Are Upper Eyelid Blepharoplasty and LASIK Compatible?

Eyelid blepharoplasty and LASIK

Because of the growing popularity of LASIK, the number of people seeking blepharoplasty who have either had or are actively considering having LASIK has increased more than ever. However, generally speaking, the two procedures are considered compatible with each other. To maximize the chance for a good refractive result, however, several general guidelines related to proper timing and selection of eyelid surgical approach should be considered. According to the most eye health experts, while either LASIK or blepharoplasty may be performed before or after the other, the two procedures should not be performed simultaneously (at the same time). However, which procedure is performed first can make a big difference to the patient outcome. The following review article investigates the changes in tear secretion and tear film stability after upper lid blepharoplasty in patients that had previously undergone excimer laser in situ keratomileusis (LASIK).

What is blepharoplasty?
Eyelid surgery or blepharoplasty is a procedure to remove excess skin, muscle or fat from the upper and lower eyelids. It can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel, and may interfere with your vision. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift.

Depending on the part of eyelid, blepharoplasty can be of two types:

Upper eyelid blepharoplasty: Upper eyelids are treated through a small incision hidden in the crease of the upper eyelid.

Lower eyelid blepharoplasty: Lower eyelids are also treated with a well -hidden incision placed just under the eyelashes

Blephoroplasty and LASIK surgery - Why should the two procedures not be done simultaneously?
It is now widely believed that both LASIK & upper or lower lid blepharoplasty should not be done together because of the following important factors:

Corneal stress: No matter how gentle your eyelid surgeon's touch, there is some stress placed on the cornea during the operation.

Symptoms aggravation: The short term interference with normal eyelid closure and positioning during healing may aggravate symptoms caused by the tear deficiency and dryness often experienced by those who have undergone recent LASIK.

What is the scientific evidence?
To investigate and evaluate the changes in tear secretion and tear film stability after upper lid blepharoplasty in patients that had previously undergone excimer laser in situ keratomileusis (LASIK), a clinical trial study was done in 9 patients (18 eyes) who had previously undergone bilateral LASIK (LASIK was done in both eyes of each of the patients) 18 months before the study. A typical carbon dioxide (CO2) laser upper lid blepharoplasty was then performed in the 18 eyes of these 9 patients. Six women and 3 men aged 35 to 52 were included in this specific group and an additional control group of 18 eyes of similar age patients with no history of LASIK, contact lens usage or dry eye symptoms was also studied for comparison. The Schirmer tear test values (a test that measures the quantity of tears in the eyes) were measured at 5 minutes in both groups before and after the upper lid blepharoplasty procedure. Tear break-up time values were also measured before and 4 weeks after (CO2) laser upper lid blepharoplasty. The Schirmer tear test and tear break-up time values were then analyzed. Fortunately and promisingly, there was no statistical difference between the two groups. In other words, no difference (in terms of symptoms) was found in both groups. This clearly shows that after a safe interval period, blepharoplasty can be safely done in patients who have already undergone LASIK surgery.

Because of the similar nature of some side effects after LASIK and blepharoplasty (such as dry eye symptoms) both, the decision to perform both procedures together should be a serious consideration. However, fortunately, if LASIK is performed first, most of such symptoms are usually temporary, and upper lid blepharoplasty can be safely performed in these patients after a certain time interval(ideally should be delayed for about six months or more) by closely monitoring their preoperative (before surgery) and postoperative (after surgery) tear function.

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