Blepharochalasis : Eye Surgery in NYC
Changes in the appearance of the upper and lower eyelid are one of the most common reasons that patients schedule a consultation with a plastic surgeon. For the upper eyelid, the most common complaint is over hanging skin or a bulge on the inner aspect of the eyelid- just adjacent to the nose. Patients will often say that family, friends and colleagues tell them they look tired or sleepy. The excess of skin can get so bad that it actually interferes with a patient’s vision, but most patients seeking correction of this excess of skin will usually do so before that time. This excess of skin which plastic surgeons term blepharochalasis should not be confused with actual drooping of the eyelid or ptosis.
With blepharochalasis the eyelid is in its normal position and the skin alone is hanging down and covering the normal eyelid. With eyelid ptosis the eyelid itself has fallen out of its normal position. This is often due to alterations in function of the muscles of the eyelid which help open the eye. Patients may have either or both blepharochalasis and ptosis. In addition, the findings may not be exactly the same in both eyes. It is very important that the proper diagnosis be made as the treatment is different. Also, sudden onset of eyelid ptosis can be indicative of other medical problems and needs to be evaluated.
Treatment of both of these entities requires a respect and understanding for the underlying anatomy of both the upper and lower eyelids. It is commonly believed by many patients that the term eyelid only refers to the upper eyelid. In reality, both of the thin, intricate, multilayered structures of skin, muscle, cartilage and fat that close to protect and help lubricate your eye are your eyelids. Cosmetic correction of the upper eyelid, is known as an upper lid blepharoplasty. Although this procedure is commonly performed at the same time as other procedures such as lower lid blepharoplasties, face lifts, etc., it is frequently performed as an isolated procedure. One of the reasons is that as an isolated procedure the upper eyelids can be corrected under a local anesthesia in less than ½ hour. The recovery is relatively easy and there is minimal interference in daily activities.
As easy as this sounds, surgically an upper eyelid blepharoplasty involves more than simple removal of excess skin and any bulging fat. Proper planning is required to make sure that the final position of the sutured incision is hidden in the fold of the lid. The skin is the most superficial structure of the upper eyelid and correction should not need to involve the underlying muscles. The first step in the surgical procedure is the removal of an ellipse of skin. Clearly, the removal of an excess of skin may result in an inability to close the eyes properly. Too little skin removal will leave that patient with an unsatisfactory cosmetic result.
Often patients also have a bulge at the medial end (adjacent to the nose) of the eyelid. This is fat which is located beneath the muscle (orbicularis oculi). This fat is easily trimmed during an upper lid blepharoplasty. After the surgical incision is made, the surgeon will gently create a small opening parallel to the fibers of the orbicularis muscle. This is made directly over the fat and can be done so without damaging the muscle. Once the fat is revealed, the excess is removed, the remaining fat allowed to fall back into its normal location and the opening in the muscle closes as it was before. Closure of the surgical incision in the skin is usually accomplished in one of two fashions. In our practice we close the eyelid skin with a type of suture known as a continuous, running subcuticular. This means that except for the two ends of the suture that are visible on either side of the incision, the suture is totally hidden beneath the skin. Some surgeons will close the upper eyelid incision with many small interrupted sutures.
We prefer the subcuticular stitch as it is easier to remove, has a much lower risk of causing small suture related cysts or marks, and is cosmetically preferable. Sutures are removed 4 to 5 days following the procedure. The post-operative care is simple: head elevation when sleeping, occasional ice packs during the first 48 hours, and the application of an ophthalmic ointment 3 times a day. Patients must take care to prevent the sun from direct sun exposure for 3 months. This can be as simple as sun glasses and a brimmed hat when outside. Makeup may be placed 24 hours after the stitches are removed and normal daily activities resumed fairly quickly.
Throughout his extensive career, board-certified plastic surgeon Dr. Kenneth Rothaus, MD has mastered many treatments utilizing modern surgical techniques to help his patients with excessive skin removal around the eyes. Dr. Rothaus has unmatched experience to ease his patients during the surgical process and recovery time. To schedule a consultation, please contact our Manhattan or Westchester face & body cosmetic surgery locations.