Blepharoplasty (Eye Lifts) by Dr. Haworth

Terminology Notes

BLEPHAROPLASTY the collective term for eye rejuvenation procedures which include: 1. Upper Blepharoplasty to remove excess skin or ptosis (drooping) on the upper eyelid due to aging or genetics. The incision follows the crease of the eyelid where, once healed, the scar becomes practically invisible. About 20% of patients also need to have some fat taken away as well, while another 15% need fat added. The reason for this latter maneuver is to restore a youthful fullness to an otherwise hollow upper eyelid socket. 2. Traditional lower blepharoplasty (lower outside) to remove excess skin and, where necessary, pockets of fat under the eyes due to aging. The incision follows the lower lash line where it heals invisibly. There is also an incision behind the lower eyelid through which the surgeon can remove any excess fat. About 30 % of patients will need to get the fat “bags” reduced. Fat can be carefully transferred to the “hollows” below the eye to produce a smooth transition from the lower eyelid onto the upper cheek. 3. Lower lid pinch blepharoplasty simply to remove the excess skin without removing any fat. The incision follows the lower lash line where it heals invisibly. Only one stitch is required and healing is very quick. 4. Transconjunctival blepharoplasty (lower inside), usually done on younger patients with thicker more elastic skin who have congenital puffy under eye bags, to take away the under eye fat pocket without removing any skin.

NEW TECHNIQUES VS. OLD THINKING

Blepharoplasties have become significantly more sophisticated than in generations past, resulting in a far more subtle, natural outcome than ever before. These breakthroughs include:

• HOLLOW NO MORE: Though the finished outcome was clean and smooth, older blepharoplasties often resulted in sunken, skeletal look because too much fat was removed along with the excess skin. Today, we’re far more aware that it is plumpness and volume that impart a look of youth and refreshment. In fact, sometimes fat needs to be added, particularly in the tear trough.
• CONSIDER THE BROW LIFT: A large number of patients with sagging over the eyes think they need an upper blepharoplasty when in fact what’s required is a brow lift instead. Today, we’re much more accurate in our assessment of facial structure – particularly when setting and controlling the shape of the brow – and how best to improve it. Dr Haworth’s technique of endoscopic browlifts is designed to avoid the “surprised” look and instead, create a brow that is elevated in a glamorous lateral arc.
• INTACT MUSCLE: Older blepharoplasties often removed muscle tissue under the lower eyelash line which resulted in unnatural, deadened expression. Today the muscle is usually left alone, using a subtle lid pinch technique to tighten lower eyelid skin that looks totally youthful and natural.
• SINGLE STITCH CLOSURE: Dr. Haworth’s capabilities with fine, precision work has lead to his signature blepharoplasty suture technique of closing incisions with a single, invisible stitch which he will remove 5 days after surgery.

Operation and Recovery Logistics

SURGERY DURATION: One to 2 hours, depending on the procedure. ANESTHESIA: Local or sedated, depending on the patient and what other procedures you are having done at the same time. Either way, you will be comfortable and will not feel any pain. SUTURES REMOVED: Depending on the procedure, from 5-7 days. As you wake up from surgery, your eyelids may feel slightly sore and tight as the anesthesia wears away, but most feel none of this. However, lubricating ointment and prescription painkillers will easily control the discomfort.

RECOVERY

You may don eyeglasses or sunglasses immediately after surgery. Gradually, you will be able to resume to your normal activities:

• 2-3 days – Read or watch television
• 5-7 days – Resume wearing makeup
• 7 days – Be out in public, back to work, may resume wearing contact lenses
• 2 weeks – Resume strenuous exercise

During healing, you may experience:

• Bruising that looks like a black eye usually reaches its peak during the first week, and generally takes about 7 to 14 days to completely fade away
• Dryness, itching or burning. We can prescribe eye drops to ease all of these
• Excessive tearing
• Temporary changes in your eyesight, such as blurring or double vision
• Sensitivity to sunlight, wind, and other irritants. We advise all our patients to wear sunglasses with UV protective lenses to help with this

Risks and Challenges

No surgery is entirely risk-free. However, both our staff and facilities have the highest possible qualifications to produce a happy outcome. While risks and complications are extremely rare, be aware that those for a blepharoplasty can include:

• Eyelid retraction resulting in a drooping lower eyelid
• Dry eye
• Minor visible scarring at the corners, especially in Asian patients or those with a natural almond eye shape

Conditions that make blepharoplasty more of a challenge and may require additional information from the appropriate medical specialist include:

• Thyroid disorder such as hypothyroidism and Graves’ disease. The good news is that we have had successful results correcting the bulging eyes that occasionally occur here
• Dry eyes unable to produce tears
• Cardiovascular and circulatory disorders
• Blood pressure that is too high or too low
• Diabetes
• Detached retina or glaucoma