Blepharoplasty is a surgery that repairs droopy eyelids and may involve removing excess skin, muscle and fat. As you age, your eyelids stretch, and the muscles supporting them weaken.
Upper blepharoplasty surgery uses incisions to allow for removal of skin and fat. A thin stitch is then used to bring the skin together to allow for a creation of an eyelid crease.
Lower eyelid surgery can involve skin incisions directly below the lash line or an incision on the inside of the eyelid.
Why is eyelid surgery performed?
Excess skin and fat can create a heavy looking eyelid, aged appearance, puffiness, and sometimes block the upper field of vision. Upper blepharoplasty can improve the field of vision.
How much does eyelid surgery cost? Does insurance cover the cost of blepharoplasty?
Insurance carriers will only cover the cost of upper eyelid surgery if the patient has obstruction of their visual field. This must be documented with formal visual field testing and photographs. Some insurance carriers require submission of the visual fields and photographs before approving the blepharoplasty as a medically indicated procedure.
Entropion is a condition in which your eyelid turns inward so that your eyelashes and skin rub against the eye surface. This causes irritation and discomfort. Your eyelid may be turned in all the time or only when you blink or look down. Entropion is more common in older adults, and it generally affects only the lower eyelid.
Artificial tears and lubricating ointments can help relieve symptoms of entropion. But usually surgery is needed to fully correct the condition.
The signs and symptoms of entropion result from the friction of your eyelashes and outer eyelid against the surface of your eye. You may experience:
The feeling that something is in your eye
Eye irritation or pain
Sensitivity to light and wind
Mucous discharge and eyelid crusting
Entropion can be caused by:
Muscle weakness. As you age, the muscles under your eyes tend to weaken, and the tendons stretch out. This is the most common cause of entropion.
Previous trauma or burns
Age. The older you are, the greater your chances of developing the condition
Quickert Sutures- performed in the office. Sutures are placed in the lower lid to create a scar and redirect the lid into its normal position.
Incisional Surgery-Performed in an outpatient surgery center. The lid is cut and the muscles are shortened to make them stronger and redirect the lid into its normal position.
Ectropion is a condition in which your eyelid turns outward. This leaves the inner eyelid surface exposed and prone to irritation.
Ectropion is more common in older adults, and it generally affects only the lower eyelid. In severe ectropion, the entire length of the eyelid is turned out. In less severe ectropion, only one segment of the eyelid sags away from the eye.
Artificial tears and lubricating ointments can help relieve symptoms of ectropion. But usually surgery is needed to fully correct the condition.
Normally when you blink, your eyelids distribute tears evenly across your eyes.
If you have ectropion, your lower lid pulls away from your eye and tears don't drain properly into the puncta. The resulting signs and symptoms can include:
Watery eyes (excessive tearing). Without proper drainage, your tears may pool and constantly flow over your eyelids.
Excessive dryness. Ectropion can cause your eyes to feel dry, gritty and sandy.
Irritation. Stagnant tears or dryness can irritate your eyes, causing a burning sensation and redness in your eyelids and the whites of your eyes.
Sensitivity to light. Stagnant tears or dry eyes can irritate the surface of the cornea, making you sensitive to light.
Ectropion can be caused by:
Muscle weakness. As you age, the muscles under your eyes tend to weaken, and tendons stretch out.
Facial paralysis. Bell's palsy, and certain types of tumors can paralyze facial nerves and muscles.
Scars or previous surgeries. Skin that has been damaged by burns or trauma. Previous eyelid surgery.
Eyelid growths. Benign or cancerous growths on your eyelid.
Ointments and Artificial tears provide some temporary relief, as well as taping of the lid.
Surgical Repair is done in an outpatient surgical center to correct the ectropion.
Ptosis is when the upper eyelid droops over the eye.Ptosis can limit or even completely block normal upper field of vision.
Children and adults can have ptosis. Fortunately, this condition can be treated to improve vision as well as appearance.
Adults get ptosis when the levator muscle stretches or separates away from their eyelid. This can be caused by aging or injury. Sometimes ptosis happens as a side effect after certain eye surgery. Rarely, diseases or tumors can affect the eyelid muscle, causing ptosis.
The cause must be found before treatment is recommended.
There is a new prescription eye drop for some adults with acquired ptosis. The medication Upneeq activates the muscle that raises the eyelid. It needs to be used daily to keep working.
Ptosis surgery is done in an out- patient surgical center. A local anesthesia will be used to numb your eye and lid skin.
The muscle is repositioned on the lid to raise it to a higher position.
Before eyelid surgery blood thinners will be stopped and recovery is about a week.
Dermatochalasis refers to redundancy of eyelid skin and is often associated with orbital fat protrusion or prolapse. Significant dermatochalasis of the upper lids leads to complaints of a heavy feeling around the eyes, brow ache, eyelashes in the visual axis, and, eventually, reduction in the superior visual field
Indications for upper eyelid blepharoplasty
Indications for upper eyelid blepharoplasty include redundant and lax skin and fat herniation that result in either functional visual symptoms. Dermatitis of the redundant skin can also be an indication for surgery.
Inflammatory diseases affecting the eyelids
Chronic lid swelling/edema associated with systemic disease or allergy
Patients often report drooping, sagging, tired appearing eyelids that interfere with various activities of daily living. In severe cases, patients may have to manually lift the skin upward to improve their visual field. A complete medical and ophthalmic history should be obtained that includes:
Impact of upper eyelid changes on activities of daily living
Previous ocular conditions and surgeries
Systemic disease which will influence the outcome of the surgery such as rheumatologic conditions, collagen vascular diseases and diabetes
Prior cosmetic procedures
Dry eye symptoms and treatments
Complete list of medications including blood thinners and herbal supplements
Quality, quantity and relative symmetry of redundant skin
Eyelid crease height and symmetry
Fat pad herniation
Evaluation for presence of concurrent ptosis
Assessment of brow position
Ocular vital signs Visual acuity, pupillary examination, extraocular motility, intraocular pressure, corneal exam, and tear evaluation.
Visual field testing with the eyelids untaped and taped can be used to quantify the degrees of visual field obstruction present in patients with severe dermatochalasis and preaponeurotic fat herniation.