The Skin Loses Its Vitality And Our Muscles Also Relax With Age. For the eyelids, this leads to a buildup of loose skin that collects as folds in the upper eyelids and forms deepening creases in the lower eyelids.
At the same time, there is a loosening of the muscle under the skin allowing the fat, which stuffs the eyes in their sockets, to protrude forward to give the appearance of bagging. In some families, the sacs tend to develop in early adulthood before any skin changes.
What Is Blepharoplasty Surgery?
Blepharoplasty surgery, commonly known as eyelid reduction, is an eyelid reshaping operation. A reduction in the upper eyelids can improve your vision and make you look younger. Reducing the lower eyelids can help reduce wrinkles and puffiness.
Why Eyelid Reduction?
With age, our muscles relax and the skin loses its elasticity. In addition, the relaxation of the muscles under the skin allows the fats that cushion the eyes in their sockets to bulge forward to give the appearance of bagging. In some families, the sacs tend to develop in early adulthood.
Folds and puffiness often seem worse when you wake up, especially after periods of stress and insufficient sleep. This is because the fluid that is normally distributed throughout the body when standing tends to settle in areas where the skin is loose, such as the eyelids, when a person is lying down.
Old age can also cause sagging eyelids and skin folds gathering in the upper eyelids. Sometimes there is so much skin that the upper eyelids hang over the eyelashes.
The skin loses its vitality and our muscles also relax with age. For the eyelids, this results in a buildup of loose skin that collects as creases in the upper eyelids and forms deepening creases in the lower eyelids. At the same time, there is a loosening of the muscle under the skin allowing the fat, which stuffs the eyes in their sockets, to protrude forward to give the appearance of bagging. In some families, the sacs tend to develop in early adulthood before any skin changes.
What Will Happen Before My Operation?
You will meet with your surgeon to explain to you why you want surgery and what you want. The surgeon will take note of any illnesses you have or have had in the past. In particular, you should tell them if you have ever had thyroid disease, high blood pressure, diabetes, or eye disorders (such as a detached retina or glaucoma). The surgeon will also record any medications you take, including herbal remedies and medications not prescribed by your doctor.
Your surgeon will examine your eyes, face, and skin, and may take pictures for your medical records. They will ask you to sign a consent form to take, store and use the photographs.
Depending on your weight and height measurement the surgeon can make sure it is safe to do an operation. If you are overweight, pregnant, or planning to become pregnant, your surgeon may suggest delaying your operation. If you are to have the surgery under local anesthesia, the surgeon will make sure that you can lie flat and still to be checked by an ophthalmologist.
How Is The Surgery Performed?
Eyelid reductions can be done under local anesthesia or general anesthesia (in hospital only). In a typical procedure, the surgeon makes cuts that follow the natural lines of your eyelids - in the creases of the upper eyelids and just below the lashes in the lower eyelids (see the eye to the left of the diagram opposite). These cuts extend a bit into the crow's feet (also called laugh lines) at the corners of the eyes.
With these cuts, extra fat, excess skin and muscle sagging are eliminated. If you have a pocket of fat under your lower eyelids without additional skin, the fat can be removed from the inside of the lower eyelid (see the eye to the right of the diagram opposite). All cuts made will be sewn up.
Choosing A Surgeon
If you decide to have an eyelid reduction, go only to a surgeon who is properly trained and registered in the register of specialists kept by the General Medical. They will tell you about what is possible for you or could give the best results. Members of several different organizations perform cosmetic surgery, so your GP is the best person to advise you on who to see No one needs urgent eyelid reduction. If you don't have time to think about it, you should look elsewhere.
How Can I Do For Operation Succes?
Be as healthy as possible. It is important to keep your weight stable with a good diet and regular exercise. Your GP can help you for this. If you smoke, stopping at least six weeks before the operation will help reduce the risk of complications. Don't worry about removing hair near where the cuts will be made, but take a bath or shower for the 24 hours before your operation to make sure the area is as clean as possible.
What is the alternative treatment?
Sometimes a sagging forehead and eyebrow can make the eyelid look saggy. Your surgeon can recommend to perform an eyebrow lift operation instead of or at the same time an eyelid reduction.
Only the skin wrinkles cut by surgery will be improved. Skin folds extending over the cheek will not normally improve. If you have wrinkles and saggy skin elsewhere on your face and neck, having a facelift or facelift (or both) along with the eyelid reduction may help. A facelift can be used not only to lift the eyebrow and upper eyelid, but also to lift and open the outer corner of the eye.
While eyelid reduction is the best way to reduce eyelid sagging, sometimes a laser can be used to burn your skin surface in a controlled manner. This is called laser surfacing and it can be done at the same time as eyelid reduction to improve the remaining wrinkles. After laser surfacing, the skin heals to be smoother and less wrinkled. This is not permanent and the process does not work well on dark skin. It has not any effect on dark circles under the eye.
Botox (botulinum toxin injections) can also be used to smooth fine wrinkles.
What are the main risks and complications of eyelid reduction?
As with all operations, eyelid reduction comes with risks. While the risks are unlikely, it is important to weigh them against the potential benefits of surgery. Discuss each of these with your plastic surgeon to make sure you understand the complications and potential consequences.
Complications Associated With Surgery
Scars There will be scars from the surgery. These will usually be red at first, then purple, then fade to paler in 12-18 months. Sometimes the scars can become larger, thicker, red, or painful, and you may need to have surgery to correct them.
Bleeding Bleeding into the wound or socket is unusual but possible, and you may need a blood transfusion or other operation (or both) to stop the bleeding. If there is bleeding in the eye socket, it is an emergency because increased pressure in the eye socket can cause permanent blindness. The risk of bleeding into the orbit is higher if your surgeon has to remove the fat. This usually happens immediately after or shortly after surgery. A buildup of clotted blood under the wound can delay healing or cause scarring, and you may need another operation to remove it. Before surgery, your surgeon will discuss any medications that increase the risk of bleeding, and it is important to control high blood pressure.
Infection If you get an infection in the wound, you may need antibiotics or another operation. This can affect the end result of the surgery.
Swelling, Bruising, and Pain There will be swelling and bruising around the eyes after the operation, and it may take weeks to set in. Rarely there might be long-term pain. The end result may take several months to appear after the swelling has completely subsided.
Healing Problems Sometimes wounds take longer than expected to heal. This problem is usually solved by dressing the wounds, but you may need an operation to remove the tissue that has not healed. Healing for smokers is difficult. Sometimes there may be small and white cysts along the stitch line. There is nothing to worry about and your nurse practitioner can remove them with a needle. If you have a tendency to suffer from dry eye or eye flushing, surgery will temporarily make it worse. However, it should settle down within six weeks.
Extrusion This is where deep points pass through the skin. These can be easily removed.
Increased or reduced sensation after surgery, the skin near the scar may be more or less sensitive. Rarely the change in sensation can be permanent.
Asymmetry is the situation that the eyes are not symmetrical. Almost everyone has a slight degree of asymmetry, and eyelid surgery can make you much more aware of this.
Eyelid Position For the first day or two after surgery, it's quite common for the lash line of the lower eyelid to be slightly away from the eye due to swelling. This is usually resolved on its own or with simple dressings, but you may need another operation. If too much skin is removed, it can make your eyelid so tight that you cannot close it properly. This can lead to dryness of the surface of the eye. If this is serious, you can need a small skin graft.
Damage to Deeper Structures Although rare, surgery can damage deeper structures including the eyes, nerves, blood vessels, and muscles. This damage can be temporary or permanent. Blindness is an exceptionally rare complication. However, temporary changes in the moisture film on the eyeball or pressure on the eye itself can affect your eyesight and make you more aware of age-related deterioration in vision. Any temporary effect of the surgery will go away within six months. Rarely, the surface of the eye may be scratched during the operation or by a point. If this happens, you may need to use antibiotic ointment for a few days. If the operation was to remove fat from a lower eyelid, there may be damage to the eye muscle in the fat, which can cause double vision. It can be permanent and you will need to have a second operation.
Unsatisfactory result Sometimes patients are nothappy for the result of their eyelid operation. It may be related to the look or feel of the eyelids or the shape of the eyelids not meeting expectations. It is very important that you talk to your surgeon, before having the operation, about the result you want, and whether it can be safely achieved with a good result. A very small number of patients require another operation to achieve the desired result.
Change over time The result of an eyelid reduction typically lasts five to 10 years and can sometimes be permanent. The appearance of your eyelids will change due to aging, sun exposure, or other circumstances unrelated to your surgery. You may need more operations or other treatments in the future to maintain the results of eyelid reduction.
Allergic reaction Rarely, allergic reactions , stitches or solutions have been reported. If you have an allergic reaction, you may need extra health service.
Risks of anesthesia
Allergic reactions You may have an allergic reaction to the anesthetic.
Chest infection There may be rarely chest infection. The risk is higher if you are smoker.
Blood clots Blood clots can form in the leg (called deep vein thrombosis or “DVT”). These cause pain and swelling and should be treated with blood thinning medications. In rare cases, part of the clot ruptures and goes into the lungs (called pulmonary embolism or “PE”). Your risk is higher if you smoke, are overweight, or take birth control pills.
Heart attack or stroke A heart attack or stroke can be caused by the strain placed on your heart during surgery. Your case will be assesed before operation. Death As with any surgery, it is possible to die as a result of the operation
What To Expect After The Operation
Eyelid reductions are usually done under general anesthesia, or local anesthesia and sedation (where the whole area is numb from injections and you are awake but sedated to keep you calm). Eyelid reductions for the upper eyelid are usually done under local anesthesia. The operation generally takes 1-2 hours.
You may be given antibiotics to keep the wound clean. You can go home the same day or stay in the hospital overnight. If you are going home the same day, a responsible adult should stay with you overnight. Simple pain relievers should be enough to keep you comfortable. After surgery, you should not drive or use machinery for at least 24 hours until you have regained feeling, movement and coordination.
It is common to have watery eyes after eyelid reduction, partly because of the swelling under the conjunctiva (the membrane that covers the front of the eye and lines the inside of the eye socket) and partly because that the tear ducts are swollen and not draining properly. It will last a few weeks. Your surgeon will give you eye drops to help lessen the feeling of granulation. After surgery, the eyelids may look and feel tight when closed due to swelling and shrinkage of the skin. If you cannot completely close your eyes at night, you should apply eye ointment before going to sleep. This tightness will subside as the swelling decreases.
The surgeon may apply suture bands to support the eyelids. If these bands become crusted, they can be changed . Cleaning the eyes with water is helpful, and the surgeon may advise you to use eye drops or ointment. Sleeping soundly will help reduce swelling and help you stay on your back. Using cold compresses on your eyelids for a day or two can also help reduce bruising and swelling. Do not applicate ice direct to your skin.
The stitches are usually removed after three to five days, and you can use makeup shortly after. It may be advisable to use the suture bands to support the lower eyelids for about a week.
Generally you will not stay at hospital. You might have a little bleeding from your eyelids for the first day or two after your operation. Dab gently with squares of gauze or a clean tissue. Activities that increase blood flow to your face (for example, bending, straining, lifting, or taking a hot bath) can increase your chances of bleeding, so avoid them for the first week. Sleep with extra pillows to keep your head up and be soft with your eyelids for at least another month. You can gently clean your eyes with damp gauze.
You can perform some activities after one or two weeks. Generally patients take at least two weeks off work after the operation. Do not lift heavy objects for several weeks and avoid sex for at least two weeks. With all activities, start slow. Don't drive until you feel safe and comfortable wearing a seat belt. Check your homework for the results
At first, the skin in your eyes may seem too tight and swollen, and you will get bruising, which can be disguised with makeup and dark glasses. The swelling may take a few weeks and several months for the final result to appear.
The scars will be pink for a few months, but eventually they will become almost invisible. The scars can also become tight after a few weeks, but this normally sets in after four to six months. Most patients are happy with the end result, but some find their new form difficult to use. It can happen to you.
- To protect your body and get the best result, take care of yourself.
- Avoid strenuous activities after your operation.
- Protect your injuries as you are told.
- Gaining weight will affect the results. Maintain a convenient weight and performing a level of exercise.
Bleeding after surgery can cause swelling, color change, and pain, usually on one side. If the bleeding is inside the eye socket, it can cause a headache and affect vision. If this happens, go directly to the nearest A&E service.
Signs of infection are pain, redness, swelling, and pus on the wound, and you can also have a temperature.
A blood clot in the leg may make swelling and pain in the calf. If the clot goes to the lungs, you may be short of breath or have pain in your chest. If the wound does not heal well, it may be painful and weep. If you have any concerns after your operation, talk to a doctor.