Eyelid Plastic Surgery (Blepharoplasty)

The eyelids may become droopy or baggy at younger ages, due to aging or sometimes heredity as well as excessive fatigue of the eyes. Sometimes, there is only sagging skin without bag formation. Eyelid surgery, or blepharoplasty, is a cosmetic surgical intervention intended for the eyelid. In this intervention, excess adipose tissue, skin and muscle are removed from the upper and lower eyelids. However, amount of tissues to be removed should be well planned. An appropriately performed blepharoplasty gives a younger appearance to the patient. Eyelid surgery is performed under local anesthesia, with a light intravenous sedation (tranquilizer). Each surgical intervention leaves a scar that is more or less visible. The important thing is that such a scar is very thin and unnoticeable. The eyelids are almost the areas of the body, where incisions leave the least scar. Incisions of the intervention are positioned in the natural creases of the upper and lower eyelids. They are made horizontally 1 mm below the eyelashes. Therefore, the scar is not noticeable. When applied to the upper eyelids, the incisions are positioned in the natural curve that forms above when the eye is open. The scar is not visible when the eye is open. However, it can be noticed if it is observed too closely during sleep. The surgical scar is pink in the beginning but it return to white and normal skin color in the course of time.

Blepharoplasty does not eliminate wrinkles around the eyes and dose not lift droopy eyebrows. For this purpose, additional interventions can also be made in the same session. Dark circles around the eyes are also eliminated to a certain extent, if they are related to under eye bags.

Can anyone have blepharoplasty?
The best candidates are healthy people who are psychologically well-balanced and conscious. Some systemic diseases increase the risk of blepharoplasty. These include thyroid diseases, hypertension, and conditions in which adequate amount of tear is not produced for moisturizing the eyes.

When performed by an experienced plastic surgeon, the rate complications is very low. In all patients, bruises and swelling develop and last for a few days after surgery. Some patients may temporarily experience blurred vision due to pomades applied to the incision sites. And rarely, the lower eyelid may be slightly pulled down, leading to ectropion (the eyelid is not fully closed, may remain slightly open). This is usually temporary condition. But if is not eliminated, a second surgery may rarely be needed. Bleeding, infection, wound dehiscence, and severe scars, which are the theoretical complications of any surgery, are likely to occur, despite being rare.

Blepharoplasty can be performed alone or in junction with other facial plasty procedures, such as face lift and eyebrow lift. If you consider having an eyelid surgery, only information about the basic features of the surgery—such as when the surgery will be helpful for you, how is it performed, and what you must expect—can be given to you. Your all questions cannot be not replied because their answers mainly depend on the patient and the surgeon. If there is anything that you do not understand, please ask your surgeon. Blepharoplasty enhances your appearance and your self-confidence; however, it may fail in changing your appearance to an extent that can be compared with your ideal or ensure other people to treat you differently. Before deciding to have surgery, think about your expectations and discuss them with your surgeon. The best candidates are men and women, who are physically healthy, psychologically stable, and who have realistic expectations. Most of them are at the age of 35 or over; however, you may decide to have eyelid surgery at a younger age if droopy and baggy eyelids run in your family.

When performed by a skillful plastic surgeon, the rate of complications is low. The minor complications that appear after blepharoplasty include double or blurred vision for a few days; temporary swelling at the corners of the eyelids; and a slight asymmetry in healing or scar formation. Small whiteheads may appear after removal of the sutures; your surgeon can easily eliminate with a very fine needle. After surgery, some patients may have difficulty in closing their eyes when sleeping; and rarely this condition may be permanent. Another rare complication is ectropion, a pulling down of the lower lids. In such a case, a surgical intervention may be needed. Eyelid surgery is performed under local anesthesia that numbs the area around the eyes, in conjunction with oral or intravenous sedatives. You will be awake during the surgery, but you will be relaxed and will not feel pain. (However, you may feel some tugging or discomfort)

Blepharoplasty usually takes one to three hours. If blepharoplasty will involve both the upper and lower eyelids, first the upper lids and then the lower ones will be operated. In a typical intervention, the surgeon makes incisions following the natural lines of your eyelids; which are the lines of your upper lids, and the ones just below the eyelashes in the lower lids. The incisions can be extend to the crow’s feet or laugh lines at the outer corners of the eyes. Working through these incisions, the surgeon separates the skin from the underlying adipose tissue and muscle tissue, removes excess fat, or spreads the herniated fat over the hollow area below for achieving a proper appearance in fat-protecting techniques, and removes the excess skin and muscle tissues. Then the incisions are closed with very fine sutures. If you have fat bags beneath your lower eyelids, which do not require removal of skin, a transconjunctival blepharoplasty can be performed. In such an intervention, the incision is made inside the lower eyelid, leaving no visible scar. It is usually performed on younger patients who have thicker and more elastic skin.

After surgery, the surgeon will moisten your eyes with pomade and may also apply a bandage. May feel your eyelids tightened after recovery from the anesthesia; however, the pain and discomfort can be managed with the painkillers prescribed by your surgeon. If you feel a severe pain, call your surgeon immediately. Your surgeon will advise you to keep your head elevated for a period of several days, and to apply cold compresses for reducing the swelling and bruising. (Bruising varies from person to person: it reaches the highest level during the first week, and usually lasts two to four weeks). Many doctors recommend eyedrops because you may feel your eyelids dry, and your eyes may burn or itch. For the first few weeks certain temporary changes may be experienced, such as excessive tearing, sensitivity to light, blurring or double vision. Your surgeon will follow your healing process closely for the first week or two. Sutures should be removed three to seven days after surgery. After the removal of the sutures, the swelling and bruises around the eyes will gradually disappear and you will begin to see and feel better. You will be able to read and watch television after two to three days. However, you will not be able to wear contact lenses for two weeks, and even if you wear, you may feel uncomfortable for a while. Many people feel ready to return to their daily lives and works within a week to ten days. Depending on the rate of healing and your doctor’s advices, you will be able to wear makeup to hide the remaining bruising. You may be sensitive to sunlight, wind, and other irritants for a period of several weeks; therefore, you should wear sunglasses when you go out. You should stay away from daily activities for 3 to 5 days, and avoid strenuous activities for about three weeks. It is especially important to avoid certain activities such as bending, lifting, and rigorous sports, etc. which raise your blood pressure. It will be appropriate to abstain from alcohol because it causes fluid retention. At the end of surgery, bandages that close the eyelids are applied. However, you will be able to see through narrow gaps in the bandages. The next day, the bandages will be replaced with new ones. Then this process will be repeated two times within 3 to 7 days, and the sutures are removed gradually.

Healing period
Healing is a gradual process, and your scars may remain slightly pink for a period of six months or more after surgery. In the course of time, they will fade until turn into a thin, nearly invisible white line. On the other hand, the positive results of your eyelid surgery—more alert and youthful looks—will last for years. For many people, these results are permanent.


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