Ageing is an irreversible, relentless process of tissue degeneration resulting in loss of elasticity and stretching of skin. Whilst the eyes themselves are expressionless, the eyelids are very important indicators of our emotions. If you feel that the natural ageing process is making you look tired, you can enjoy a younger, more energized and confident appearance with eyelid surgery.
The eyelids are complex structures that are very unforgiving and must be treated with care, for these reasons its extremely important to seek out an expert who has experience with blepharoplasty. It requires a delicate touch, an artistic approach and a full understanding of the eyelid anatomy to maintain and enhance one’s facial natural beauty.
Blepharoplasty is generally performed in a fully accredited hospital, however if only upper eyelid surgery is required can be performed under local anaesthesia in our clinic. The operation can take from 1 – 3 hours, depending if only the upper, lower or both eyelids and whether ancillary procedures like fat grafting are being performed. Most patients are discharged home the same day.
Prior to the operation your eyelids will be marked out so that the incisions follow natural lines or creases and ultimately become “invisible”, and to allow the determination of the correct amount of skin to be removed. During the procedure the excess skin is removed, muscle is tightened, and redundant orbital fat is excised or replaced in the orbit. The surgical incisions are sutured meticulously leaving hairline scars that usually fade quickly, but probably never completely disappear. The upper eyelid scar lies in a natural crease line formed by the attachment of your eyelid muscle to the skin at the upper level of the tarsal plate (that structure that stiffens and supports the upper eyelid). This is usually 8mm to 12mm above the eyelash line, but may be higher as a normal variant, or non-existent as in Asians. This fold can be created by a procedure termed supratarsal fixation and can Europeanize the Asian eyelids. If eyelids are droopy (ptosis) this can also be corrected by shortening the muscle (known as the “levator muscles”) that raises your upper eyelid.
If lower eyelid fat bulging is the only problem, there may be no need for skin or muscle adjustment. It is then possible to perform this procedure without any external lower eyelid scar. An incision is made on the inner aspect of the lower eyelid and the excess fat removed. This is called a transconjunctival blepharoplasty. This has application in very selected cases and will be discussed with you by Dr Turner if it is an option for you. Otherwise the incision is made just below the lash line to prevent visible scars.
WHAT CAUSES EYELID PUFFINESS?
uffiness or swelling about the eyelids is produced by
any one or more of three possible factors:
Weakened eyelid muscles (the orbicularis muscles) allow the orbital fat to billow forward under the influence of gravity. The problem can be surgically corrected by tightening the muscle sling with resuspension in the outer aspect of the lower eyelid (a procedure known as canthoplasty).
Excessive fatty deposits about the eyeball produce bulges or bagginess. These fatty deposits are compartmentalized and when present in excess, the fat pushes the overlying thin eyelid muscle and skin forward producing the baggy contour defect. Removing the excessive fat or strengthening the retaining membranes (skin and muscle) corrects this problem.
Excessive fluid accumulation about the eyes. This occurs commonly as a result of allergy and is usually worse on getting up in the mornings and improves as the day goes on – with the redistribution of body fluids on rising from the recumbent to the erect posture. Fluid accumulation is not corrected by surgery and if present may lead to a more protracted post surgery recovery. Some morning swelling can be expected in all patients for some variable time after eyelid surgery.
PREPARING FOR BLEPHAROPLASTY SURGERY
Once you have decided to have eyelid lift surgery, Dr. Turner and his staff will guide you in your preparation. You will be given instructions to help make your surgery and recovery go smoothly. And you may be given various tests so that your medical records are as up to date as possible before proceeding to an operation.
As with other types of surgery, a chest x-ray and blood tests may be necessary to assess your general health. Dr Turner may want photographs of your eyelids in your medical record to document your problem and to compare results.
Dr. Turner will ask that you to stop taking aspirin-containing products two weeks before surgery to minimize bleeding. You will also be asked to stop smoking before surgery because it restricts the blood flow and may affect healing, resulting in wound breakdown and less than optimal results. In the week prior to blepharoplasty surgery, if you develop any sign of infection such as cold, flu or pimples on your face-please notify our office so that we can treat this effectively. If you have a history of facial Herpes please let us know, as Acyclovir started before your blepharoplasty surgery should prevent an outbreak.
AFTER BLEPHAROPLASTY SURGERY
After your surgery, you wake up in a recovery room if preformed in hospital. Dr Turner and the nursing staff monitor you, checking your blood pressure, temperature and pulse. Once you are alert, you may be discharged. You may be given prescriptions to relieve pain and prophylactic antibiotics are commonly prescribed. Have someone fill the prescription, drive you home and take care of you as you recover. Follow any mastopexy post-op instructions given to you.
The eyelids have a protective and lubricating role for your eyes. After blepharoplasty surgery, whilst the eyelids are swollen, this function is compromised and so for a few weeks it will be necessary for you to lubricate your eyes regularly with the ointment or drops. The nursing staff will instruct you about this.
At 1 week after your blepharoplasty surgery you return to Dr Turner’s office and your eyelids are reviewed. Here, you begin to see the results of your despite some initial swelling. Dr Turner will remove any sutures present and will tell you how to care for your wound.
During your follow-up visits Dr Turner will monitor your eyelids and watch for any asymmetry or infections. Healing takes several weeks or longer, depending on how long swelling lasts. You will be given advice on scar management and also the resumption of normal activities and exercise.
WHEN CAN I RESUME SOCIAL / WORK ACTIVITIES
You can return to your activities at a slow, gradual pace. You may be back to work as soon as five to seven days after surgery and may begin light exercise in a week or so. Strenuous exercise should be restricted for several weeks or longer. Follow the golden rule – “If it hurts, don’t do it”.
WHAT CANNOT BE ACHIEVED BY EYELID SURGERY?
Eyelid surgery will not stop the rate at which the skin ages, but certain lifestyles can hasten the ageing process such as excessive sun exposure, smoking and poor skin care. Attention to these areas can prolong the improvement achieved by blepharoplasty surgery. Whilst eyelid contours are markedly improved, all wrinkles are not removed. This applies especially in the crow’s feet area which is not addressed by a blepharoplasty. The crow’s feet are actually part of the cheek or temple. To improve this problem a brow lift or temporal lift must be considered.
Drooping of the brow produces low flattened eyebrows with a scowling look. This adds to heaviness in the upper eyelids and produces furrowing in the nasal bridge line. This problem is not improved by eyelid surgery, but is better corrected by a foreheadplasty or brow lift.
Skin pigmentation is common in the lower eyelids and is occasionally seen in the upper lids as well. It is most commonly a hereditary ethnic characteristic, but may also be sun induced. Eyelid surgery will not remove this, but rather may make it slightly more obvious by stretching wrinkled loose skin to an improved contour. A skin care program incorporating a light skin peel, either at the time of eyelid surgery or at a later date, may help this problem. Makeup will, of course, camouflage it. The scars from a blepharoplasty will not be as “invisible” in this type of skin.
Facial asymmetry is normal. We all have a strong and a weak side of our facial skeleton and hence left and right eyelids are never identical, nor is the position of the eyebrows. This is of course present prior to blepharoplasty surgery, but occasionally patients notice it more after blepharoplasty surgery as they study their improvements closely. This asymmetry is normal and in fact enhances beauty. It is never the result of blepharoplasty surgery.
UNDERSTANDING THE RISKS AND COMPLICATIONS
Before you make a decision to undergo plastic surgery it is important that you be informed of the major risks and side effects of the blepharoplasty surgery you are contemplating. While all care is taken to avoid or minimize these events, it must be recognized that complications may occur despite the best medical care.
It is important that you carefully read and understand the potential risks and they will be discussed in further detail when you have your consultation with Dr Turner.
During your first visit, your general health and medical history will be noted. Your expectations and concerns about your nose will also be documented. Dr Turner will analyse what you don’t like about the shape of your nose and your surgery preferences.
The inside of your nose may be examined and any obstructions to your airway noted. In some cases it may be necessary to get the opinion of an ENT surgeon about any potential or existing problems inside your nose. If there are significant problems with nasal function, Dr Turner may recommend a combined operation, with an ENT surgeon attending to the internal problems whilst Dr Turner reshapes the external features of your nose.