Having Eye Surgery or Blepharoplasty?
Understand your eyelid anatomy and eye concerns for a better result The eyelids serve as very efficient protectors of the eye. Some changes that might occur with ageing can make the eyelids droop, which requires blepharoplasty to correct. Drooping of the eyelids is not merely a cosmetic problem where it can also affect eyesight and block your field of vision.
Here we will talk a little more about the anatomy of eyelids and discuss some of the common glossary related to blepharoplasty.
Focused anatomy of the upper eyelids
The eyes and eyelids are complex and formed of many muscles and different types of tissue. Here are the five layers of the upper eyelids from most superficial to most deep:
- Skin and subcutaneous tissue: The upper eyelid is covered with very thin skin, which can become lax and cause droopy eyelids.
- Muscle: The muscle in your upper eyelid is known as the orbicularis oculi muscle, and it’s responsible for opening and closing your eyes.
- Orbital septum: A thin layer of dense connective tissue right below the muscle.
- Fat: The deepest layer is composed of fat, and it’s called the “pre-aponeurotic fat pad”. It’s located right under the orbital septum.
- Conjunctiva: The conjunctiva is the mucus membrane that covers the inside of your eyelids. It’s the pink part you see when you flip your eyelid out.
Some important anatomical parts of the eye
- Iris: The coloured part of your eye
- Pupil: The black central part of your eye
- Sclera: The white part of your eye
- Palpebrae: The inner surface of the eyelids
- Conjunctiva: The red-pink mucosal membrane covering the inner part of your eyelids (the palpebrae) and eye socket. It also forms a clear coat that covers your sclera.
Eyelid conditions corrected with blepharoplasty (eyelid lift)
Blepharoplasty is the most commonly performed cosmetic procedure of the eyes, and it’s usually done to fix droopy or baggy eyelids. Blepharoplasty can be done on the upper eyelids and/or the lower eyelids, on one or both sides. Here are the main conditions treated by blepharoplasty:
- Blepharoptosis (droopy eyelids): It is the medical term used to describe upper eyelid drooping regardless of its cause. Also referred to as “hooding” of the upper eyelid, where it drops down and partially covers the eye. This condition is treated by an upper eyelid lift (upper blepharoplasty). It’s usually due to excess skin and fat in the eyelids.
- Dermatochalasis (baggy eyelids): This is when you have puffy eyelids with excess skin, and it’s commonly associated with droopy eyelids. Swollen eyelids can be a result of a medical condition or just a normal consequence of ageing. As you grow older, your skin loses elasticity and becomes loose. Baggy eyelids are commonly seen in middle-aged and elderly women and men. Excess skin is more noticeable in the upper eyelids, but it can affect both the upper and lower eyelids.
Other important medical conditions of the eyelids
- Steatoblepharon: Steatoblepharon is when the deep eyelid fat herniates through the orbital septum covering it, leading to baggy eyelids. Another name for this condition is “pre-aponeurotic fat prolapse”.
- Double eyelid: This is a descriptive term that describes blepharoptosis when the excess skin and tissue create multiple creases in the eyelids
- Lateral hooding: This is a descriptive term that describes blepharoptosis when the eyelids drop to cover the outer poles of your eyes.
- Uneven eyelids: This is a descriptive term that describes blepharoptosis when only one eyelid is drooping causing an uneven appearance. This can be a result of strokes, facial nerve palsy (Bell’s palsy), or tics.
- Blepharochalasis: An inflammation of the eyelids that causes temporary swelling. When it resolves, blepharochalasis leaves excess tissue and skin.
- Thyroid orbitopathy: Growth of the tissue under the eyelids related to Grave’s disease (a disease of the thyroid gland)
- Xanthelasma: Fat deposits on your eyelids. These lesions are seen in men and women who have high cholesterol levels or thyroid problems. Xanthelasmata can be removed by surgery, cryotherapy, laser ablation, or electrodissection.
- Stye (hordeolum): This is a painful (usually red) pimple-like lesion that can develop on your eyelid. It happens when an eyelash hair follicle becomes infected. Styes usually go away on their own, but if they persist, they can be surgically removed.
- Chalazion: This is a painless nodular lesion that can develop on your eyelid. It happens when an oil gland on your eyelid gets clogged and form a granuloma (nodule). Chalazions can go away on their own or with certain medications, but if they persist, they can be surgically removed.
- Conjunctivitis: Also known as pink eye. It’s caused by a viral or bacterial infection, allergies, or eye trauma. All these can lead to the inflammation of the conjunctiva (the clear outer layer of your eye).
What are the causes of droopy eyelids?
Droopy upper or lower eyelids can be a normal result of aging, however, there are several medical conditions that can also cause them:
- Congenital ptosis: Some people are born with droopy eyelids due to a developmental problem of the eye muscles. This condition is usually observed on a single side. If drooping is severe and interferes with the baby’s vision, it can lead to permanent damage and even blindness. This is why blepharoplasty should not be delayed in these cases.
- Aging: This is the most common cause of droopy eyelids. The correct medical term to describe age-related eyelid ptosis is “aponeurotic ptosis”. As you grow older, the tissue in your eyelids becomes weaker and stretches down with gravity. The condition might be unilateral or bilateral.
- Myasthenia gravis: This is a neurological condition that causes muscle weakness in the whole body, but is usually first observed in the eyes. Myasthenia gravis leads to droopy eyelids and interferes with eye movement.
- Muscle problems: Certain conditions like oculopharyngeal muscular dystrophy and progressive external ophthalmoplegia lead to weak eye and eyelid muscles, and subsequent ptosis and vision problems.
- Nerve problems: The muscles in your eyelids are controlled by nerves. Problems with the nervous system, like a stroke, brain tumour, or brain aneurysm can put pressure on these nerves or alter how they work. This can lead to visual problems and eyelid drooping.
- Eye problems: Eye infection, local tumours, or trauma can all lead to eyelid ptosis.
Why is blepharoplasty done?
When your upper eyelids are drooping they might affect your peripheral vision and prevent your eyes from fully opening. Blepharoplasty removes the excess tissue and restores the normal field of vision. In addition, blepharoplasty of the upper and lower eyelids can restore a young and more alert look. You would benefit from blepharoplasty if:
- You’re not satisfied with the appearance of your eyelids
- You have puffy or drooping eyelids
- Your droopy eyelids are affecting your vision
- Bags under your eyes that are cosmetically unappealing
How is blepharoplasty performed?
The procedure is simple and can be done in your doctor’s office. First, your doctor will draw some markings on your eyelids to determine where he/she will cut. After that, they will scrub your eyelids with antiseptic and apply some drapes. Your surgeon will then inject some local anaesthetic into the eyelid skin to make it numb. After that, a skin incision will be made, and the excess skin and possibly underlying fat or muscles will be removed. The surgeon will then close the wound with very small sutures that are barely visible. The sutures will be removed after a few days and the wound will eventually become invisible.
Is blepharoplasty covered by insurance and Medicare in Australia?
Most of the time, blepharoplasty is considered a cosmetic procedure and is hence not covered by Medicare or insurance. In some cases, however, like if your eyelids are affecting your vision, blepharoplasty can be considered as a medical necessity and is hence eligible for a rebate.
Some commonglossary of Eyelid Anatomy
- Blepharoplasty: Cosmetic surgical procedure to fix eyelid drooping
- Blepharitis: Inflammation of the eyelid which can cause redness, swelling, and scaling on your eyelashes.
- Ectropion: This is when the lower eyelid is rolled outward showing the inner pink surface.
- General Anesthesia: This is when the anaesthetist gives you a combination of intravenous and inhaled drugs to put you to sleep during surgery.
- Local Anesthesia: This is when your surgeon injects drugs directly into the surgical area to numb the region so that you won’t feel any pain.
- Hematoma: Can be a complication of surgery. This is when blood accumulates in your wound.
- Seroma: Can be a complication of surgery. This is when fluids accumulate in your wound.
- Conjunctivitis: Inflammation of the conjunctiva (mucosal layer covering your eye, inner part of your eyelids, and eye socket)
- Lacrimal glands: The glands that produce tears
- Medial angle of the eye: The angle near your nose
- Lateral angle of the eye: The angle at the side of your face
Our surgeons are some of the best plastic and reconstructive surgeons in Australia, and they offer blepharoplasty with outstanding results. They can help you restore the normal young, alert look in your eyes and remove any excess skin that might be disturbing your vision. Call us to set up an appointment and learn more about your options!
Further Reading – Medical Sources: