BLEPHAROPLASTY

(‘Blepharo’ = eyelid, ‘plasty’ = to shape or mold). Blepharoplasty is customarily a cosmetic procedure to enhance the appearance of the eyelids. It is sometimes called an ‘eye lift’. A blepharoplasty may involve the upper lids, or the lower lids, or both. Prime objectives in this surgery are to achieve a natural, refreshed appearance, and by all mean to avoid an artificial over-done appearance.

Upper Blepharoplasty

In an upper blepharoplasty the excess skin and fat is removed. Other enhancing procedures may be done such as smoothing the skin with laser and stabilizing the lid crease. An upper blepharoplasty is typically a cosmetic procedure and not covered by insurance. Where the upper lid skin can be clearly demonstrated with a visual field test to obstruct peripheral vision, removal of the excess skin may be covered by some insurance plans.

Lower Blepharoplasty

This is typically a more complex operation than an upper blepharoplasty and each patient should be carefully evaluated and the procedure individualized to hisor her specific needs. In the basic procedure the skin is tightened and any bulging fat (‘bags’) removed. Additional procedures are often included, such as smoothing the skin with laser and tightening the outer attachment of the lid to prevent retraction following surgery. When the skin tone is good and the problem is excess fat only, no skin incision may be required. In this situation the fat is removed through an incision on the inner surface of the lid and no stitches are required. Additionally, the skin may be tightened and wrinkles reduced with a laser. A lower blepharoplasty is a cosmetic procedure. A possible exception is where there is significant tearing or chronic eye irritation caused by the lids falling or being pulled away from the eye (ectropion--see below). In this circumstance a portion of the operation may be covered by insurance. As a specialist in eyelid surgery, Doctor Stephenson is able to customize each procedure as appropriate to achieve the optimum result.

CHEEK
The malar-cheek lift has become increasingly popular in recent years. Dr Stephenson often does this in conjunction with a lower blepharoplasty. This procedure can significantly enhance the appearance of the cheek, eyelid and mid-face area in the appropriate patient.

BLEPHAROPTOSIS
In this condition the eyelid itself, not just the skin, droops and may partially cover the pupil. This condition is not corrected by simply removing excess skin. It requires a specific ptosis operation. Adult onset ptosis is usually caused by stretching of the muscles that lift the lid and a repair must address this condition. In rare instances ptosis can be due to a systemic disorder such as myasthenia gravis or muscular dystrophy. In children it is usually present at birth and due to underdevelopment of the levator muscle.

ECTROPION AND ENTROPION
In these conditions the eyelid turns out (ectropion) or turns in (entropion). Either can cause eye irritation and excess tearing. The repair is usually uncomplicated, although in some cases of ectropion a skin graft can be required. As previously noted an ectropion can occur when preventive measures are not included in the surgery.

EYELID RECONSTRUCTION
There are circumstances where it is necessary to rebuild part or all of an eyelid with flaps and skin grafts. Doctor Stephenson does this type of surgery most often for the reconstruction of an eyelid following removal of a malignant tumor by a dermatologic surgeon. .