PLASTIC SURGERY OF THE EYELIDS (BLEPHAROPLASTY)

Indications - As key elements in facial expression, the eyes convey messages of emotion, vitality, and age. Over time, the eyes undergo changes that often make people feel as if they appear sad or tired. The aging process can cause the eyelids to sag and droop, which in combination with bags and puffiness can make someone look tired and older than he really are. Eyelid surgery can help freshen and revitalize the face by reducing the appearance of heavy and sagging eyelids, puffiness, and bags under the eyes. The eyelids are composed of layers of skin, muscle, and fat. With time, age and environmental factors like sun damage, cause the skin's support network in the dermis to break down. As a result, the skin loses its structure and elasticity and becomes lax.
The muscle layers also weaken, which with the skin's loss of elasticity and the effects of gravity, cause the eyelids to droop and sag. Fat deposits normally give eyelids a full appearance. However, fat too is depleted over time and shifts in response to weakened, sagging muscles, which results in puffiness and bags around the eyes. While eyelid surgery addresses these problems, the procedure cannot correct crow's feet, dark circles under the eyes, or sagging eyebrows. In these instances, eyelid surgery performed with other procedures may produce better results.

Preoperative period (before surgery) – Some exams are previously requested. The use of medications containing salicylic acid or vitamin E should be avoided 10 days before surgery. Smokers should quit smoking 15 days before surgery. It is necessary to stop any oral intake (not even water) 8 hours before surgery.

Surgical Technique - Several different techniques can be used to alter the appearance of the eyes. The standard surgical technique usually involves removing or redistributing fat deposits, as well as removing excess skin and muscle from regions of the upper and lower eyelids. Depending on the specific problems that need correction, the upper eyelids, lower eyelids, or both sets of eyelids may be treated.  An eyelid surgery procedure may last approximately 1 to 2 hours, depending on the extent of treatment. Prior to the start of your procedure, the treatment area will be cleansed and anesthesia will be administered. The procedure will most likely be performed under local anesthesia with sedation, in which the eyelids and surrounding areas are numb and the patient is in a relaxed state during the procedure. Alternatively, general anesthesia can be chosen, in which the patient is asleep during the procedure. Before making the incisions, incision guidelines may be drawn. This will ensure that the incisions follow the natural contours of the eyelid and the resulting scars will be as inconspicuous as possible. To begin, an incision, in the fold of the upper eyelid, is made. A layer of excess skin from the upper eyelid, exposing the underlying muscle layer, is removed. In some instances, a small strip of muscle from the upper eyelid, exposing the layers below, is also removed. In order to gain access to the two fat deposits in the upper eyelid, very small incisions in the orbital septum, which is a thin membrane that lies between the layers of muscle and fat, are done. By pressing on the upper eyelid, the fat deposits are exposed through each of the incisions. A portion of each fat deposit is removed to reduce the puffy appearance in the upper eyelid. The portion remaining will be allowed to recede back through the opening. After sculpting the fat deposits, the incisions will be closed with non-absorbable or absorbable sutures. Some small sterile bandages are used to keep the incisions moist and promote proper healing.

Post operative period (after surgery) - Some swelling and bruising can be alleviated with cold compresses. Non-absorbable sutures are typically removed in 5 to 7 days. Although feeling well enough to return to work in approximately 5 days, the patient should continue to avoid strenuous activity such as heavy lifting or exercise for 30 days following the procedure.  While small scars remain, they are usually well hidden by the contours of the eyelid.