Eyelid Correction: A procedure to correct the eyelids

Many people want to live up to their ideal of beauty and have physical imperfections removed to achieve this. A flawless, youthful appearance symbolizes attractiveness, success, and vitality.

Natural aging and UV radiation from the sun cause the skin to lose its elasticity over time. The skin on the eyelids is particularly thin and sensitive, causing the eyelids to begin to droop. This results in drooping eyelids, which make the eyes look tired.

Eyelid correction is also known as an eyelid lift or blepharoplasty. This minor surgical procedure tightens the skin above the eye, and the surgeon removes excess tissue. As a result, the eyes look more radiant again.

This eyelid surgery is rarely medically necessary. Eyelid correction is therefore classified as a plastic-aesthetic procedure, often referred to as “cosmetic surgery.”

Health insurance companies do not cover procedures performed for purely cosmetic reasons. In these cases, you must pay for the eyelid correction yourself.

Please note: The decision to undergo eyelid surgery should be your personal choice, not your partner’s!

In the upper eyelid area, however, sagging tissue can actually impair vision. Medical reasons for eyelid correction include:

• Restricted field of vision due to drooping eyelids, especially when looking up or to the side
• Altered eyelid position following a stroke or due to other neurological disorders

The procedure is performed similarly to eyelid correction for aesthetic reasons. However, if your health insurance recognizes the medical necessity of the procedure, it will cover the costs of the surgery.

In the run-up to eyelid surgery, the doctor first takes the patient’s medical history (anamnesis).

The doctor then performs various preliminary examinations, including a visual field test. This helps determine how the desired outcome can be achieved. Surgical eyelid correction is not always necessary. In some cases, excess skin around the eye can also be corrected through laser skin resurfacing.

An assessment of the patient’s overall health is also necessary. This helps determine whether there are any physical limitations that would preclude surgery.

Reasons that would preclude blepharoplasty include

• tumors of the eyelids,
• eye diseases such as glaucoma, retinal detachment, or dry eyes, or
• conditions such as diabetes mellitus, cardiovascular disease, high blood pressure, blood clotting disorders, or thyroid disorders.

In addition, the doctor checks whether the patient has a drooping eyelid (ptosis) or asymmetry.

The skin’s condition and the position of the eyebrows are also important factors in planning the surgery. Sagging skin in the forehead area can be accompanied by a lowering of the eyebrows. This further accentuates the appearance of drooping eyelids. If the eyebrows are positioned very low, the doctor may recommend a combination of eyelid surgery and a forehead-eyebrow lift.

After ruling out any contraindications for surgery, the doctor will discuss the eyelid correction with you in detail. He will explain exactly which methods are available and how the eyelid surgery will proceed. He will also inform you about possible risks and complications.

Eyelid surgery is one of the most common cosmetic procedures—it is a routine operation. Typically, eyelid surgery takes about 30 minutes. For slightly more complex procedures (such as when both eyelids are corrected), the duration can increase to up to three hours.

Before the procedure, the anesthesiologist will discuss appropriate anesthesia options with you and ask about any potential sensory disturbances. You will usually receive either local anesthesia and/or be placed under twilight sedation. General anesthesia is rarely required for eyelid surgery.

Depending on the type of blepharoplasty you have chosen, either the upper or lower eyelid will be corrected or tightened.

Upper Eyelid Lift

An upper eyelid lift is performed to tighten drooping eyelids. This eyelid surgery is either performed on an outpatient basis or requires a one-day hospital stay. The procedure typically takes about 30 minutes.

Before the surgery, the skin is disinfected. The plastic surgeon then marks the area to be treated on the skin of the awake, upright patient. This allows the surgeon to know exactly where to make the incision during the procedure.

The surgeon then numbs the eyelid with a local anesthetic. To make the incision, the surgeon uses either a scalpel and scissors or a laser or a very fine electrosurgical knife. The electrosurgical knife simultaneously cauterizes small blood vessels as it cuts, minimizing bleeding.

The surgeon removes excess skin in the area of the upper eyelid’s crease. If necessary, parts of the eyelid-closing muscle are also removed. If the patient wishes, the surgeon tightens the connective tissue. The surgeon can remove or reposition small pockets of fat.

Once this reshaping is complete, the surgeon closes the incision. In doing so, he ensures that the scar lies within the area of the natural skin folds. This makes it virtually invisible later on.

Lower Eyelid Lift

Lower eyelid blepharoplasty removes the excess skin of the lower eyelid, commonly referred to as “eye bags.” Another reason for a lower eyelid lift may be the protrusion of orbital fat tissue due to age-related tissue laxity. Often, it is a combination of both.

Lower eyelid lift surgery is usually performed on an outpatient basis or involves a one-day hospital stay. It typically takes about one hour.

As with other eyelid surgeries, the surgeon first marks the area to be corrected while the patient is awake and sitting upright.

There are two common methods that can be used for lower eyelid correction:

Most Common Procedure

In most cases, the surgeon begins at the lower lash line. There, he makes a barely visible incision one to two millimeters deep just below the lower eyelid’s lash line. He extends this incision approximately five millimeters outward into the laugh lines.

The surgeon then removes excess fatty tissue and portions of the orbicularis oculi muscle and tightens the skin. The underlying connective tissue can also be tightened if necessary.

Procedure for Good Skin Elasticity

Especially in young patients with good skin elasticity, it is not necessary to remove skin. In this case, the surgeon can also make the incision in the conjunctival fold (transconjunctival blepharoplasty). This approach offers the advantage of leaving no visible scars.

Even for patients who only have protruding fat tissue, the incision is now made from the inner side of the eyelid. This ensures that no visible scars remain, and wound healing is faster and carries fewer risks. Careful hemostasis is crucial with this method.

Follow your doctor’s recommendations exactly after surgery. This will minimize the risk of complications. During the healing phase, you should take it easy and avoid subjecting the incision lines to excessive strain or movement.

Like any medical procedure, blepharoplasty carries risks, such as bleeding or infection. In rare cases, complications or undesirable changes may occur, such as asymmetry or overcorrection or undercorrection. However, these have become less common due to improvements in techniques over the past few years.

Nevertheless, overcorrection—that is, the removal of too much skin—must be avoided at all costs. In extreme cases, this could prevent the patient from closing their eye, putting their vision at risk. For this reason, blepharoplasty should always be performed by an ophthalmologist trained in plastic surgery.

If the patient is unable to close their eye following the procedure, a follow-up surgery may be necessary.

Additional Surgical Risks

• Potential increases in intraocular pressure or corneal injury during eyelid surgery are generally considered critical risks.
• In most cases, the surgeon can easily conceal the surgical scar within a skin fold, making it barely visible. However, in some cases, due to individual predisposition, unsightly scarring or scar tissue growth may occur.
• Temporary blurred or impaired vision may also occur, and a (permanent) change in tear flow is possible.
• Very rarely, difficulties closing the eyes or bleeding may occur. Occasionally, skin sensitivity between the suture and the edge of the eyelid may decrease.
• After blepharoplasty, this area may initially feel numb. This numbness generally disappears after a few weeks or months, once small skin nerves have regenerated.

The risks associated with lower eyelid surgery are generally higher than those associated with upper eyelid surgery.

After Eyelid Surgery

As soon as the surgeon has completed the procedure, you can recover from the surgery in a patient room. In most cases, it is sufficient to stay at the facility for a few more hours so that the doctors and nurses can monitor your condition. Patients who have received general anesthesia must stay a little longer.

After the procedure, your eyes will be covered with eye pads and an elastic bandage. It is advisable to arrange for someone to accompany you home after your eyelid surgery.

You’ll be given eye drops to take home, which you should use to keep your eyes continuously moist.

In the initial period, you should get as much rest (including bed rest) as possible and lie in bed with your upper body slightly elevated. Avoid activities that strain your eyes, such as reading or watching TV.

In the first few days after eyelid surgery, mild pressure or soreness is normal. However, this discomfort can be effectively managed with pain medication.

After blepharoplasty, your eyelids will remain swollen for some time. Bruising may also occur. However, the swelling will subside within a few days.

The surgeon uses dissolvable sutures, which the body absorbs over time. If regular sutures are used, the doctor will remove them after about a week.

After seven days, you can resume your normal daily routine. After 14 days, you may begin using cosmetics.

However, you should avoid sports and physical exertion for the first three to four weeks after blepharoplasty.

For optimal results, you should take care to protect your eyes from sunlight after eyelid surgery. Sunglasses with large, dark-tinted lenses can help with this.

In general, good sun protection, plenty of sleep, and a healthy diet are the best ways to maintain the results of the surgery as effectively as possible and slow down the natural aging process.

However, this process cannot be stopped entirely. If necessary, a repeat blepharoplasty should therefore be considered. However, repeated eyelid corrections may be associated with poorer healing. This also increases the risk of malposition.