Eyelid Surgery

Lower Blepharoplasty: This procedure involves the removal of fat and skin, as well as possible tightening of muscles.

An incision can be made just below the lash line or on the inside of the eyelid, which is called transconjunctival Blepharoplasty.

While the incision directly below the lash line is nearly invisible after healing, the transconjunctival approach heals without a visible incision.

Lower eyelid surgery can be combined with laser resurfacing of the eyelid skin, which helps reduce lines and wrinkles that Blepharoplasty alone cannot.

Double eyelid surgery or “Asian blepharoplasty”: the purpose of this third type of eyelid surgery is to create a horizontal crease, technically known as a supratarsal epicanthal fold, in an upper eyelid that is naturally without one (monolid).

This is done by making a fine incision in the upper eyelid and suturing the tissue together. There is also a technique that does not require incisions, called non-incision double eyelid surgery.

Ideal candidates for Blepharoplasty should also be: At an age when the signs of aging have taken hold.

This means that most patients are middle-aged, but if drooping eyelids or bags under the eyes are common in your family, you might be a good candidate at a younger age.

In good physical and mental health. Blepharoplasty is a relatively minor procedure compared to other types of plastic surgery, but like any surgery, it carries some risks that can vary from patient to patient.

A good candidate carefully weighs these risks before making the final decision to undergo the procedure—a realistic assessment of the outcome.

Although Blepharoplasty can have a lasting impact on both appearance and function, it is important to understand that even the most long-lasting results may ultimately prove temporary due to the effects of aging and lifestyle.

Make sure you have realistic expectations and goals for the procedure beforehand.

There are some medical considerations that should be taken into account before you decide to have eyelid surgery.

Some of the medical conditions that may prevent a patient from being an ideal candidate for Blepharoplasty include:

• Glaucoma or dry eye, which can be worsened by the
• procedure
• Hyperthyroidism
• Cardiovascular disease
• Diabetes
• High blood pressure
• An existing disease
• Weaknesses in the anatomy of the eye socket. This can include a variety of issues but generally refers to the support structures around the eye being inadequate to facilitate surgery.

10 Eyelid Surgery Preparation tips

1. Plan to have a friend or loved one stay with you at the hotel after the surgery and stay for at least the first 24 hours. This person should be able to talk to a nurse and receive and understand some post-operative instructions. Taking these precautions in advance will help you feel in control, and it will help eliminate any lingering fears you may have before the procedure.
2. Go to your appointment without makeup or skincare products on your face.
3. Wear loose-fitting, comfortable clothing. It is highly recommended that you wear flat shoes, comfortable pants, and a button-down shirt.
4. You should not put anything over your head for at least a few days after surgery. Also, bring dark sunglasses to protect your sensitive eyes.
5. Do not wear contact lenses to your appointment. Bring your glasses instead. Contact lenses can irritate and dry out your eyes. Try to avoid direct sunlight for two weeks before your surgery. If you must be in the sun, be sure to wear sunscreen with SPF 30 or higher. SPF 50 is ideal. UV radiation weakens your skin.
6. Discontinue all medications before the day of surgery. After surgery, it may be a few days before you can return to your normal routine, so it’s a good idea to make sure you take all your medications ahead of time.
7. Make sure that all of your obligations are taken care of in advance. This may mean making arrangements in advance for the kids, taking care of chores, booking time off work, or simply making sure you have the appropriate supplies like food and toiletries.
8. These are all things you don’t want to worry about during your recovery. Purchase supplies ahead of time to help you during your recovery. These supplies should include:
   • Ice cubes or a cold pack
   • Gauze
   • Cotton swabs
   • Pillow
   • Thermometer
   • Over-the-counter laxative
   • Lubricating eye drops
9. The night before your surgery, do not eat or drink anything after midnight. If your procedure is done under local anesthesia, you do not need to fast.
10. Be sure to follow all pre-operative instructions given to you by your surgeon.

How eyelid surgery is performed

Blepharoplasty can be divided into three different procedures: Upper Eyelid, Lower Eyelid, and Double Eyelid. The surgery can be one or a combination of these.

Upper Blepharoplasty

Upper Blepharoplasty is performed to remove or reposition excess skin and fat from the upper eyelid. The procedure usually takes between 1 and 3 hours, depending on the details of your specific needs.

This surgery can be performed under either local or general anesthesia.

Upper eyelid surgery is usually performed in 8 steps:

1. Taking into account the contours and shape of your eyelid and the desired outcome, your surgeon will carefully plan the incisions before they are made.
2. Anesthesia is administered. With general anesthesia, you will be put to sleep; with local anesthesia, the area will be numbed.
3. Following the natural folds of the upper eyelid, incisions are made to camouflage any scar that may develop.
4. Excess skin is removed. The rest of the surgery can be performed through this incision.
5. A strip of the orbital septum is taken along the entire length of the eyelid. This allows your surgeon to access the fat pads that lie directly underneath.
6. The eyelid is reshaped by carefully removing (or, in some cases, adding) fat from various areas around the eye.
7. Any bleeding, especially from the orbicularis oculi muscle, is actively and aggressively controlled through a collaborative effort between your body’s natural responses and your surgeon.
8. The incisions are closed. Either dissolvable, absorbable sutures or traditional, non-absorbable sutures may be used. If the more traditional sutures are used in your procedure, you will need to have them removed approximately 3 to 7 days after surgery.

Upper eyelid surgery is often combined with other procedures. Fat or filler injections may be done to make sunken eyes or brow areas look fuller and more youthful. Patients who suffer from ptosis may also have a tightening of the muscle that controls the upper eyelid.

Laser tightening of the skin to treat some wrinkles can also be performed in combination with upper eyelid blepharoplasty.

Finally, many patients combine upper Blepharoplasty with lower Blepharoplasty, brow lift, canthoplasty (to shape the outer corners of the eyes), and other eye or facial procedures.

Lower Blepharoplasty

Lower Blepharoplasty is used to treat bags under the eyes, sagging skin, and droopy lower eyelids.

Surgeons have a few different approaches available, but generally, each technique involves removing or reshaping fat or repositioning the orbital septum while removing excess skin and tightening sagging muscles.

The two most common approaches for lower Blepharoplasty are the transcutaneous approach and the transconjunctival approach.

Transcutaneous approach

Transcutaneous means “through the skin” and describes the type of incision made in this technique. The incision is made just below the lash line on the lower eyelid, where it is virtually invisible once healed.

After this initial incision, the surgery proceeds similarly to upper Blepharoplasty, with fat being removed, added, and/or reshaped.

This approach works well for sagging skin or the orbicularis oculi muscle, which supports the lower eyelid from below.

Transconjunctival approach

In this approach, the first incision is made within the lower eyelid: transconjunctival means “through the conjunctiva.” This approach requires an understanding of the delicate structures near the eye.

Fat and muscle are also removed or added and reshaped through this incision.

This technique offers several advantages over the transcutaneous approach, including:

• No external incisional scar
• Better preservation of the shape of the orbicularis oculi muscle.
• Less trauma to the delicate network of fibrous supportive tissue within the eyelid

Double eyelid blepharoplasty

Double eyelid surgery or “Asian blepharoplasty” gives the upper eyelid a visible crease when the eye is open.

It is estimated that about 50% of Asians do not naturally have a double eyelid crease.

Not only is the double eyelid crease considered a desirable feature by some, but the procedure can also help the eyes look more open, fuller, and less tired.

The amount of skin and fat present, as well as the epicanthal fold and other structures, can vary from patient to patient, so one technique may not be appropriate for all cases.

The two most common approaches are incisional and non-incisional.

Incisional approach

If you have excess skin and fat that you want to remove from your upper eyelids, an incisional approach is used to create the crease.

The procedure is similar to an upper blepharoplasty: the surgeon draws the appropriate pattern and then makes an incision on the upper eyelid.

A small amount of skin and fat is then removed. This is done not only to shape the eyelid but also to allow the new crease to fold naturally without creating a hollow-looking area.

Non-incisional approach

Although technically still a surgical procedure, the non-incisional approach does not involve making incisions or removing tissue.

Instead, small openings are made in the skin where the new fold will be created. A stitch is then inserted through these openings to connect the skin of the upper eyelid to the underlying levator muscle.

The result is a natural-looking upper eyelid crease when the eyes are open. However, there is a higher risk of asymmetry and loss of results.

Regardless of the specifics of your particular procedure, Blepharoplasty is typically performed on an outpatient basis.

Swelling around the eye area may gradually worsen over the first few days, but it will slowly subside. Initial recovery usually takes about two weeks, but it can take up to 6 weeks for all swelling to disappear and for the final result to be visible.

Day 1

Once the procedure is complete, your eyelids will be supported with paper tape to ensure they heal properly and with the desired contours. Your eyes may also be covered with gauze for up to 3 days after the procedure.

You will need someone to drive you to your hotel after surgery. Your vision will be blurry, and your eyes may need to be covered for a while after the surgery.

This may be uncomfortable at first, but it is only temporary, and your full vision will return as your recovery progresses.

The blurring is caused by these factors:

• Swelling
• Dryness and the drops that are used to keep your eyes moist
• The ointment your surgeon will use to protect your eyes during surgery

Week 1

Eyelid surgery is often done with dissolving sutures, so you may not need to come back to have the sutures removed.

If you receive traditional sutures, you will need to come back after about three days to a week to have them removed.

If you experience excessive tearing or dryness after surgery, your surgeon may recommend eye drops to help you. Be sure to follow any instructions your surgeon has given you after surgery.

If you wish to use over-the-counter pain relievers, please discuss with your surgeon which ones are appropriate.

You must continue to stay away from non-steroidal anti-inflammatory drugs such as aspirin and ibuprofen as they increase the risk of bruising and bleeding.

Week 2

Most patients are able to return to work within ten days of their eyelid surgery. However, some tasks, such as reading, may still be difficult due to remaining vision loss.

You can begin light exercise after just a few days, but it is best to avoid anything strenuous for at least 4 to 6 weeks. You should avoid contact sports completely until your surgeon gives you the green light.

You should be able to go back to using eye makeup as long as it is sterile (as it can increase the risk of infection).

If you have black eyes or “washbear eyes” after your procedure, rest assured that they will fade over time. Many patients find that eye makeup helps to “camouflage” any bruising or discoloration of the eyes during the recovery period.

Eyeglasses can be used immediately after surgery, but you should wait at least two weeks before wearing contact lenses. Your eyes may be sensitive to light for a short period of time, so protect your vision with dark sunglasses.

Eyelid surgery scars

Thanks to the techniques used in today’s eyelid surgery, there should be virtually no visible scars once you have fully recovered. Initially, the scars can be quite noticeable, but they will fade over time.

Remember that all new scars go through a known series of stages: At the beginning of your recovery, your scars will appear red (sometimes very red) and slightly thickened. Sometimes this thickening can continue to increase for up to 4 weeks after surgery.

The scars may also appear shiny. Small white cysts called milia might appear on the inside of the incision. These are temporary and rarely need to be treated. After upper eyelid blepharoplasty, it is not uncommon to notice a small extra bump at either end of the scars. This usually fades over the course of a few months.

As with any other healing incision, you will notice improvements daily at first, then weekly for about a month, and then monthly for six months to a year. Eventually, you will not notice the scars at all.

Just as the outer scars take time to heal, the inner incision of a transconjunctival lower blepharoplasty also takes time to heal completely.

This incision goes through much more than the skin; in most cases, three or four layers of muscle, fat, septum, and tendons are cut. This can take longer than an upper eyelid scar, and your eyelids will feel stiff, “rubbery,” and tight until healing is nearly complete.

Ten tips for a speedy recovery

1. Try to keep your head elevated at all times during your recovery, whether you are awake or asleep. This simple measure will prevent your eyelids from swelling too much and help speed up your recovery. Always place 2-3 pillows under your head when you are in a lying position.

2. Wait at least 24 hours before showering for the first time after surgery. Be careful not to fully submerge your incisions in water until they have closed.

3. Limit reading and watching television for at least the first 48 hours after surgery, or avoid it longer if you can. It may be tempting to engage in any of these activities during recovery, but they can dry out your eyes and prolong the healing process.

4. Avoid sunbathing for 4-6 weeks or until your surgeon says it’s okay.

5. Wear dark sunglasses and/or SPF 30+ sunscreen when you go outside.

6. Stick to easy-to-digest foods, such as Jell-O, ginger ale, and soups, for the first 24 to 48 hours after surgery. These foods are easily absorbed by your body, allowing it to focus all of its energy on healing. If you don’t experience nausea, you can return to your normal diet.

7. Stay hydrated and stick to healthy, low-sodium foods. Your body needs all the right nutrients it can get for a faster recovery. Salty foods should be avoided as they can contribute to swelling.

8. Put a cold compress on your eyes for the first few days to reduce swelling and bruising. Try to apply the compress for 20 minutes every 2 hours for the first 48 hours of your recovery. Don’t leave the compress on too long – you don’t want to get frostbite! Pay special attention to how you touch your face during recovery.

9. For best results, try not to poke, stretch, scratch, or rub your eyes for four weeks. You can wash your face 24 hours after surgery, but be careful around your eyes and pat dry.

10. Avoid heavy physical exertion or heavy lifting for the first four weeks after surgery. Try not to bend down to lift heavy objects during this time, but if you must, keep your head elevated and bend at the knees.

Call your surgeon immediately if you notice the following:

• Fever of 101 or higher
• Redness that spreads away from the incision sites
• An unusual and painful swelling
• Active and excessive bleeding
• Pus oozing from the incisions
• Pain that does not go away even with medication
• Blurred vision or stabbing pain in the back of the eye
• Any swelling or protrusion of the eyeball or surrounding tissue

Because eyelid surgery is a relatively minor procedure, complications are extremely rare and usually temporary.

In addition to the normal risks of infection and adverse reaction to anesthesia, Blepharoplasty carries a few minor side effects, including:

• Dryness and a burning sensation immediately after the surgery.
• Minor bleeding Swelling at the corners of the eyelids
• Slight asymmetry during healing or scarring
• Temporary blurred or double vision
• Undercorrection of the eyelids
• Overcorrection, i.e., when too much tissue is removed Temporary excessive tearing of the eyes.
• Pronounced or firm scars
• Numbness in the eyelids

Blepharoplasty also carries an extremely low risk of several more serious complications, including:

• Inability to close the eyelids: This rare complication usually resolves itself after a few weeks, but during this time, you may need eye drops, humidifiers, and even tape to keep your eyes completely closed at night to ensure adequate lubrication. If this condition persists for more than about eight weeks, further intervention may be required to correct the problem.
• Scratched corneas that can affect vision.
• Bleeding behind the eyes. This unlikely complication must be treated immediately if it occurs. This type of bleeding causes severe pain in the eye sockets and can affect your vision. In the worst cases, it can lead to blindness, but this is extremely rare.

Maintaining your results

The final results of Blepharoplasty can take a few weeks to show, but typically the end result is quite long-lasting. It is not uncommon for upper eyelid blepharoplasty results to last 10-15 years, and lower eyelid blepharoplasty is rarely repeated. However, the natural effects of aging will affect your results.

In general, eyes appear healthier, younger, and more rested. Most patients are very pleased with the results and generally feel more confident.

Those who undergo eyelid surgery to correct a vision problem should notice an immediate improvement, as the skin obscuring their vision is simply gone.

Even though the end result of your eyelid surgery will last for years, age and other factors will continue to affect your skin.

The best way to ensure that your results last as long as possible is to live a healthy lifestyle. Proper nutrition, good hydration, and plenty of exercises will help keep your skin looking firm and youthful.

Rest is also a key factor in the longevity of your results, so make sure a good night’s rest is a regular and important part of your schedule.

Smoking, on the other hand, is very harmful; since cigarette smoke can contribute to skin sagging, it is best not to smoke after surgery. If you are a smoker, this may be a good time to quit.

Latest techniques and scientific studies

As the demand for blepharoplasty surgery has increased, so has its evolution and surgeons’ views on all elements of the procedure.

Blepharoplasty remains one of the most challenging surgical procedures, which is why surgeons are constantly thinking of new ways to approach and perform the procedure to achieve the best possible outcome for patients.

Lower eyelid surgery, in particular, requires expertise, as the procedure can sometimes lead to complications such as esthetic deformity or functional impairment.

A study published in Plastic and Reconstructive Surgery in June 2017 describes the addition of a sixth step to lower eyelid blepharoplasty to improve esthetic outcomes.

This sixth step would involve the addition of fractionated fat to targeted areas of the lower eyelid to better blend the transition between the eyelid and cheek for a more seamless result.

Recent innovations in lower eyelid blepharoplasty have also sought to address what is known as the “tear trough deformity.” The tear trough is a natural depression that runs from the inner corner of the eyelid along the infraorbital rim to the far corner of the eye.

However, when the tear trough is deformed, the skin is thinner, making the underlying muscles and fat more prominent and appearing darker or discolored.

A 2017 study also published in Plastic and Reconstructive Surgery reports that the technique for treating deep tear troughs under the lower eyelid can be improved by adding micro fat grafts to add volume.

In an initial study of 32 patients who received the treatment as an adjunct to lower eyelid blepharoplasty, very good results were achieved with no significant complications such as eyelid retraction or infection.

Frequently asked questions

Am I a good candidate for Blepharoplasty?

The best patient for Blepharoplasty is in good mental and physical condition, is a non-smoker, and has realistic expectations of their outcome. If you have excess skin or fullness in your eyelids or have noticeable bags or furrows under your eyes, you are most likely a good candidate.

However, there are some pre-existing medical conditions that can keep someone from being a good candidate, including Glaucoma, Hyperthyroidism High blood pressure.

Am I too young for Blepharoplasty?

Although most blepharoplasty patients are over the age of 35, there is no lower age limit. If you suffer from vision problems, do not have monolids, or have a family history of droopy eyelids, you may be a good candidate at a much younger age.

Can I combine Blepharoplasty with other procedures?

Yes. It is quite common for patients to opt for a facelift, mid-facelift, neck lift, brow lift, skin resurfacing, or facial liposuction at the same time. Having multiple procedures performed on the same day will likely increase your recovery time, but it also allows you to potentially achieve many goals with a single procedure.

How much does eyelid surgery cost?

The cost of eyelid surgery depends on a few factors, including:

• What you want to achieve
• Where you live
• Whether eyelid surgery is combined with other procedures

In general, prices can range from _____________THB..

Is Blepharoplasty covered by insurance?

Most likely, no. This is because Blepharoplasty is considered a cosmetic procedure, and cosmetic procedures are not typically covered by insurance. However, if your eyelid surgery is necessary for medical reasons, then it may be covered.

Are creams an effective alternative treatment for puffy eyes?

There are countless creams that claim to treat puffy eyes, but none of them can address the most common cause of bags under the eyes: fat pads that bulge and push through weakened muscles.

No matter how expensive or exclusive a cream claims to be, no topical ointment can treat the underlying structures of the eyelid. Creams can help make the skin appear smoother, but only Blepharoplasty can treat the source of the puffiness.