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Blepharoplasty (
Greek Greek may refer to: Anything of, from, or related to Greece, a country in Southern Europe: *Greeks, an ethnic group *Greek language, a branch of the Indo-European language family **Proto-Greek language, the assumed last common ancestor of all kno ...
: ''blepharon'', "eyelid" + ''plassein'' "to form") is the plastic surgery operation for correcting defects, deformities, and disfigurations of the
eyelid An eyelid ( ) is a thin fold of skin that covers and protects an eye. The levator palpebrae superioris muscle retracts the eyelid, exposing the cornea to the outside, giving vision. This can be either voluntarily or involuntarily. "Palpebral ...
s; and for aesthetically modifying the eye region of the face. With the excision and the removal, or the repositioning (or both) of excess tissues, such as
skin Skin is the layer of usually soft, flexible outer tissue covering the body of a vertebrate animal, with three main functions: protection, regulation, and sensation. Other animal coverings, such as the arthropod exoskeleton, have different ...
and adipocyte fat, and the reinforcement of the corresponding
muscle Muscle is a soft tissue, one of the four basic types of animal tissue. There are three types of muscle tissue in vertebrates: skeletal muscle, cardiac muscle, and smooth muscle. Muscle tissue gives skeletal muscles the ability to muscle contra ...
and
tendon A tendon or sinew is a tough band of fibrous connective tissue, dense fibrous connective tissue that connects skeletal muscle, muscle to bone. It sends the mechanical forces of muscle contraction to the skeletal system, while withstanding tensi ...
tissues, the blepharoplasty procedure resolves functional and cosmetic problems of the
periorbita The periorbita is the area around the orbit. Sometimes it refers specifically to the layer of tissue surrounding the orbit that consists of periosteum The periosteum is a membrane that covers the outer surface of all bones, except at the articu ...
, which is the area from the eyebrow to the upper portion of the cheek. The procedure is more common among women, who accounted for approximately 85% of blepharoplasty procedures in 2014 in the US and 88% of such procedures in the UK. The operative goals of a blepharoplastic procedure are the restoration of the correct functioning to the affected eyelid(s) and the restoration of the aesthetics of the eye-region of the face, which are achieved by eliminating excess skin from the eyelid(s), smoothing the underlying eye muscles, tightening the supporting structures, and resecting and re-draping the excess fat of the retroseptal area of the eye, in order to produce a smooth anatomic transition from the lower eyelid to the cheek. In an eye surgery procedure, the usual correction or modification (or both) is of the upper and the lower eyelids, and of the surrounding tissues of the eyebrows, the upper nasal-bridge area, and the upper portions of the cheeks, which are achieved by modifying the periosteal coverings of the facial bones that form the
orbit In celestial mechanics, an orbit (also known as orbital revolution) is the curved trajectory of an object such as the trajectory of a planet around a star, or of a natural satellite around a planet, or of an artificial satellite around an ...
(eye socket). The periosteum comprises two-layer connective tissues that cover the bones of the human body: # the external layer of networks of dense, connective tissues with blood vessels, and # the internal, deep layer of
collagen Collagen () is the main structural protein in the extracellular matrix of the connective tissues of many animals. It is the most abundant protein in mammals, making up 25% to 35% of protein content. Amino acids are bound together to form a trip ...
ous bundles composed of spindle-shaped cells of connective tissue, and a network of thin, elastic fibres. The East Asian blepharoplasty procedure differs from the classic blepharoplasty. In younger patients, the goal of the surgery is to create a supratarsal fold ("double eyelid surgery") whereas in older patients the goals are to create or elevate the supratarsal fold and to resect surplus eyelid skin ("Asian blepharoplasty").


Medical uses

The thorough pre-operative
medical Medicine is the science and Praxis (process), practice of caring for patients, managing the Medical diagnosis, diagnosis, prognosis, Preventive medicine, prevention, therapy, treatment, Palliative care, palliation of their injury or disease, ...
and surgical histories, and the physical examination of the patient's
periorbita The periorbita is the area around the orbit. Sometimes it refers specifically to the layer of tissue surrounding the orbit that consists of periosteum The periosteum is a membrane that covers the outer surface of all bones, except at the articu ...
l area (eyebrow-to-cheek-to-nose), determine if the patient can safely undergo a blepharoplasty procedure to feasibly resolve (correct or modify, or both) the functional and aesthetic indications presented by the patient. Sequentially, lower eyelid blepharoplasty can successfully address the anatomic matters of excess eyelid skin, slackness of the eye-muscles and of the
orbital septum In anatomy, the orbital septum (palpebral fascia) is a membranous sheet that acts as the anterior (frontal) boundary of the orbit. It extends from the orbital rims to the eyelids. It forms the fibrous portion of the eyelids. Structure In the ...
(palpebral ligament), excess orbital fat, malposition of the lower eyelid, and prominence of the nasojugal groove, where the orbit (eye socket) meets the slope of the nose. Concerning the upper eyelid, a blepharoplasty procedure can resolve the loss of
peripheral vision Peripheral vision, or ''indirect vision'', is vision as it occurs outside the point of fixation, i.e. away from the center of gaze or, when viewed at large angles, in (or out of) the "corner of one's eye". The vast majority of the area in the ...
, caused by the slackness of the upper-eyelid skin draping over the eyelashes; the outer and the upper portions of the field of vision of the patient are affected and cause him or her difficulty in performing mundane activities such as driving an automobile and reading a book.


Cosmetic uses

In many East Asian countries, double-eyelid surgery is the most popular surgery, especially in South Korea. Depending on the methods, directing doctors' experience and the difficulty of the individual case, this surgery can cost between about
US$ The United States dollar (Currency symbol, symbol: Dollar sign, $; ISO 4217, currency code: USD) is the official currency of the United States and International use of the U.S. dollar, several other countries. The Coinage Act of 1792 introdu ...
2,000 to $4,000. The procedure is famous for producing double-eyelid for patients for the long term. This kind of operation normally takes about thirty minutes to an hour, and patients are not required to stay hospitalized afterward. Stitches are removed five to seven days after surgery. Many foreigners go to South Korea each year for blepharoplasty.


Procedures

A blepharoplasty procedure usually is performed through external surgical incisions made along the natural skin lines (creases) of the upper and the lower eyelids, which then hide the surgical
scar A scar (or scar tissue) is an area of fibrosis, fibrous tissue that replaces normal skin after an injury. Scars result from the biological process of wound repair in the skin, as well as in other Organ (anatomy), organs, and biological tissue, t ...
s from view, especially when affected by the skin creases below the
eyelash An eyelash (also called lash) (Neo-Latin: ''cilium'', plural ''cilia'') is one of the hairs that grows at the edges of the top and bottom eyelids, spanning outwards and away from the eyes. The lashes grow in up to six layers on each of the upper ...
es of the lower eyelid. The incisions can also be made from the
conjunctiva In the anatomy of the eye, the conjunctiva (: conjunctivae) is a thin mucous membrane that lines the inside of the eyelids and covers the sclera (the white of the eye). It is composed of non-keratinized, stratified squamous epithelium with gobl ...
, the interior surface of the lower eyelid, as in the case of a transconjunctival blepharoplasty. Transconjunctival lower blepharoplasty technique was pioneered by Clinical Professor of Surgery at the University of Chicago Medicine, Dr. Anthony J. Geroulis and introduced to medical trial in 1998. This technique is particularly useful for patients with darker skin tones where standard external incision often leaves a visible white scar. Transconjunctival blepharoplasty technique permits the excision (cutting and removal) of the lower-eyelid
adipose tissue Adipose tissue (also known as body fat or simply fat) is a loose connective tissue composed mostly of adipocytes. It also contains the stromal vascular fraction (SVF) of cells including preadipocytes, fibroblasts, Blood vessel, vascular endothel ...
without leaving a visible scar, but the technique does not allow the removal of excess eyelid-skin. A blepharoplasty operation usually requires 1–3 hours to complete. Post-operatively, swelling and bruising is expected and will usually resolve without further intervention; application of cold compresses can help to reduce the duration and discomfort. There are no standardized outcome measures for upper or lower blepharoplasty. Blepharoplasty is generally a relatively safe surgery, but possible complications include hematoma/ecchymosis, lagophthalmos (incomplete or abnormal closure of the eyelids), ptosis (drooping of the upper eyelid), scarring, dry eyes, orbital hematoma/compartment syndrome, lymphedema, and ocular motility disorders. After the procedure, a type of stitch known as a canthopexy is placed near the outer corner of the lower eyelid, which is inside the tissue. This allows the eyelid's position to remain fixed during the healing process. The canthopexy is dissolved after four to six weeks of use. For particular patients, a mid-face elevation may be required to rejuvenate the lower eyelid-cheek complex. * Lower Blepharoplasty 3X Vector Suspension technique lifts and tightens the lower eyelid and mid face using sutures, ensuring a natural look. The anatomic condition of the eyelids, the "wear-and-tear" quality of the patient's skin, age, and the general condition of the adjacent tissues affect the functional and aesthetic results achieved. Additional to the anatomic conditions of the eye region of the patient, the possible occurrence of medical complications is determined by factors including: * Dry-eye syndrome – which can become exacerbated by the disruption of the natural, lacrimal (tear) film of the eyes * Palpebral skin laxity – looseness of the lower eyelid margin, which predisposes the lower eyelid to malposition * Eyeball prominence – the protrusion of the eyeball in relation to the malar (cheek) complex, which predisposes the lower eyelid to malposition File:Removal of fat from lower eyelid during blepharoplasty 1.jpg, Fat is removed from the lower eyelid by means of an incision to the inner surface of the eyelid. A surgical suture retains the inner tissue of the eyelid over the eyeball. File:Removal of fat from lower eyelid during blepharoplasty 2.jpg, The fat is held with forceps (left), and clamped with a hemostat (right), while a small medical retractor keeps away the extra tissue, so that the surgeon can operate (bottom right). File:Removal of fat from lower eyelid during blepharoplasty 3.jpg, The fat is excised (cut away) with surgical scissors.


History

As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures.
Aulus Cornelius Celsus Aulus Cornelius Celsus ( 25 BC 50 AD) was a Roman encyclopedist, known for his extant medical work, '' De Medicina'', which is believed to be the only surviving section of a much larger encyclopedia. The ''De Medicina'' is a primary source on ...
, a first-century Roman, described making an excision in the skin to relax the eyelids in his book '' De Medicina''. Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.


Laser

Laser blepharoplasty is the performance of eyelid surgery using a laser instead of a scalpel. Laser blepharoplasty is often combined with laser eyelid rejuvenation, as the two procedures can be performed in conjunction. A CO2 laser blepharoplasty offers many benefits over a blepharoplasty performed using a scalpel. Some of these benefits include less bleeding, shortened surgical time, better intraoperative visibility, less bruising and swelling, less pain or discomfort, and smoother healing. Historically there has been some contention as to the categorization of laser treatment on upper or lower eyelids as blepharoplasty, which is itself by definition surgical. The statutory definition of surgery and that supported by the American College of Surgeons states that surgery is the "treatment ... by any instrument causing localized alteration or transportation of live human tissue, which include lasers...".


See also

* Eye surgery * Oculoplastics * Plastic surgery * Maxillofacial surgery


References

{{Cosmetics Dermatologic procedures Eye surgery Oculoplastic surgery