Usually the removal of excess skin and fat from the eyelids is performed for cosmetic reasons. However, upper blepharoplasty can be medically necessary when the excess skin covers the eyelid margin or deflects the eyelashes downward, impairing the patient’s vision.
To ensure that upper eyelid surgery is a medical necessity rather than a cosmetic condition, case managers should consider having the patient take good, high resolution photographs of the eye region. If the upper eyelid margin of the eye crosses the plain of pupil in the photo, then further testing can be done. An ophthalmologist can run a visual field mapping test on the patient. If the patient’s visual interference with upper case letters is at 20 percent above horizon, and if taping the patient’s eyelids back improves his or her vision 20 degrees above the horizon, then the treatment probably is required.
In upper eyelid surgery, the surgeon first marks the individual lines and creases of the lids in order to keep the scars as invisible as possible along these natural folds. The incision is made, and excess fat, muscle, and loose skin are removed. Fine sutures are used to close the incisions, thereby minimizing the visibility of any scar. If your eyelid droops close to your pupils as can occur in some situations blepharoplasty is done in conjunction with another procedure to address that particular aspect of the problem, which is called ptosis (TOE-sis) (surgery performed to strengthen or tighten the levator muscle and lift the eyelid).
In lower eyelid surgery, the surgeon makes the incision in an inconspicuous site along the lashline and smile creases of the lower lid. Excess fat, muscle, and skin are then trimmed away before the incision is closed with fine sutures. Eyelid puffiness caused primarily by excess fat may be corrected by a transconjunctival blepharoplasty. The incision in this case is made inside the lower eyelid, and excess fatty material is removed. When sutures are used to close this kind of incision, they are invisible to the eye. They are also self-dissolving and leave no visible scar. Under normal conditions, blepharoplasty can take from one to two hours.