a thin, nearly invisible white line. The more alert and youthful look usually lasts for years. These results are permanent for many people.

Convalescence
The patient can usually leave the hospital the day of surgery. The eyes and eyelids will be covered with ointment and a bandage. They may feel tight and sore as the anesthesia wears off, though the discomfort is easily controlled with pain medication. The head should be kept elevated as much as possible for several days and cold packs applied to reduce swelling and bruising. Eyedrops may be recommended to reduce burning or itching of the eyes.

Patients should be able to see well after 2 to 3 days. Contact lenses should NOT be worn for at least 2 weeks and may feel uncomfortable for longer. Keep activities to a minimum for 3 to 5 days, and avoid strenuous activities that raise the blood pressure, including lifting, bending, and rigorous sports for about 3 weeks.

The stitches will be removed 2 to 7 days after surgery. The amount of bruising depends on the amount of surgery done and the person’s general health but usually reaches its peak during the first week and lasts from 2 to 4 weeks. The patient may notice increased tears, increased sensitivity to light and wind, and temporary vision changes (such as blurring or double vision) for the first few weeks.

Johns Hopkins patient information

Last revised: December 6, 2012
by Dave R. Roger, M.D.

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