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Misty Wray, MD
Blepharoplasty Is It Right For You?
Maryland Eye Associates
. http://marylandeyeassociates.com

Blepharoplasty Is It Right For You?

The term blepharoplasty refers to an operation in which excess tissues (skin, muscle, or fat) are removed from the eyelid. The procedure is considered functional if the excess tissue is causing some form of visual compromise. The procedure is considered cosmetic when the procedure is performed to improve your appearance in the absence of any signs or symptoms of functional abnormalities. Blepharoplasty of the lower lid is almost always considered cosmetic and not covered by insurance.
The most common functional indication for blepharoplasty is a loss of part of your peripheral vision from redundant eyelid skin. A simple way to determine if you need a blepharoplasty is to pinch the excess eyelid skin without lifting your brow or eyelid and see if the excess skin is causing a block in your side vision. Also, you can look in the mirror and see if your lashes are starting to turn down and you no longer can see your normal eyelid crease. Another important observation is to look in the mirror and see if lifting up your eyebrow alone improves your side vision and appearance of the heavy upper eyelids.
The symptoms of excess upper eyelid skin are brow fatigue, difficulty reading, recurrent upper eyelid inflammation and swelling, and being able to see your eyelashes and upper eyelid during different activities.
Several tests are performed by your eye doctor to determine if you have significant excess eyelid skin. A complete eye exam and medical history is performed. Your visual complaints are documented. Visual fields and photographs are taken to document your level of visual impairment.
In taking a medical history, your doctor may question you regarding illnesses, medications, allergies, and swelling. Emphasis is on ruling out thyroid disease, heart failure, hypertension, bleeding tendencies, and unusual swelling. For example, patients with thyroid disease may look as if they need cosmetic surgery, but the treatment needed is frequently medical, not surgical. There are also rare circumstances that someone may complain of droopy lids but after a careful history and physical exam your doctor may suspect another reason such as myasthenia gravis (neuromuscular disease) or chronic progressive external ophthalmoplegia (progressive eye muscle weakness).
It is important on your eye examination that your visual acuity, ocular motility, and assessment of your tear production are performed. If your eyes are dry then removing the excess skin can worsen your dry eye symptoms. The position of your brows, eyelid crease, and the bone structure around your eye are very important measurements to take into consideration to insure a good cosmetic outcome. In some individuals, when the excess eyelid skin is removed the eye will appear smaller because of the position of the eyebrow and cheek bones. In these individuals it is important to look at the whole face and not just the excess eyelid tissue it determining the best surgical procedure to be performed. Fullness in the temporal aspect of your lateral brow may represent a prolapsed lacrimal gland that should be repositioned during the blepharoplasty procedure.
Finally, your eye doctor should explain to you the risks, benefits and what to expect from the procedure. You should feel comfortable prior to surgery that the procedure you are undergoing will improve your vision and quality of life.

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