This is a surgical procedure involving the upper or lower eyelids. It is one of the most common esthetic procedures performed. It can be performed at most any age, but is most often performed in middle age.
A few common reasons to perform Blepharoplasty is to remove excessive skin in the upper or lower eyelids or to correct bulging as seen in the lower eyelid. There are several reasons an individual would opt for this procedure, but these are the two most common reasons.
In the excessive skin category, it is the upper eyelid that is most often involved. As you age, there is a thinning of the skin and laxity develops. The skin can fall over the eyelashes in such a way that the skin will irritate the eye itself. Sometimes the skin falls not over the eyelash but creates a fold in the upper eyelid. For women who use makeup on the upper eyelid (called the platform area), the extra skin causes a make-up crease line where the fold is. In other cases, the fold of skin may decrease the visual field. This is usually seen in lateral (outside part) visual field.
It is important to determine the cause of the excess skin. As you age, parts of your body drop. In the eyelid area, the anatomic part that drops is the eyebrow. This is called brow ptosis. As the brow drops, the upper eyelid skin can fold on itself giving the appearance of excessive upper eyelid skin. If this is the case, then removing excess skin is not the best treatment. The best treatment would be to re-position the eyebrow back to its youthful position. This is called a brow lift.
If the eyebrow is in the proper position but there is excessive skin, then the surgical procedure of choice would be to remove the excess skin.
In the category of bulging as seen in the lower eyelid, this is usually caused by a bulging of fat (herniation) against a structure (the orbital septum) of the lower eyelid. As you age, the orbital septum weakens and structures behind it can cause bulging. In this type of blepharoplasty, the fat is removed.
The surgery to perform on the eyelids is determined by what structures need to be corrected. If the problem is simply excess skin, then the surgery is designed to remove the excess skin. If the problem is bulging fat in the lower eyelid area, then the surgery is designed to remove the fat.
There are two approaches to removing fat causing a bulging of the lower eyelid. There is a traditional approach from the skin side and another approach from the inside of the eyelid (called the conjunctival approach). Both approaches have advantages and disadvantages; the approach to use is based upon the surgeons experience and judgment.