What is functional eyelid surgery?

While cosmetic eyelid surgery is primarily focused on improving the patient’s appearance, functional blepharoplasty aims to address issues in this region that inhibit proper eye function. The most common goal of this procedure is to alleviate obstructed vision, allowing the patient to see more clearly.

While blepharoplasty can treat both the upper and lower eyelids, this version of the procedure is primarily designed to address the upper eyelids. This is due to the fact that obscured vision is the most common functional problem associated with the eyelids. Over time, the upper eyelids may droop over the eyes, making it difficult for the patient to see. This condition is known as ptosis.

For some patients, the excess skin in sagging upper eyelids can make it difficult for them to wear contact lenses or glasses, preventing them from having proper vision. Beyond that, patients who have chronic pain in the upper forehead region may require functional eyelid surgery. This is due to the fact that, when the skin around the upper eye region starts to sag or becomes heavy, the patient has to flex their brow muscles in order to elevate their upper eyelids. Functional eyelid surgery will lighten the load on these muscles and provide relief from all associated pain.

Functional eyelid surgery can also mitigate the discomfort and irritation that results from the upper and lower eyelids rubbing together.

What causes Ptosis?

There are multiple factors that can lead to the development of ptosis. Some individuals are naturally born with sagging upper eyelids on one or both of their eyes. In cases where the ptosis is extensive enough that it obstructs a baby’s vision, it is usually recommended that surgery be carried out right away to prevent long-term vision damage and other potential issues. If the ptosis doesn’t completely block the baby’s vision, treatment is usually put off until around age 5. 

Ptosis can also manifest in adult patients, either due to the natural aging process or because of a tumor, eye issue, or muscle disease. If the ptosis has resulted from aging, functional eyelid surgery is an effective method for addressing it. In cases where patients are dealing with a muscle disease or other related problem in the eye, such as a tumor, the first approach will be to treat the disease or tumor directly before resorting to a blepharoplasty.

What are the benefits?

As mentioned previously, this procedure is designed to address functional issues that result from ptosis (sagging eyelids). As such the primary benefits that patients seek to gain from the treatment are functional. Some of these include: 

  • Improved vision (as the upper eyelids are no longer obstructing the eyes)
  • Eyewear fits more comfortably and securely in or over the eyes (contacts and glasses)
  • Discomfort and irritation that results from the upper and lower eyelids rubbing together are greatly attenuated 

While the procedure is functional in scope, it also comes with cosmetic benefits. These can include:

  • A more youthful appearance
  • A less ‘tired’ look
  • A boost in self-confidence
  • A smoother forehead (as there is no more need to ‘elevate’ the eyelids by straining the forehead muscles)
  • Minimal scarring
  • Fewer misunderstandings with interlocutors (patients’ expressions are much better-aligned with how they actually feel) 

Who is an ideal candidate for functional eyelid surgery?

Ideal candidates for functional blepharoplasty are patients who:

  • Are free of pre-existing medical issues that can lead to complications with the procedure
  • Are non-smokers
  • Are free of other eye issues
  • Have realistic expectations for the outcome of the procedure

Beyond these criteria, ideal patients for upper eyelid surgery include patients who are struggling with excess skin hanging over their upper eyelids. Patients should have normal brow position and eye margins. Having healthy skin that’s free of discoloration and no eye problems is also important. 

What does the procedure entail?

Functional blepharoplasty is performed on the upper eyelids to remove excess tissue that is obstructing the patient’s field of vision. The procedure is usually performed under mild sedation and/or a local anesthetic. First, a discrete incision is made within the natural fold of the eyelid. This incision serves as an access point through which excess skin can be removed. During the procedure, the symmetry of the patient’s eyes is closely monitored to ensure that the results are both functionally and aesthetically pleasing.

What is the recovery process like?

Generally speaking, functional blepharoplasty is associated with a mild recovery period. The eyelids may remain swollen or bruised anywhere from 1 to 3 weeks following the treatment. The appearance of the eyes will slowly improve over a period of 1 to 3 months. That said, most patients feel ready to get back to work and their daily activities in just 10 to 14 days. Overall, the length and details of the recovery process will depend on the severity of the patient’s problems. More information will be provided following a formal assessment of the patient’s condition.

Written by Dr. Halaas

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