Eyelid Surgery (Blepharoplasty)

Deformities develop in the lower and upper eyelids due to the loss of the skin's elastic fibers and herniation of fat tissue. This condition, characterized by sagging skin and herniation of the orbital fat tissue, is called blepharoptosis. The eyes are the focal point of the face and should be examined in detail before any rejuvenation procedure.

The aim of blepharoplasty is to give the lower and upper eyelids a younger appearance without altering their natural look and shape. Aging causes changes in the skin, muscle, fat, bone and ligament attachment points.

No single surgical technique is suitable for every patient. A tailored procedure should be performed in patients with signs of aging around the eyes, such as a tear trough deformity or malar bags.

Although blepharoplasty targets the eyelids, the entire periorbital region needs to be evaluated and treated.

In upper blepharoplasty, the aim is to preserve, stabilize and elevate the eyebrow and to maintain fullness in the upper eyelid. Brow ptosis and eyelid ptosis are ideally corrected during blepharoplasty.

In lower blepharoplasty, the main aim is to create a smoother transition between the lower eyelid and the cheek. Malar bags and a descended cheek fat pad may require treatment.

Before blepharoplasty, visual acuity should be measured, eye movements evaluated and standard photographs taken in all patients.

The procedure is performed under local anesthesia with sedation or under general anesthesia. Eye drops and ophthalmic ointment are used after surgery. The head is kept elevated and ice is applied.

The eyelids are the area where age-related changes in facial anatomy are most visible. These changes can include drooping eyelids that sometimes obstruct the field of vision, the formation of under-eye bags, and the side wrinkles at the corners of the eyes known as crow's feet, causing aesthetic and sometimes functional problems.

In past years, eyelid surgery was considered to involve only the eyelid, and corrective procedures were performed accordingly. However, once it was understood that changes in the eyelids are influenced by other changes in facial anatomy, cosmetic eyelid surgery began to be performed together with the aesthetic correction of these other changes in facial anatomy.

For example, we correct the hollows that form when the fat making up the under-eye bags spreads downward by lifting the fat upward, creating a continuous, smooth surface from the cheekbones to the lower eyelids.

If there is significant sagging of the cheeks, we always correct it together with the eyelid surgery. In upper eyelid surgery, if there is sagging of the forehead, that is, if your forehead and eyebrows are spreading over your eyes, these are first corrected with temporal lifting, and then the eyelid aesthetic procedures are performed. When eyelid surgery is performed without correcting other problems in facial anatomy, the aesthetic improvement is shorter-lived and the aesthetic problem recurs.

Aging causes changes in the skin, muscle, fat, bone and ligament attachment points. The eyelids are the area where the resulting changes in facial anatomy are most visible. These can include drooping eyelids that sometimes obstruct the field of vision, the formation of under-eye bags, and the side wrinkles at the corners of the eyes known as crow's feet, causing aesthetic and sometimes functional problems.

Deformities develop in the lower and upper eyelids due to the loss of the skin's elastic fibers and herniation of fat tissue. This condition, characterized by sagging skin and herniation of the orbital fat tissue, is called blepharoptosis. The aim of blepharoplasty is to give the lower and upper eyelids a younger appearance without altering their natural look and shape.

Who Is Eyelid Surgery Suitable For?

Although it varies depending on the patient's condition, it is generally suitable for people over 30 who have a family history of drooping eyelids, are healthy and do not have serious eye diseases. However, if excess eyelid tissue is negatively affecting the field and range of vision, the surgery can be performed at an earlier age.

How Is Eyelid Surgery Performed?

The eyes are the focal point of the face and should be examined in detail before any rejuvenation procedure. No single surgical technique is suitable for every patient. The preoperative evaluation determines which procedures will be combined during surgery. Although blepharoplasty targets the eyelids, the entire periorbital region needs to be evaluated and treated.

• The aim of upper blepharoplasty: To preserve, stabilize and elevate the eyebrow and to maintain fullness in the upper eyelid. Brow ptosis and eyelid ptosis are ideally corrected during blepharoplasty. For better concealment, the incision is made within the natural crease of the eyelid. When necessary, depending on the patient's condition, fat grafting can also be applied to hollows in the inner upper part of the eyelid.
• The aim of lower blepharoplasty: To create a smoother transition between the lower eyelid and the cheek. An incision is made just below the lower lashes or on the inside of the eyelid. Through this incision, the bulging tissues are corrected and excess skin is removed. Malar bags and a descended cheek fat pad may also need treatment.

Depending on the patient's condition, eyelid surgery is performed under local anesthesia with sedation or under general anesthesia.

Aesthetic Operations Performed Together with Blepharoplasty

In past years, eyelid surgery was considered to involve only the eyelid, and corrective procedures were performed accordingly. However, once it was understood that changes in the eyelids are influenced by other changes in facial anatomy, cosmetic eyelid surgery began to be performed together with the aesthetic correction of these other changes in facial anatomy. When eyelid surgery is performed without correcting other problems in facial anatomy, the aesthetic problems recur.

For example, a tailored procedure should be performed in patients with signs of aging around the eyes, such as a tear trough deformity or malar bags. The hollows that form when the fat making up the under-eye bags spreads downward should be corrected by lifting the fat upward, creating a continuous, smooth surface from the cheekbones to the lower eyelids. In upper eyelid surgery, if there is sagging of the forehead, that is, if your forehead and eyebrows are spreading over your eyes, these should first be corrected with “temporal lifting,” and then the eyelid aesthetic procedures should be performed.

Evaluation Before Eyelid Surgery

• Visual acuity should be measured in all patients.
• Eye movements should be evaluated.
• Standard photographs should be taken.

Other points to consider beforehand: it is recommended not to use aspirin and similar medications with a blood-thinning effect, herbal teas such as green tea, or vitamin E for one week before the operation. Patients should also report if they have high eye pressure, dry eye, high blood pressure or thyroid disease.

What Should You Pay Attention to After Eyelid Surgery?

• After eyelid surgery, there may be tenderness and some discomfort around the eyes.
• If you feel pain, you can take the pain relievers recommended by your doctor.
• Applying cold compresses to the eyes and sleeping with your head elevated will reduce bruising and swelling. Eye baths and eye drops will be recommended for a few days.
• In patients with thin eyelid skin, rapid swelling and bruising are seen after surgery. This swelling and bruising will subside by the end of the first week.
• Makeup can be worn at the end of the first week. For a while after surgery, there may be sensitivity to light and increased tearing.

You can get up the day after surgery, but you should follow your doctor's recommendations and warnings. For a fast recovery, you should avoid strenuous activity for about 2–3 weeks. It is also advisable to wear tinted glasses for 3–4 weeks to prevent irritation from sunlight and wind. The time it takes to return to work varies depending on how quickly you heal and how you feel.