Is there a bigger chance of having dry eyes with agressive (large amount of) skin and muscle removal as opposed to a smaller, more conservative amount of just removing only skin? If so, what is the reason why larger amounts risk greater chances for dry eyes? Thank you again.
Upper Blepharoplasty Eyelid Lift Questions?
Doctor Answers (13)
Upper blepharoplasty and dry eyes.
There is a direct correlation of worsening dry eyes after an aggressive amount of skin and muscle are removed from the upper lids. We do not recommend this for people who have dry eyes. A conservative amount of skin with no muscle removal from the upper eyelids is all that is required to give a conservative cosmetic improvement.
Larger Amounts of Skin Removal Can Lead to Dry Eyes
Larger amounts of skin removal can lead to dry eyes if the eyes cannot be completely closed. However, conservative resection leads to excess skin and the possible need for revision. This is a balancing act.
Dry eyes with upper blepharoplasty?
Dry eyes are a risk with this surgery, regardless of how aggressive the approach. Those with dry eye symptoms that are present before surgery are at greater risk. The use of lubricants and other agents may help relieve the symptoms.
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Upper Eyelid Surgery Question
Dry eyes are an occasional, although usually temporary, post-operative symptom following a blepharoplasty. Certainly people who have dry eyes before surgery are at higher risk for this problem, and should either consider not having the surgery or using appropriate lubricants aggressively after surgery. If dissection into the deep fat pockets is aggressive and/or there is removal of a large amount of stretchy skin, then swelling after surgery can result in overexposure of the eye surface to the air, which will aggravate dry eyes. It is always better to be conservative when considering removal of skin and fat from the eyelids. You will look more natural and have less chance of dry eyes or other problems.
Many of my brow-upper lid junction structural fat grafting patients have come to my practice for the correction of hollowness created by the over-zealous removal of fat during an upper blepharoplasty surgery. I am continually amazed at how many cosmetic surgeons practice 1970's-era blepharoplasty surgery in the 21st century. I almost never remove upper lid fat during blepharoplasty surgery, and in many cases I actually add fat at the brow-upper lid junction. Fortunately, essentially all cases of post-blepharoplasty hollowness can be improved dramatically by structural fat grafting. It is a more challenging procedure, as scar tissue must be overcome to create space for the grafted fat, and in many cases it takes more than one fat grafting procedure to restore adequate fullness in these patients.
Lower lid hollowness following an overly aggressive lower blepharoplasty can likewise be improved. One must exercise care and caution, as lower lid skin and the underlying soft tissues are usually quite thin, and thus the lower lids are less able to conceal grafted fat. Fat grafting must be preformed conservatively here, with a plan for secondary and occasionally tertiary fat grafting procedures depending on the 'take' of the initial fat grafting surgery.
Many patients referred to me for treatment of these frustrating and difficult post-blepharoplasty problems have reported more than just a cosmetic improvement. Excessive removal of skin and fat during upper and lower blepharoplasty can impair normal lid function and cause or aggravate dry eye syndrome. In some cases the fat grafting procedure will restore suppleness and flexibility to peri-orbital soft tissues, make eyelid closing easier, and improve the truly irritating and aggravating symptoms of dry eye syndrome.
Upper Blepharoplasty Eyelid Lift Questions?
Yes, the more upper eyelid skin that is removed, the greater the amount of eye exposure that results. If you have a history of "dry eye", you may want to have conservative upper lid skin removal.
Upper eyelid surgery and dry eye.
I have never heard of dry eye with upper eyelid surgery, regardless of the amount of skin removed, unless you already have a serious dry eye problem. Most issues with dry eye relate to lower lid surgery only.
Talmage Raine MD FACS
Risk of dry eyes after upper bleph.
To directly answer your question, Yes. It is more likely to have dry eye symptoms with too much skin removal, but this is not common with an experienced surgeon. It is always better to be a little more conservative initially as a touch up to remove any residual skin is very easily done under local anesthetic. If you have confidence in your surgeon, trust his judgment and let him/her know your concerns.
Dry Eyes after Upper Eyelid Surgery Ask Dr Ellen
The tears lubricate the eyes and the lid movement assists in distributing the tears around the eye. Eyelid closure protects the eye from the environment and also from becoming excessively dry.
If the eyelids are very short they will not be able to meet when closed, causing the eye to remain exposed to air which can cause drying of the eye surface and irritation. Also, if the lid is short, it is less able to distribute the tears over the surface of the eye, similarly risking the chance for irritation.
Thanks for asking! Dr Ellen