Upper and lower blepharoplasty

"The eyes are the point where a person's identity is concentrated" believed Milan Kundera and no one should read only our age in them. However, it is not only identity that is reflected in our gaze. Modern psychology, trying to answer questions that govern the ability of leadership, has been led to the conclusion that our look determines our position in the groups we participate in. Gaze provides a reliable, behavioral, and underutilized source of information about a group's hierarchy and functioning. Leaders differ from followers not only because they attract attention, but because while they can direct the eyes of others, they themselves manage to keep their gaze fixed.

A dynamic look therefore indicates a dynamic personality.

As we grow older, however, our gaze changes. Drooping eyebrows, heavy upper eyelids, bags under the eyes make our eyes and gaze look tired, aged and sluggish, while in advanced cases our peripheral vision is also affected.

Blepharoplasty is a small surgical procedure that can reduce or even rid us of these signs of time and restore our visual fields. Calmness, balance and dynamism return to our gaze and overall to what our face exudes. For complete results, it is recommended to combine blepharoplasty with facial wrinkleectomy, "facelift".

Upper and lower eyelid surgery

Blepharoplasty is the operation in which excess skin and periorbital fat are removed from the upper and lower eyelids in order to restore a more youthful look. The purpose of the surgery is to remove the loose skin, wrinkles or protruding fat, but without creating emptying of the eyelids.

WHAT HAPPENS AS WE GROW?

As we age the circular muscle of the eyelid weakens, relaxes and descends, dragging the skin of the eyelids with it. As a result, the lacrimal groove appears prominent, the lower eyelid elongates and relaxes, which in advanced age shows ectropion and levitation, while the upper eyelid shows skin relaxation and drooping. Loosening also occurs in the septum (supportive tissue under the skin of the eyelid) which allows the fat to project and create small hernias under the skin (bags) at the same time as the eyeball sinks inward. As we age, the skin of the eyelids atrophies, becoming thinner with fewer elastin fibers. It is therefore understandable why blepharoplasty should be performed by a plastic surgeon with a complete understanding of the problems of aging of the eye.

WHAT CAN HAPPEN?

Depending on the needs, upper, lower eyelid surgery or a combination of the two can be done. Preoperative examination and proper planning are of great importance.

In upper blepharoplasty: the incision is made in the skin (in the eyelid fold), skin and a small part of the muscle are removed, while if there are lipoceles, they must be carefully removed or placed in their correct position. The wound is closed with non-absorbable sutures which are removed on the 5th day. There is no pain, but there is swelling and small bruising (bruising), which subsides in the first week.

In lower blepharoplasty: the incision is made in the skin, a few millimeters below the eyelashes or in the conjunctiva (when skin removal is not necessary). Mainly fat and less skin is removed (when there are bags), while often the outer canthus ligament needs to be strengthened (with a canthor suture) to restore the youthful shape of the eye. The wound is closed with non-absorbable sutures which are removed in 5-6 days. As in upper eyelid surgery, there is no pain, but there is swelling and small bruising (bruises), which subside in the 1st-2nd week.

WHO IS EYELID PLASTIC FOR?

Blepharoplasty is aimed at those who wish to give a more restful look to their look and by extension to their whole face, they are usually in their 40s-50s. People with a family history of sagging eyelids, severe wrinkling, bags and dark circles turn to their plastic a decade sooner. A separate category is women with floppy eyes syndrome, who experience intense fluid retention around the eyes during their menstrual cycle and who will seek an early surgical solution for the deterioration of their eyelids. However, surgery is indicated for all patients whose vision is mechanically obstructed by excess skin of the upper eyelid and those who have already undergone a facial wrinkleectomy, and who want to restore an overall younger face.

WHAT IS THE TYPE OF ANESTHESIA FOR EYELID PLASTIC?

Blepharoplasty is performed under local anesthesia (with or without sedation) or general anesthesia. The duration of the operation is approximately one hour for the upper eyelids and 1.5 hours for the lower ones.

WHAT WILL THE SCARS BE LIKE AFTER EYELID PLASTIC?

In standard blepharoplasty incisions are made over the natural lash crease of the upper eyelid and just below the lashes of the lower eyelid. Both incisions have a slight extension to the sides, towards the "crow's foot". The incisions, which are hidden within the normal folds of the eyelids, are red at first, gradually discolor and after 8-12 months are difficult to detect. Especially for the lower eyelid, when the problem is lipoceles that project and there is no skin laxity, the incision can be made inside the conjunctiva, without an obvious incision on the skin of the lower eyelid.

WHAT WILL BE THE DURATION OF THE RESULTS?

The results are long-lasting, but it also depends on the patient to modify his daily life to maintain them. Thus, in addition to the general instructions for proper hydration, nutrition and hours of rest, instructions will be given for special cosmetic and sun creams, for the need for prophylactic use of botox to reduce wrinkles on the "crow's feet" and for the use of special fractional lasers ( ERBIUM-YAG) or herbal peelings that rejuvenate the skin around the socket. Over time the skin loses its elasticity again and the muscles relax, with the result that the surgery has to be repeated after 10-15 years.

WHAT ARE THE LIMITATIONS FOR EYELID PLASTIC?

It is important to understand that the blepharoplasty procedure reduces excess skin, along with existing wrinkles on the upper and lower lids, and that it improves the contour of the eyes by reducing the fat that is present under the lids and restoring the correct / youthful slope of the outer canthus. However, it does not significantly affect the wrinkles on the "crow's feet" and does not change the position of the eyebrows. These can be temporarily corrected using botox and threads or surgically with a brow lift.

WHAT ARE THE RISKS FROM EYELID PLASTIC?

The doctor will evaluate your general condition and your history and, if he decides that you are suitable for surgery, he will inform you about the possible complications and what needs to be done to reduce the possibility of their occurrence. You will also be asked to stop smoking and refrain from using supplements that affect blood clotting. The anesthesiologist will then talk to you about the type of anesthesia you will receive and the possible complications.

As a general rule, when the operation is performed by qualified plastic surgeons, complications are extremely rare and usually minor. It is very important that the patient follows the pre-operative and post-operative instructions and informs his doctor about everything that concerns him.

WHAT YOU SHOULD DO BEFORE THE OPERATION?

Depending on your age, you will be given instructions on the medications you may be taking and what you should take next, as well as the additional testing you may need to do based on your history. In case you have a history of chronic allergic conjunctivitis, glaucoma, Graves' disease, etc. you will need to be examined by an ophthalmologist.

The doctor will explain the value of smoking cessation and proper nutrition in wound healing. One week before the surgery you will be photographed and sign the consent form.

WHAT YOU SHOULD DO AFTER THE OPERATION?

When you leave the surgery you will wear special adhesive gauze and you will have a feeling of tension in the eyelids from the developing swelling. You will need to have an escort with you to get home safely.

In the first hours after the operation, it is recommended to use ice patches, to avoid swelling and bleeding, artificial tears and eye ointment. Analgesics are rarely needed. If you are diabetic or smoke you will need to take antibiotics.

You stay in the clinic for two hours, but the time away from work, due to the swelling and effusions, must have been calculated at 1 week. This does not mean that you will not be able to do light work much sooner, but in general you will be careful because the swelling and ecchymosis can easily worsen. You should avoid bending over, intense physical fatigue and exposure to the sun. After the stitches are removed you will be given instructions for the scar, which is easily hidden and disappears within the next few months.

WHAT IS THE COST OF THE OPERATION?

The cost of blepharoplasty is calculated by adding the cost of the clinic, in which the patient is operated and treated, the fee of the Plastic Surgeon and the Anesthesiologist.