Blepharoplasty

Eyelid surgery is recommended for removing excess skin from the upper and lower eyelids, eliminating fat pockets, and improving the appearance of “puffy eyes.”

Blepharoplasty improves the appearance around the eyes, restoring a more youthful and vibrant look to the eyes. Excess skin and fat pockets give the face a permanently tired appearance and make a person look older than they actually are. Thus, blepharoplasty is a method of facial rejuvenation.

Conditions that prevent blepharoplasty from being performed—and are therefore contraindications—include: glaucoma, dry eye syndrome, hyperthyroidism (Graves’ disease), cardiovascular disease, and severe hypertension.Upper
blepharoplasty involves removing excess skin and fat from the upper eyelid. The excess skin forms a fold that covers the tarsus (which should normally be visible) and, in some cases, may even obstruct vision. Fat pockets are visible in the upper and central corners of the eye. The procedure is performed in most cases under enhanced local anesthesia, and sometimes under general anesthesia if necessary. Incisions are made right in the crease above the tarsus (higher in women, lower in men); the resulting scars are extremely fine, becoming nearly invisible within 2–3 months.

Lower
Blepharoplasty: This procedure removes excess skin and fat pockets from under the eyes, giving the face a younger and more rested appearance. This procedure can also reposition the fat beneath the eyes, which helps eliminate so-called dark circles. Lower blepharoplasty can be combined with lateral canthopexy, which corrects muscle laxity—a condition commonly seen with aging. The incision is made immediately below the eyelashes, making it invisible afterward.

Transconjunctival lower blepharoplasty (without a skin incision)
is indicated only for young people who do not have excess skin. Only fat can be removed through incisions in the conjunctiva. The benefits of blepharoplasty are both aesthetic and functional. From an aesthetic standpoint, the surgery helps achieve a younger, more rested, and more vibrant appearance.

Using special techniques, dark circles and deep furrows under the eyes can be removed or reduced. Lower blepharoplasty also removes fine lines around the eyes. From a functional standpoint, it improves the field of vision. It is very important to reduce the number of cigarettes smoked or even quit smoking several weeks before the surgery.

Avoid taking aspirin, ibuprofen (or any other medication containing these ingredients), vitamin E, ginkgo biloba, and ginseng for at least 10 days before surgery (all of these increase the risk of bleeding during and after surgery).

It’s a good idea to have someone drive you to the clinic or hospital where the procedure will take place and pick you up afterward.

The night before, it is recommended that you wash your hair and face very thoroughly. Before the surgery, remove any makeup from your face, false eyelashes, contact lenses, and jewelry.

The surgery is performed under enhanced local anesthesia or general anesthesia and lasts between 1 and 3 hours, depending on the complexity of the procedure. The patient may go home after a few hours or may stay overnight. After the surgery, the eyelids will be swollen, and blue-purple bruises will appear. The eyes may water more or, conversely, may feel dry. They may also be very sensitive to light.

Swelling and bruising can be minimized by keeping the head elevated at a 45-degree angle during the first few days after surgery and by applying ice to the eyelids. Various antibiotic creams may be applied to the incisions as directed by the surgeon to keep the scars moisturized and prevent infection. Eye drops are recommended to prevent dry eyes.

During the first week after surgery, it is best to avoid activities that cause the eyes to dry out (reading, watching TV, using a computer, wearing contact lenses). The sutures are removed after 5–7 days.

You can resume daily activities as early as 2–3 days after surgery, but bruising may prevent you from appearing in public for 7–10 days. Wearing sunglasses helps prevent your eyes from drying out due to wind or sunlight and keeps dust out.

The patient may notice that their eyes tire more easily in the first few weeks after surgery.

Swelling peaks the day after surgery and then gradually subsides during the first week; it may persist for several weeks to months until it disappears completely, depending on the patient’s physiology. There is no way to reduce it or make it go away faster; the only requirement is the patient’s patience. It is usually more pronounced in the morning but tends to subside throughout the day as the patient resumes their activities. To alleviate the swelling and improve the appearance of scars, various creams (containing vitamin E, aloe vera, or scar-healing creams) can be used. Avoiding excessive salt intake and salty foods, as well as avoiding excessive physical exertion (both of which lead to water retention in inflamed tissues—in our case, the eyes)—allows the swelling to subside more quickly.

Patients are usually alarmed by the immediate postoperative appearance due to bruising and swelling. It is important to remember that these always go away and are completely normal!!

The incisions must be kept clean by washing them daily with soap and water, followed by the application of antibiotic ointment.

It is possible that the eyes may not close completely during the first 3 weeks after surgery. In such cases, it is advisable to use eye drops or artificial tears.

You may wash your hair 2 days after surgery.

Eye makeup can be applied after about 10 days to 2 weeks, and contact lenses can be worn again after one week.

Intense physical activity can be resumed after 10 days (jogging) or 3 weeks (swimming).

Immediately after surgery, the incisions will be red and firm. They may remain firm, and you may feel small bumps for a few weeks after surgery. These will fade over time and should normally become nearly invisible. They will soften in about 6 months. You may frequently experience an itching sensation. Any feeling of tightness or numbness will disappear within a few months. It is very important that the incisions not be exposed to the sun for the first 6–9 months after surgery; you should also avoid trauma and friction to the area for the first 6 weeks so as not to damage the delicate tissue around the eyes.

In practice, the unsightly postoperative appearance disappears within 5–7 days, and the final result—with the best appearance—is expected after 4–6 months, sometimes up to 1 year. The outcome of a blepharoplasty cannot be assessed immediately after surgery. Minor asymmetries in the first weeks or months after surgery are absolutely normal due to swelling, which varies between the two eyelids, as well as differences in the healing process. The appearance of the incisions is not fully assessed until 6–9 months later. The results of blepharoplasty are long-lasting. Once fat is removed, it does not return; however, as the patient ages, excess skin may develop again due to a loss of elasticity, which may require another procedure.Side effects are normal, resolve on their own, and do not constitute complications. However, the patient should be aware of them so they know what to expect.

1. • Pain is more of a discomfort than actual pain; pain relievers can alleviate it;
   • Swelling can be reduced by keeping the head elevated as much as possible (at a 45-degree angle) and by applying cold compresses or ice;
   • Well-performed incisions will become imperceptible to the untrained eye

Like any other surgical procedure, blepharoplasty involves certain risks and complications that can be prevented by a professional surgeon. These include:

1. 1. • Ectropion is usually caused by excessive removal of skin, both on the upper eyelid but especially on the lower eyelid; it requires careful attention and very precise preoperative markings, as well as canthopexy in high-risk patients
      • hematoma—the accumulation of blood under the skin; this is prevented through very careful hemostasis
      • infections
      • unsightly scars
      • excessive dryness of the eyes
      • excessive tearing
      • milia—small white spots that appear along the incision lines—may disappear on their own or be treated by the surgeon with minimal intervention
      • minor asymmetries between the two eyes

With patience, the patient’s cooperation with the surgeon, and adherence to the surgeon’s instructions—as well as a skilled and experienced surgeon—all of these complications can be minimized and avoided.

Blepharoplasty is an extremely effective method for eliminating the signs of aging and stress. For patients who are not candidates for surgery but still wish to improve their facial appearance, there are alternative, less invasive—though less effective—treatment methods:

1. • Laser facial rejuvenation removes superficial skin imperfections and stimulates collagen production, resulting in a more youthful appearance
   • Themage radiofrequency stimulates collagen production and reduces wrinkles
   • Botox injections paralyze the muscles around the eyes, thereby preventing the formation of wrinkles; the results last 4–6 months
   • Collagen or hyaluronic acid fillers help reduce wrinkles by filling in the furrows they cause; the results also last 4–6 months
   • A brow lift (surgical method) can be performed at the same time as blepharoplasty or beforehand; it allows for better definition of the tarsal region by lifting the skin and, respectively, the formed fold; This procedure is particularly indicated when the eyebrow is drooping, in both women and men.