Cosmetic eyelid surgery (blepharoplasty)

Cosmetic eyelid surgery (blepharoplasty)

Rejuvenation of upper and lower eyelids is one of the most popular procedures in aesthetic surgery. The majority of patients express similar complaints about the formation of skin folds and wrinkles in their eyelids, and bulging sacs under their eyes. However, the type of correction procedure must be determined individually, based on the patient’s age, the severity of aging signs, specific ethnic eye shape, and patient’s willingness to undergo a treatment.

Blepharoplasty is particularly indicated for patients who have pseudo-herniated fat pads in upper and lower eyelids as well as those with excess skin and hooding in upper eyelids. For patients over 40, it is usually performed along with facial rejuvenations such as full-face lift, and forehead lift with laser resurfacing.

Lower eyelid incision is done 2-3 mm below the lash line, and extends 5-9 mm further around outer corner of the eye, and along the medial ‘crow’s feet’ (fig 3). Skin excess is removed or repositioned into the lacrimal (tear) groove. The important intraoperative step is determining excision margins on excess skin of lower eyelids. Skin flap is pulled down while patient’s eyes are kept open and looking upwards. The excess flap can be excised along with or without the muscle. The incision site on operated muscle may be closed by absorbable suture and the eyelid’s skin by subcuticular suture. In cases where flaccid external margin in lower eyelid cause eye corners to pull down, outer lid margin lifting is performed, and lid is fixated at periosteum, which helps prevent the postoperative complication, ectropion.

Different techniques in lower eyelid correction.

There are over 8 eyelid rejuvenation techniques. Sometimes the lower lids’ fat tissue (fat hernia) is removed by puncturing the eyelids’ internal surface; or transconjunctivally, ie not removed at all. In the latter, the bulging fat is pressed down somewhat by being relocated upwards, and muscle tissue is fixed.

Transconjunctival Blepharoplasty

Here are some basic indications for transconjunctival blepharoplasty: young patients with fat pads but without skin excess; people at risk of dyschromic or hypertrophic scar; secondary blepharoplasty: for patients with inadequate removal of fat or relapse after a skin flap technique; and patients with pre-existing pseudo-proptosis, who risk complications of lower eyelid retraction and further showing of scleral if transcutaneous approaches are used. It is also recommended for those planning laser resurfacing.In this case, the incision is performed on eyelid’s internal surface (fig. 3) Excessive fat is removed from all lower eyelid sacs by lower lid conjunctive incision 3 mm away from bottom of conjunctival sac. Incision can be left to heal without suturing.

Grafting

An anatomical feature that negatively affects one’s appearance is a deepening tear-duct area. In such cases, problem area is filled in with autologous graft from temporal of parotid fascia. This approach, effectively practiced by plastic surgeons around the world for many years to resolve different patients’ problems, has yielded excellent results.

Hospital stay (clinical stay)

The first hours of your postoperative recovery process as well as your surgical wounds are carefully monitored. On the second postoperative day, with your sunglasses on, you can leave for home, coming back to clinic only for changing the dressings. Sutures are removed 4 – 5 days following surgery. Any postoperative swelling and edema usually heal within 2 weeks. You can return to regular life and work activities 3-5 days after surgery, wearing sunglasses.