Plastic Surgery of the Eyelids
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Eyelid reduction (Blepharoplasty)
A blepharoplasty removes excess eyelid bagginess creating a more
youthful appearance. This is often done under local anaesthetic
as a daystay procedure. Some medical insurance companies will pay
for an eyelid reduction if there is a demonstrated functional impairment
such as visual obstruction.
It is important to first ensure that a browlift is not
also required as this may not be able to be done afterwards. The
loose fold of skin that hangs over the upper eyelid is removed making
the eye appear wider and more youthful. The scar is placed where
there is a natural fold of skin and in most cases is difficult to
detect after a few weeks. There has been a vogue for removing the
fat that bulged around the eye. I avoid this as this may leave a
hollow eyed appearance.
In a lower blepharoplasty I reposition the periorbital fat rather
than removing it. This augments the cheekbone region. It important
to reduce lower eyelid folds with a lateral vector to avoid producing
ectropian, a hanging over of the eyelid.
Some Asian eyelids are characterized by epicanthal folds and absence
of a pretarsal crease. Some people seek to have “westernization”
of their eyelids which leaves a dramatically different appearance.
I do not perform surgery to excise epicanthal folds as the scarring
is too unpredictable. In most cases these folds can be removed by
augmenting the nasal root region
Absent pretarsal creases are caused by an anatomical variation
of the levator palpebral muscle which does not insert into the deep
layers of the skin and instead allows herniation of pretarsal fat
above the eyelid. My technique for correcting this involves reattaching
this muscle to the dermis and the scars are usually excellent.
Cholesterol deposits. (Xanthelasma)
||Xanthelasma is a subcutaneous deposit of cholesterol
around the inner eye region. This does not occur without an
elevated serum cholesterol and correction of this is an important
aspect of management.
It is critical to carefully analyze just how much can be safely
removed as the deposits tend to occur in locations away from
where surgery for eyelid bags occur. Over zealous excision may
cause an ectropian (rolling over of the lower eyelid)