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The eyelid skin is the thinnest in the body and undergoes significant ageing changes. The elastic fibers are lost leading to eyelid sagging. This can cause excess amount of skin in the upper and lower eyelids.

The upper lid dermatochalasis can cause upper lid heaviness, strain and in advanced cases it can affect the visual field.

In the lower lids, the excess amount of skin along with the bulging of the orbital fat give the appearance of eyelid ‘bags’ giving a tired look.

Blepharoplasty is the most commonly performed plastic surgery procedure in the face.

Frequent questions and information about Dermatochalasis – Blepharoplasty

Before the surgery

It is important to set realistic goals before undergoing any plastic surgery procedure, especially in the eyelid area. A detailed medical history will be taken and any blood thinning medication taken will need to be stopped prior to surgery; the timeframe here depends on the type of medications used. Any non-steroidal anti-inflammatory drugs should be stopped 10 to 14 days prior to surgery as they also increase the intraoperative bleeding risk.

How is the surgery carried out?

Upper lid blepharoplasty is most commonly performed under local anaesthesia. The most important part of the procedure is the exact measurement of skin that needs removing in order to prevent any postoperative complications. The treatment is individualized and variable amounts of skin, muscle and fat may be removed. The fat can also be re-draped to fill hollow areas. The surgical wound is closed with absorbable or non-absorbable sutures. Upper lid blepharoplasty is commonly combined with internal brow stabilizing sutures that provide a more youthful appearance but also prevent any possible brow descend following the upper lid skin excision.

Lower lid blepharoplasty is a more complicated procedure and is done under sedation or general anaesthesia. It can be done either with a skin incision if excess skin needs to be removed, or through an internal incision in the lower eyelid when only fat bulging is the problem.

What are the possible complications of blepharoplasty?

Upper lid blepharoplasty has a very quick recovery time of about only 1-2 weeks, whereas in the lower eyelids the postoperative discomfort, redness and swelling need usually 3-4 weeks to resolve. Rare complications include dry eye symptoms, infection, bruising and incomplete closure of the eyelids that is usually caused by excessive skin removal. The wounds heal without leaving any visible scars behind.

Postoperative care

An eye bandage is rarely required. Anti-inflammatory and antibiotic drops are used four times a day for 2 weeks. The sutures are removed one week after the surgery.

The patient can return to work in 7 days following upper lid blepharoplasty and 21 days following lower lid blepharoplasty. Work from home is possible in both even 2-3 days after the surgery.

Upper and lower lid blepharoplasty
This patient had mild upper lid dermatoichalasis in both upper eyelids. She also had asymmetric lower lid fat pad prolapse bilaterally. She underwent xonservative upper lid skin resection and lower lid transconjunctival fat prolapse excision. The postoperative picture was taken 3 weeks following surger

Bilateral upper lid blepharoplasty with internal browpexy suture (before and 1 week after surgery).

This patient had marked dermatochalasis of both upper and lower eyelids with significant lateral hooding. She also had moderate medial fat pad prolapse in the upper eyelids and protrusion of all three fat pads in the both lower eyelids.
The upper eyelids underwent a skin and muscle resection with conservative medial fat pad removal and redraping to fill the hollows.
A transconjunctival fat pad resection and repositioning was performed in both lower eyelids. As there was significant dermatochalasis, a skin/muscle flap excision was performed in both lower lids. The subcutaneousl soft tissues were stabilized on the lateral orbital wall with internal sutures and at the conclusion of the case a bilateral lateral canthopexy was performed.

Lower lid bag removal 4 weeks following surgery. Transconjunctival fat resection (without skin incision).

Before and after following bilateral lower lid transconjunctival blepharoplasty with fat removal.

Before and 2 weeks following bilateral upper lid blepharoplasty.

Dr. Thanos Bezatis is an ophthalmologist in Athens and maintains a modern ophthalmology practice in Kolonaki. He specializes in cataract surgery, refractive surgery and surgery of the eyelids and lacrimal system. He is a specialist and doctor of the University of Bonn and trained for six years in the United Kingdom. He has served as head of the Cataract and Ophthalmoplasty department at Moorfields Eye Hospital London.

Dermatochalasis – Blepharoplasty