Eyelid Reduction – Blepharoplasty

eyelid

Blepharoplasty

Blepharoplasty

Changes, such as wrinkles, bag formations, sagging and swelling that occur in the course of time in the eyelids that play a key role in facial expressions cause the person to look sad, tired and older.

What Changes Occur in the Eyelids, and Why?

The eyelids consist of skin, muscle and fat layers, inwards respectively. The eyelid skin loses its elasticity and gets loose with the effect of genetic factors and environmental factors such as age and sun rays. The subcutaneous muscle layer gets loose as well, and begins to sag with the effect of gravity. On the other hand, the fat pads, which are deeper seated and which adds a fuller and vivid appearance to the eyelids, begin to herniate forward. Thus, sagging and bag formation occur in the eyelids.

If there is a descent in the eyebrows, the excess skin in the eyelids becomes more noticeable. The make-up applied on the eyelid is hidden by the excess skin fold. In advanced cases, the excess in the upper eyelid can grow to an extent that leads to visual difficulties.

With Blepharoplasty, the excess skin in the eyelid and the excess part of the muscle layer (if any) are removed, the muscle layer is tightened, and the herniated parts of the fat bags are removed or their positions are changed. This surgery gives a livelier and younger appearance to the facial expression. However, wrinkles called crow feet around the eyes, fine wrinkles on the eyelids, dark circles around the eyes, or droopy eyebrows are not treated. Additional procedures need to done to solve these problems.

Age for the Surgery

It can be done at any age depending on the deformity of the eyelids, although it is usually performed in patients aged 30 and above.

Before the Surgery

The use of Aspirin, vitamin E, and certain painkillers or herbal preparations that reduce blood clotting should be stopped at least 10 days prior to the surgery, in order to avoid hemorrhage complications during or after surgery. The best way is to avoid using any medicines or supportive pills apart from a well-balanced diet.

Blood pressures of people who have hypertension should be taken under control with medications.

Surgery

  • The surgery should be done under the supervision of an anesthetist, and under hospital conditions.
  • Surgery can be done under local anesthesia, i.v. sedation (sedative given intravenously), and also under general anesthesia. The patient can be discharged the same day.
  • Only one of the upper or lower eyelids can be operated alone, or all the 4 eyelids can be operated at the same time.

The excess skin to be removed from the upper eyelid is marked before the operation, when the patient is in the standing position. The incision is planned in such a way as to ensure that the eyelid will be in accordance with the natural fold that occurs when the eye is open. And in the lower eyelid, the incision is made in a way that passes 1-2 mm below the eyelashes and becomes aligned to the natural folds of the skin. In some cases, where the eyelid skin is not too loose, only the fat pack can be removed by making an incision from inside the eyelid.

There is not a standard surgical technique; so, different techniques can be used depending on the existing problem and the surgeon’s preference. At the end of the surgery, the incisions are closed with sutures.

Especially surgeries of the lower eyelids require more experience. The lower eyelid gets loose in advanced ages, and may turn outward and downward (ectropion) if it is not adequately tightened during the surgery. Blepharoplasty surgery is a very technical operation done with a low margin of error. This surgery should be done by plastic surgeons trained in this field for years.

In some cases, where the eye is seated very deeply, the bones surrounding the eye can be planed or supported with surgical intervention. Again, the eyelids may need fat support.

Cosmetic surgery of the upper eyelid is mostly combined with eyebrow lift surgery. It allows for achieving a much more ideal and satisfactory result around the eyes.
The surgery time ranges from 1 to 2 hours, depending on the operation done.

After Surgery

  • Edema and bruising may occur in the eyelids, and for such cases, it is recommended to apply cold compresses, and use a high pillow when lying.
  • It does not cause severe post-operative pain, but if it does, the pain might be a sign of bleeding, and the doctor should be informed of the situation.
  • Lachrymation, burning sensation and dryness may occur in the eyes. The eyelids may remain a little bit open but this situation is expected to end as the edema goes down.
  • The sutures can be completely removed within 3-5 days after the surgery.
  • The patient can go back to work a week later, but the complete recovery of a minimal edema in the eyelids may take 3-4 weeks.
  • The patient can use contact lens a week after the operation.
  • The surgical scars can be hidden with make up in the first weeks. The scars that are pink-colored in the first weeks generally get pale, light and skin colored gradually in the following months, and consequently become less noticeable.
  • Accumulation of blood (hematoma) in the eyelids is one of the most important postoperative complications.  In order to avoid hemorrhage;
    • The patient should use a high pillow when lying during the postoperative period,
    • Cold compress should be applied,
    • Blood pressure should be monitored, and should be reduced if it is high,
    • Coughing or sneezing hard should be avoided,
    • Excessive straining in the toilet  should be avoided,
    • Lifting heavy things should be avoided,
    • Heavy sports should be avoided for a period of 2 weeks,
    • Blood thinning drugs should not be used.

A Second Surgery

The eyelids maintain their new shapes for years. If the eyelids get loose again, a second surgery is always possible.
If an undesired result is encountered in the previous surgery, a second surgery may be a necessity.

To get information about Eyelid Plasty, Blepharoplasty, please fill out the contact form.

Prof. Dr. Cengiz Açıkel, Aesthetic Plastic Surgeon, Eyelid Plasty (Blepharoplasty)