Blepharoplasty
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Blepharoplasty can be both a functional or cosmetic oculoplastic surgical procedure intended to reshape the upper eyelid or lower eyelid by the removal and/or repositioning of excess tissue as well as by reinforcement of surrounding muscles and tendons. When upper eyelid descent is severe in the elderly, blepharoplasty may be undertaken to open up the field of vision impaired by overhanging skin. The procedure can also be used cosmetically to improve the appearance of sagging upper eyelids and puffy lower "bags".
Blepharoplasty is performed through external incisions made along the natural skin lines of the eyelids, such as the creases of the upper lids and below the lashes of the lower lids, or from the inside surface of the lower eyelid. Initial swelling and bruising take one to two weeks to resolve but at least several months are needed until the final result becomes stable. Depending upon the scope of the procedure, the operation takes one to three hours to complete.
The anatomy of the upper/lower eyelids, patients' skin quality, patients' age, and the adjacent bony and soft tissue all affect the cosmetic and functional outcomes after blepharoplasty. Factors which are known to cause complications after surgery include failure to recognize factors such as
- preexisting dry eyes - which may become exacerbated by disrupting the natural tear film
- laxity (loosness) of the lower lid margin (edge) - which predisposes to lower lid malposition
- prominence of the eye in relation to the malar (cheek) complex - which predisposes to lower lid malposition
The American Society for Aesthetic Plastic Surgery estimates the average physician/surgeon fee for blepharoplasty for 2005 to be around $2,813. These fees are for the physician/surgeon fees only and do not include fees for the surgical facility, anesthesia, medical tests, prescriptions, surgical garments or any other miscellaneous costs related to the surgery. Physicians most qualified to perform blepharoplasties are plastic surgeons, otolaryngologists, ophthalmologists, and oral and maxillofacial surgeons
An upper blepharoplasy in someone who is Asian is termed Asian blepharoplasty or double eyelid surgery.[1] It is the most popular form of cosmetic surgery among those of east and southeast Asian background. Due to anatomic differences between the asian and occidental eyelid, about half of this population are born without a supratarsal eyelid crease and are called single-lidded. Surgery can be used to artificially create a crease above the eye.
[edit] History
Karl Ferdinand von Gräfe coined the phrase blepharoplasty in 1818 when the technique was used for repairing deformities caused by cancer in the eyelids.
The roots of the present cosmetic advancements began around 3000 years ago with the ancient Egyptians. Documents “written on papyrus text detail how surgeons, even in that primitive age performed reconstructions on lips, noses, and ears using skin grafts cut from folds from the forehead or cheek”. [2] As techniques began developing the ancient Greeks and Romans began writing down and collecting everything they knew involving these procedures. Aulus Cornelius Cellus, a first century Roman, described making an excision in the skin to relax the eyelids in his book De Medicine.[3] Knowledge of blood circulation and tissue health were discovered and spread throughout the ancient world allowing techniques to improve. However, during the middle ages, plastic surgery was prohibited because it was viewed as something that was spiritual and unethical. This ban was also due to poor hygiene. Luckily, during the Renaissance, modern intellectuals from ancient Greece and Rome developed text illustrating the rediscovery of surgical procedures and techniques.
As the 19th century approached developments were being made that would eventually be the foundation to modern cosmetic surgery. The First World War was the first major event that really relied on the dedication of surgeons and advancements in cosmetic surgery. This gave doctors a chance to practice and perfect reconstructive surgical procedures. It also prepared medical personnel for the tragedies of World War II and other subsequent catastrophes.
Other procedures have stemmed from Blepharoplasty including Transconjunctival blepharoplasty and Asian blepharoplasty. Transconjunctival Blepharoplasty, developed in the early 1990s, involves the resurfacing of skin with chemical peels and carbon dioxide lasers combined with lower lid fat resection. [4] This allows for a faster recovery process. Asian Eyelid Surgery is a procedure popular among Asian women in Taiwan and Asia in which they have their eyelids creased, along with heightening their nose bridges.[5]
Eyelid surgery is not only a procedure for those who wish to improve their looks, there are real medical reasons for it. Many patients choose to undergo the procedure to correct conditions such as entropion and ectropin. Entropion is a result of the lashes being forced into the eye because of lax tissues around the eye and ectropin results when the pink rim of the eye is exposed caused by loss of muscle tissue allowing the lower lid to turn inward. As with any medical advancements, the development of surgical techniques goes through a period of trial and error as reconstructive surgery did during World War I. Each improvement eventually becomes the root of future advancements allowing physicians to combine procedures such as a basic lid fat resection and chemical peels insuring a speedy recovery.
[edit] References
- ^ McCurdy JA Jr. "Upper blepharoplasty in the Asian patient: the 'double eyelid' operation." Facial Plast Surg Clin North Am. 2005 Feb;13(1):47-64. Review. PMID 15519927.
- ^ “History of Cosmetic Surgery”. Wise Medical & Health, 26 September 2006, http://www.resources4cosmeticsurgery.com/topics/history.html
- ^ Cecilia Tran,“Preoperative Considerations in Blepharoplasty,” Baylor College of Medicine, 25 September 2006, http://www.bmc.edu/oto/grand/04_22_04.htm
- ^ John Kitzmiller, “Blepharoplasty, Lower Lid Subciliary” 2006. eMedicine. Ed. 25 September 2006, http://www.emedicine.com/plastic/topic4.htm
- ^ "When `sleepy eyes' won't do," Psychology Today 26 (September-October 1993): 11.
