In this video, Dr. Addona provides a comprehensive overview of upper and lower eyelid surgery (blepharoplasty), covering everything from the procedure’s intricacies and eyelid anatomy to patient candidacy, surgical techniques, and post-operative care. He emphasizes the importance of understanding individual patient needs and expectations, highlighting the differences between upper and lower lid procedures, including anesthesia, incision types, and recovery timelines. The video also addresses potential complications and stresses the significance of a thorough pre-operative evaluation to ensure optimal results and patient safety, concluding with a glimpse of before and after photos.
Transcript:
Today I’m going to speak to you about upper and lower lid blepharoplasties. In terms of what that procedure entails, the blepharoplasty is a surgical procedure that we use to correct skin and soft tissue defects around the upper and lower lids. It involves removing excess fat, sometimes addressing muscle, and then sometimes addressing the tension around the eyes.
Important here is to understand the anatomy of the eyelids. It’s really the crucial portion here from the surgeon. We want to understand how the skin and the tissue behind it plays a role, or understand how the orbicularis, the muscle that goes around the eyes to help us close our eyes, plays a role. There’s an area called the tarsal plate that helps suspend the eyes, almost like a hammock. And there’s our orbital septum, which is that separation between the fat and the muscle and the tissue, as well as the fat pads and where they sit. Understanding that anatomy is crucial in this operation. We have a drawing or a figure behind me.
In terms of surgery. And who is a candidate or what are indications for a patient to undergo this surgery? Let’s start with the upper eyelids. Most often I’ll see patients that come in and have requests with regards to their upper eyelid because they have some excess skin, some loose hanging skin that may or may not obstruct their visual field, meaning that they can’t see as smoothly and also overall just esthetic concerns. Regards to lower eyelids, it’s more important to keep in mind sometimes patients with low eyelids have excess tissue and bags under their eyes that can be related to the fat bulging, or it can be related to something that’s family related and a functional aspect there. Wrinkles and sagging skin are crucial in this circumstance.
We have a patient that may be indicated for the procedure. What are some of our preoperative considerations or thought process that we run through in this circumstance? Well, as a physician, it’s always important to take a pertinent and a very thorough patient evaluation in medical history. We want to indicate any issues with regards to bleeding, bruising, things that are called dry eye syndrome that may lead to complications or issues after the procedure itself.
We discuss with our patients their expectations. This is crucial. Some patients are candidates for this procedure where they can see substantial improvement. Some patients may see some more modest improvements. It’s important to have that conversation early on. We also have pre-surgical instructions. We want them to stop any medications that will increase the risk of complications after the procedure.
In terms of surgical techniques when it comes to the upper eyelids, the upper eyelids really tend to be a location that we can often manage if that’s a patient’s only concern in the office under local anesthesia. That’s important. Right? Doing a procedure under local anesthesia. Patients recover. They’ll be home that day, a short period thereafter. If they do get to go about most of their normal routine within the next 2 to 3 days. They have some bruising that after about 72 hours can be covered with makeup. And honestly, the recovery is pretty smooth.
In terms of an upper lip procedure and upper lid blepharoplasty the incisions often placed in a crease in the eyelids that we identify at the time of surgery. I’m able to remove not only the skin, some of the musculature, and if need be, not as often as we once did in the past, a little bit of fat that’s involved in that location. Then repairing the area with some fine suturing really does help create the esthetic that patients are looking for in this circumstance.
Lower eyelids. Those are more complex. Those are more involved. They often require either some form of general anesthetic or deep sedation where the patient is thoroughly under anesthesia, because it’s a bit more discomfort for our patients. In that setting, we’re able to access the eyelid through either the skin or at times inside called a trans conjunctival.
So we have two options. There are incisions that go right underneath the eyelashes and the lower lid. Or we can go within the actual eyelid and hide the incision entirely. Different patients are different candidates for different procedures in that circumstance. Crucial to the lower eyelid is to be very judicious and cautious with the amount of skin we remove. The effort here is to reduce the risk of post-operative headaches or complications where the eyes may pull a bit. There are treatments for those, but if we can minimize or reduce that risk in the perioperative phase, better to do that.
During the lower lid blepharoplasty the goal here is to really achieve some improved esthetic. One is to tighten the skin if needed. Two is to remove fat if indicated and three is to reposition fat to a location where it better serves the patients. Meaning we want to blend what’s called that eyelid to cheek junction so we have a much more naturalized that in that setting. That procedure takes a bit longer than the upper lid blepharoplasty. Normally about 45 minutes to an hour for upper lids, about an hour and a half, possibly two hours for lower lids when done properly. Patients still go home the same day, but they do vary in terms of anesthesia. Of course, these two procedures can be done together at the same time and patients do exceptionally well in that circumstance.
In terms of the post-operative care and what you can expect. Cold compresses are used early on for limited periods of time, but this helps reduce swelling. We avoid strenuous activity. No lifting pushing pulling. You will be given a prescription eyedrops and ointments. And usually patients follow up within the first 72 hours to keep an eye on how they’re healing. Complications that could be associated with this procedure might be some swelling, some bruising. Dry eyes, which we’ve often identified prior to the procedure, may need to manage at the time of the procedure. Sometimes there’s some imbalance that may need required addressing, but very rare in those circumstances.
Please enjoy some of the before and after photos.
