Types Of Surgery And Their Pros And Cons
Blepharoplasty or Eyelid surgery is a broad term that refers to any surgery on the eyelid. The success of surgery is entirely dependent on choosing the correct procedure that will address the patients concerns. There are many specific terms that describe surgery based on which eyelid is operated upon or the type of technique used. Often these terms are used incorrectly. Eyelid surgery is marketed extensively in print, digital and social media using these terms so it is natural that patients pick up these terms and use them too. In this Blog, I will describe some of the common terms used.
Upper Eyelid or Upper Blepharoplasty
Surgery performed on the upper eyelid to get rid of excess skin, correct a droopy eyelid or a combination of both.
Skin Only Upper Blepharoplasty
Is an operation where the excess skin on the upper eyelid is surgically removed. If the excess eyelid skin is resting on the eyelashes it qualifies as a medical condition and hence attracts Medicare benefits. It is a simple and effective operation usually done as a day case. Not everyone is suited for this operation. In fact, one of the commonest causes of post operative droopy eyelids is performing a skin only blepharoplasty in a patient who needs a ptosis correction as well. If you remove excess skin when there is a coexisting droopy eyelid, the droopy eyelid will become more noticeable. It is suitable for patients under 40.
Upper Eyelid Ptosis Correction
This is an operation to correct droopy eyelids either one or both droopy eyelids can be done at the same time. This operation is effective and results are usually permanent. Typically eyelid ptosis is related to ageing changes and hence seen in patients over the age of 50. In some mild cases it may be very subtle and not obvious. If you are very young you may not need an upper eyelid blepharoplasty combined with your eyelid ptosis repair as the skin, muscle and fat of the eyelid will have minimal ageing changes, but most patients over 50 need a combined upper blepharoplasty and ptosis correction.
Combined Upper Blepharoplasty and Ptosis correction
As the name suggests this is an operation that combines two operations for maximum benefit. The upper blepharoplasty will address the loose and excess upper eyelid skin, muscle and excess fat while at the same time the eyelid ptosis can be corrected. This can correct the droopy lid and reverse the ageing changes in the eyelid and improve the vision. Patients over the age of 50 would benefit the most from this option.
Is surgery performed on the lower eyelid to get rid of excess skin, excess fat, correct eyebags and the tear trough deformity.
Link to lower eyelid surgery
Transconjunctival Lower Blepharoplasty
Conjunctiva is the inner lining of the eyelid. In transconjunctival lower blepharoplasty, a small cut is made in the conjunctiva and the excess fat and eye bags are reduced. It is possible to redrape the fat and correct the tear trough deformity but it is not possible to remove excess skin. The excess skin is removed by a “skin pinch” blepharoplasty. This type of ‘skin pinch’ blepharoplasty combined with transconjunctival fat removal is effective if the patient has excess fat or eyebags and very little excess skin.
Transcutaneous Lower blepharoplasty
In this type, the skin is cut just below the eyelash margin. Using this cut the excess muscle is removed, the excess fat is removed and the eyebags reduced. The tear trough deformity can be corrected at the same time by redistributing the fat. Additional procedures such as lateral canthopexy or lateral canthoplasty (to tighten the corners) and mid face lift can be performed at the same time. Effective for all patients needing lower blepharoplasty. The procedure of choice if the tear trough deformity needs correcting or the patient needs a mid face lift for mid face rejuvenation in addition to a lower blepharoplasty.
Lower Eyelid Lateral Canthopexy or Lateral Canthoplasty
Is a procedure to tighten the outer corner of the eyelid. Usually performed at the time of lower eyelid surgery. Restores the aesthetics of the eyelid and prevents “rounding” of the corners.
Marketing term not a medical one to describe upper eyelid surgery where the excess skin is removed or droopy eye corrected or a combination of both.
When a Laser device is used it is termed as ‘Laser eyelid surgery’. Usually the laser is used to make a cut in the skin, muscle or conjunctiva. Occasionally the laser can be used to resurface the eyelid skin to erase any ageing changes.
Asian Eyelid or Double Eyelid
Refers to the surgical procedure to creating an upper eyelid crease in an Asian eyelid. The structure and anatomy of the ‘Asian eyelid' is a lot different to a ‘non Asian eyelid’ and knowledge of this anatomy is the key to the success of this operation.
Link to double eyelid surgery