Ronald J. Caniglia, M.D., F.A.C.S.
 Upper and/or lower eyelid surgery, also known as blepharoplasty, is a surgical procedure designed to address sagging eyelid skin and muscle, as well as puffiness or excess fat pads, which present themselves over time. While the surgery can also improve wrinkles of the eyelid skin, additional procedures such as laser resurfacing are sometimes required. A successful outcome requires the skill of an experienced surgeon with an artistic understanding of the eyelid, its shape and position, and its relationship to the eyebrow and forehead.
Aging changes are often visible sooner on the eyelids than on the lower face. It is for this reason that eyelid surgery is typically performed at younger ages, in the 30's and beyond. Once eyelid surgery has been performed, the surgery often does not have to be done again, though that is not to say that it cannot be repeated at a much later age if necessary. It is essential that the eyebrows be evaluated along with the upper eyelids prior to surgery. Some patients may require a forehead or browlift rather than upper eyelid surgery. Many times, the upper eyelid surgery and the browlift are performed simultaneously to optimize the results.
All of Dr. Caniglia's patients choose to have their surgery performed at the Plastic Surgery Center at Kierland (PSCK), located in The Caniglia Center in Scottsdale, Arizona. The PSCK is a state- and Medicare-licensed outpatient surgery center and is also AAAHC-accredited.
Most eyelid surgeries are performed on an outpatient basis and typically take between thirty to forty minutes for upper eyelid surgery and about one hour for a combined upper and lower eyelid surgery. Dr. Caniglia performs all eyelid procedures under local anesthesia with intravenous sedation, also known as deep twilight sleep. This form of anesthesia keeps the patient from feeling any discomfort or remembering anything from surgery while also allowing them to feel more alert and refreshed after surgery. All of Dr. Caniglia's patients have a board certified anesthesiologist present at all times before, during, and after surgery in order to monitor their vitals.
The upper eyelid incision is placed in the natural crease of the upper eyelid. The excess skin is then excised. A very thin strip of muscle is often removed, though younger and heavy-skinned patients will require more muscle excision. There is often an abundance of fat in the middle and inner part of the upper eyelid. If this is the case, these two fat pads are re-contoured to remove the puffiness from the upper eyelid. The incision is then closed with a very fine suture, often hidden underneath the skin, and a small piece of brown paper tape is placed on the outside of the incision. This is done to minimize any suture marks on the skin.
There are three different surgical approaches to the lower eyelids: 1) transconjunctival, 2) skin-muscle flap, 3) skin flap only. For those patients with good lid tone, Dr. Caniglia prefers the transconjunctival approach. With this approach, the incision is hidden inside of the lower eyelid, thereby making it unnecessary to transect or cut the lower eyelid muscle which is the main support mechanism for the lower eyelid. This is important as it maintains the eyelid support and minimizes the risk of altering the lower eyelid shape. Dr. Caniglia prefers to use the laser to make the incision because it creates a very precise incision with minimal to no bleeding. A stainless steel contact is placed in the eye at all times for protection. There are three fat pads in the lower eyelids which create the puffiness one sees on the outside. Through this inside approach, the three fat pads are re-contoured to allow the eyelid to lay flat. The lower eyelid is then returned to its natural position. The inside incision will close on its own and does not require stitches. After re-contouring the fat pads, the skin of the lower eyelid is addressed. If there is excess skin and wrinkling, Dr. Caniglia prefers to laser the lower eyelid skin on the outside. The laser will both tighten and smooth the skin. If there are no wrinkles and just excess skin, the skin is removed through a tiny incision hidden underneath the eyelashes of the lower eyelid. In some cases in which the lower eyelid muscle has lost considerable tone, the skin-muscle flap technique is used. This technique is similar to the above but also involves a tightening of the lower eyelid muscle.
Recovery is very simple and quick with eyelid surgery. There is very little, if any, discomfort the next day. Bruising is minimal, particularly in the lower eyelids with the use of the laser and inside approach. All sutures are removed in 7 days and the patient can apply makeup the next day if desired. If laser resurfacing is added to the lower eyelid skin, one will need 10-14 days before makeup can be applied. Most patients can return to work after 7 days, or 10-14 days when laser resurfacing is also used. Dr. Caniglia asks all patients to wait 2 weeks before resuming heavy strenuous activity or exercise.
Eyelid surgery is a safe, effective procedure. Major risks and complications are fortunately very rare but can include ectropian (eyelid turning out), hematoma, suture line complications and blindness. Selecting a qualified and experienced facial plastic surgeon can help to minimize your risk and better ensure a beautiful and successful result. |
