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Upper and lower eyelid surgery – Blepharoplasty

Plastic surgery of the eyelids corrects excess and sagging skin, which results in a tired and sadder facial expression. The eyelid skin is very delicate. Moreover, it is the tissue most exposed to environmental effects. As a result, the first signs of skin ageing are visible in this part of the face. It is not only the loss of elasticity of the skin, but also the creation of skin surplus on the eyelids. The formation of sagging eyelids may be affected by factors such as hereditary traits, skin type, diet, allergy, kidney disease, etc. However, it is not only an aesthetic problem, but also a functional matter that causes a feeling of fatigue and eye pain.

The procedure is mostly performed under local anaesthesia, where both the upper and lower eyelids of the eye can be operated on simultaneously. Excess skin, pouches of fat and also, sometimes, part of a dropped muscle are surgically removed during the procedure. After surgery, localised bruising and swelling may occur. They disappear in 10-14 days. Gradually, the appearance of scars subsides and smooths out, and the result of the operation is visible in about 6 months.

Who is the treatment suitable for?

Blepharoplasty, or an eyelid operation, is suitable for both women and men of all ages and is performed throughout the year without restriction. This procedure is one of the most popular in the field of plastic surgery. The main benefit of successful blepharoplasty is an overall refreshing look and rejuvenation of the facial appearance for up to several years.

Clients begin to observe the first signs of ageing in the eyelids around 30 years of age. However, surgery is rarely performed before ones 35th birthday. Mostly, the age of clients undergoing upper eyelid reduction is around 45 years, when the result is also very visible and can greatly rejuvenate the face, with results lasting from 7 to 12 years. Blepharoplasty can be repeated, but it is not recommended to undergo this operation more than twice in one’s life. The procedure is relatively simple and requires no specific preparation in a healthy client. Fourteen days prior to surgery, the patient should discontinue using blood thinners containing acetylsalicylic acid, such as Acylpyrin, Warfarin, and Anopyrin, as a precaution. It is also not recommended to undergo surgery within 3 days before and after menstruation. In case the client is taking medication for blood pressure and/or to thin the blood, treatment and possible discontinuation should be consulted with the relevant specialist before surgery. 

Blepharoplasty cannot be performed if the patient does not have a sufficiently functional lacrimal apparatus. For evaluation, tests of lacrimation (for example, Schirmer's test, where a piece of paper with high absorption properties is placed behind the edge of the lower lid, and its moisture distance is calculated for a set period).

How is the procedure performed?

The procedure is usually performed as outpatient surgery, only under local anaesthesia. An exception is that, unlike other treatments, it is not recommended that patients fast or reduce fluid intake. In addition to the anaesthetic injection, the procedure is absolutely painless, lasting about an hour. If the lower eyelids are also operated on, too, the duration of the procedure is extended by about two hours. A physician must be consulted before the surgery, and if the patient decides to undergo the operation under general anaesthesia, preoperative examinations are required. Usually, however, the procedure is performed only under local anaesthesia.

The procedure removes excess skin from the lids and reduces the pouches of fat, which create a soft support for the eye in the eye cavity. The resulting scar on the upper lid is located at the site of the natural eye line, into which the skin is folded when the eye is opened. In the lower eyelids, a delicate cut is made just below the lashes, where the scar is as inconspicuous as possible. Sutures will be removed by the doctor at a post-operative check-up, usually 5 to 7 days after surgery.

Post-operative course and recommendations

After plastic surgery on the eyelids, the wounds are covered with a thin sterile strip. A patient is released immediately after the procedure, without any significantly limited ability to see, but he/she is not allowed to drive. For the first 24 hours, a patient in home care puts a cold compress (ice in a plastic bag, cooling gels) over the patch and he/she abides by a hydration regimen. It is recommended not to lie in a horizontal position but rather to be half-sitting.

On the second day after surgery, the patient himself/herself will remove the strip that protects the wounds of the eyelids, but he/she keeps the strip stuck to the skin. He/she leaves it dry, without immersion in water for 7 days. After surgery, oedemas and bruises develop on the eyelid skin and around the eyes, which may persist for 2-3 weeks.

On the 10th day after blepharoplasty, it is necessary to start with a fine massage of the scars. The patient will press his/her fingertips gently against the scar for about 30 seconds and then move the finger to another scar location. This way the scar is massaged several times a day. It is possible to use an oil-based cream. Having undergone eyelid operation, the patient should not expose this area to sunlight for at least two months. Otherwise, the scar may darken. It is advisable, for this reason, to use a sun cream with a high UV protection to protect the skin against the sun.

Work incapacity

The patient can perform undemanding office work already on the 3rd day after surgery, but it is necessary to anticipate significant swelling and bruising, which will still be present. In the early days, it is not recommended to watch TV or to work with a computer for a long time. Participating in sport and carrying physical loads are recommended only after two weeks after the plastic surgery on the eyelids. Finishing the result of the eyelid surgery is evaluated after 4-8 weeks, when the swelling is completely absorbed and the scars should be almost invisible.

Complications of plastic surgery on the eyelids

If you decide to undergo eyelid surgery, you should be aware of all complications that may occur in relation to this operation. One of these is oculocardiac reflex, induced by increased eye pressure. It is manifested by a decrease in blood pressure and pulse. This might be a very serious condition, but it is usually takes a small drop in pressure. Sometimes we encounter wounds after removing the suture. Another possible complication is a dry eye sensation, which is treated in a conservative manner using artificial tears in the form of drops. We commonly encounter hyperpigmentation (pigment highlighting) of the operated area. If the colour change is very noticeable, it might be corrected using a laser beam, but only for the first time about half a year after surgery. Often the condition is complicated by minor infections, but they are very easy to treat.

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