Upper and Lower Eyelids
Definition
Blepharoplasty refers to a procedure in aesthetic surgery that is designed to remedy flaws, whether the flaws are hereditary or due to age. The procedure can target just the upper lids, just the lower, or all four at the same time. Blepharoplasty can be undertaken alone or in combination with other surgical procedures, such as a brow lift, a temple lift, a mini facelift, laser abrasion, peeling and dermabrasion. Sometimes the procedures can be done in combination, and sometimes they require a second operation.
Objectives
Blepharoplasty is designed to correct the signs of aging present in the eyelids, replacing a "tired" look by eyes that are bright and healthy. The most common flaws in the eyes include:
- Heavy, fallen eyelids, with extra skin sometimes forming an apparent fold
- Sagging and withered lower lids with small horizontal wrinkles caused by cutaneous distension
- Hernias of fat, responsible for the "bags under the eyes" in the lower lids, or in pockets in the upper lids
Principles
Blepharoplasty permanently corrects these flaws by removing cutaneous and muscular excesses as well as fat pockets without altering the function of the eyelids.
It is worth noting that numerous conditions may require various procedures in association with, or other than, a classic blepharoplasty. These might include fallen eyebrows, worry lines between the brows, crow's feet in the corner of the eyes, under-eye circles, sunken eyes, and sad eyes with fallen corners, as well as small imperfections in the skin, such as spots and scars.
Men and women usually opt for blepharoplasty in their forties. Sometimes, however, the procedure is undertaken earlier, especially when the flaws are hereditary and unlinked to age, such as certain forms of under-eye bags.
Before the procedure
A patient history followed by an examination of the eyes and lids is performed by the surgeon in order to analyze abnormalities that could complicate the surgery or preclude the procedure altogether.
A special ophthalmologic exam is often necessary in order to avoid any ocular complications as well as other pre-operative checks. The anesthesiologist should be consulted no later than 48 before the surgery.
No product containing aspirin should be taken ten days prior to the surgery.
Depending on the type of anesthesia, the patient may have to avoid eating and drinking six hours prior to surgery.
Types of anesthesia
There are three kinds:
- A Local anesthesia, which numbs the eye area
- Local with light sedation, which puts the patient lightly to sleep
- General anesthetic, which fully tranquilizes the patient
The choice of anesthesia is the outcome of discussions among the surgeon, the patient and the anesthesiologist.
Hospitalization
Blepharoplasty is often an outpatient procedure, with the patient being released a few hours after the surgery. Sometimes, in certain cases, a short hospitalization is preferred. The patient checks-in the morning of the procedure (or perhaps the night before), and checks-out the day after surgery.
Procedure
Each surgeon personalizes his or her surgical technique, though certain procedural features are held in common.
Cutaneous incisions
- Upper eyelids: the incisions are dissimulated in the fold in the middle of the lid, between the moving and fixed parts of the lid.
- Lower eyelids: the incisions are placed 1 or 2 millimeters under the eyelashes, though in some cases they may extend slightly beyond the eye.
The position of the incisions corresponds to the scars, which will be dissimulated in the natural folds of the eyes. Please note: in terms of the lower lids, and in cases of bags under the eyes without excess skin, the blepharoplasty can be performed by entering underneath the eyelid itself so that there is no visible scar on the surface of the eye.
Resectioning
Once the incisions have been made, the fat can be removed along with excess skin. At this stage, the surgeon makes technical decisions based on his or her expertise.
Sutures
The sutures are made with a very fine thread. They are either absorbed or removed after a few days. Depending on the surgeon, the number and kind of procedures to be performed, as well as various potential complementary procedures, the blepharoplasty lasts anywhere from one half-hour to two hours.
Post-operative procedures
There is no pain, although some discomfort is common along with a feeling of tightness in the lids. The eyes may be irritated, and there may be slight trouble in vision.
Patients should take it easy after the procedure and avoid all strenuous activity.
Swelling often occurs, along with a very slight bruising, which varies from one person to the next. Sometimes patients have trouble closing their eyes immediately following the procedure, and sometimes the eyelids feel stiff. These are normal stages in healing which rapidly disappear.
The sutures are removed between the third and sixth day after the procedure. Swelling diminishes progressively, permitting a return to work between the 6th and 20th day, depending on the complexity of the procedure.
The scars may be a little pink for the first few weeks, but they can be covered with make-up a week after the surgery.
Results
The results of the blepharoplasty become final in three to sex months. It takes this much time for the tissues to become supple again and for the scars to fade.
Since the procedure often targets the correction of flabby skin around the eyes and removal of under-eye bags, the eyes lose their old and tired look.
The results of the blepharoplasty are recognized to be among the most durable in the field of aesthetic surgery. The ablation of under-eye bags is often permanent, since they usually do not reappear. The skin, however, continues to age and lose its tone, possibly resulting in extra folds. It is rare, however, to have a second procedure in less than 12 years
Imperfections
Even though the blepharoplasty is performed for aesthetic reasons, it's still a surgical procedure and accompanied by the risks, though minimal, of other surgical interventions.
There are two kinds of risks: anesthetic and surgical.
In terms of risks linked to anesthesia, the anesthesiologist will inform the patient of possible complications. Sometimes the anesthetic causes side effects that are more or less difficult to control. For this reason, a top anesthesiologist, experienced in surgery, is necessary so that the risks are statistically negligible. That said, techniques in anesthesia have made enormous progress in the last 20 years and are perfectly safe for someone in good health.
In terms of the surgery, it is absolutely necessary to choose a surgeon who is qualified, competent, and trained in the procedure. In this way, the risks are minimized though not completely negated.
Fortunately, real complications are rare in a blepharoplasty that follows the rules. In practice, the vast majority of procedures are without complication, and the patients extremely satisfied with the results.
However, you should know that the following complications are possible:
- Hematoma. Most of the time, hematoma are not serious, but can be drained if necessary.
- Infection. This is rare when the procedure is conducted under normal antiseptic conditions.
- Superficial cysts that disappear on their own without impacting the final result.
- Minor superficial lesions to the eyeball that, with proper treatment, heal rapidly without complication.
- Trouble with tears. Too much tearing is more rare than a "dry" eye. The latter sometimes follows a situation in which there has been too much tearing prior to surgery.
- Difficulty opening the upper lid of the eye is very rare in patients younger than 70 years of age.
- Difficulty closing the upper lid of the eye is possible in the first few days following the procedure, but normally does not persist.
- Difficulty retracting the lower lid is extremely rare, but when it occurs, it is usually treated with massage.
- Finally, in the most exceptional circumstances, there is a risk of double vision, glaucoma and even blindness that have been reported in international scientific literature.
While these risks exist, they should not be exaggerated. The patient should simply be aware that there are risks any time surgery is performed. A qualified Plastic Surgeon with the required knowledge and skill knows how to avoid complications and treat them in the rare circumstances in which they occur.
