COSMETIC SURGERY OF THE EYELIDS or
COSMETIC BLEPHAROPLASTY

DEFINITION, AIMS AND PRINCIPLES

‘Blepharoplasties’ means aesthetic surgical procedures of the eyelids aiming to correct unsightly aspects, whether due to heredity or age. They can be performed on the upper or lower
eyelids alone, or all four at the same time.
This technique may be carried out alone or in association with other cosmetic facial surgery (brow-lift, forehead-lift, faceand neck-lift) or with techniques such as laser resurfacing, dermabrasion or chemical peels.
The goal of a blepharoplasty is to correct signs of aging and remove the tired look due to the heavy eyelids by a more rested, relaxed appearance.
The unsightly aspects most commonly found are the following:
Drooping heavy upper eyelids, with a more or less marked skin-fold.
Lower eyelids which have drooped and shrunk, leading to horizontal wrinkles due to distended skin.
Bulging fat, responsible for ‘bags under the eyes’ at the lower eyelid level, or sagging upper eyelids
The procedure aims to correct these problems durably by surgical removal of excess skin, fat and muscle, without of course affecting the normal functions of the eyelids.
This procedure, for both men and women, is often carried out around the age of forty.
It can however be done much earlier where the problem is congenital rather than age-related, for example in the case of bags under the eyes.

BEFORE THE OPERATION

Prior to the operation a thorough examination of the eyes and eyelids will have been carried out in order to detect any anomalies which could complicate the procedure or indeed show that it is not recommended in this specific case.
A specialised ophthalmologic examination will often be prescribed to rule out any ocular pathology.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type of anesthesia

Local anesthesia with sedation given by intravenous drip. (‘twilight’ anesthesia)

Hospital stay

The procedure may be carried out on an out-patient basis, in an ambulatory facility, the patient leaves on the same day after a few hours under observation.

THE PROCEDURE

Incisions

Upper eyelids: They are concealed in the fold situated at the mid-point of the eyelid, between the mobile and fixed parts.
Lower eyelids: They are 1 to 2mm below the eyelashes, and can go slightly beyond them.
Note : For the lower eyelids, in the case of isolated “bags” (without excess skin to be removed), a blepharoplasty can be carried out by the transconjunctival approach, that is by using incisions placed inside the eyelids, thus leaving no visible scar.

Resection : Once the incision made, unsightly excess fat is removed, as are redundant muscle and sagging skin.
Sutures : Stitches are made using very fine nonabsorbable thread (they are removed a few days after the procedure).
The operation can take between 30 minutes and 2 hours depending on the specific requirements and complexity of the case.

AFTER THE OPERATION

There is no actual pain, but possibly some discomfort with a sensation of tension in the eyelids, slight irritation of the eyes and perhaps some blurring of vision.
During the first few days rest is advised, with no physical strain, no lifting heavy weights for example.
During the recovery period there will be edema (swelling), and bruising, to a variable degree for each individual patient.
For the first few days it may be impossible to close the eyes completely, a slight detachment of the external angle of the eye may also be observed, but in both cases these signs are rapidly reversible.
The sutures will be removed between the 3rd and 6th day after surgery.
Visible signs of the operation will diminish little by little, a return to normal social and professional activities will be possible after 6 to 20 days.
The scars may remain as pinkish lines for the first few weeks, but can be hidden by makeup from the 7th day onward.
Slight hardening of the detached zones may persist for a few months, but is not perceptible to others.

THE RESULT

The final aspect will not be visible before 3 to 6 months. This is the time lapse necessary for the tissues to regain their softness and for the scars to heal and practically disappear.
The results of this procedure are usually among the most durable found in aesthetic surgery. Once the fatty pads removed they do not in general return, so this is a permanent effect.

DISAPPOINTING RESULT

These can result from a misunderstanding concerning what can reasonably be achieved. For example lowering of the forehead and eyebrows can only be corrected by a foreheadand brow-lift.
They can also be due to unexpected tissue reaction or unusual scarring phenomena.
Very fine lines may persist, the eyes may appear slightly too‘hollow’ (the bony outline of the eye-socket being visible).
Other imperfect results could be a slight downward retraction of the lower eyelids, slight asymmetry, or ‘whitish’ scars.
These imperfections can be remedied by corrective surgery if necessary, usually under local anesthesia from the 6th month following surgery.

POSSIBLE COMPLICATIONS

Fortunately, real complications are rare following a blepharoplasty which has been carried out correctly. In fact practically all the operations go well and patients are completely satisfied with the result.
In spite of the fact that complications are so rare you must be aware of the following possible problems :

• Hematomas: not usually serious, they can be drained if necessary.
• Infections: extremely rare for this procedure, microabscesses can develop on stitches but are easily treated. Conjunctivitis will be prevented by routine prescription of eye-drops for the first few days after the procedure.
• Abnormal scarring: this is very rare for the eyelids where the skin usually heals leaving almost no trace of surgery, the scars can however sometimes be more pronounced than hoped.
• Epidermal cysts: they can appear along the scars, but often clear spontaneously, if not they can easily be removed and do not affect the final result.
• Lacrymal problems: excessive tear production is a rarer problem than ‘dry eye syndrome’ which can decompensate a pre-existing lack of tear production.
• Ptosis: (Drooping of the upper eyelid) : this is very rare except in the over 70’s where a pre-existing problem can be made worse by the operation.
• Lagophthalmos: (inability to close the upper eyelid completely) : this can occur for the first few days after surgery but should not persist after a few weeks.
• Ectropion: (lower eyelid retraction) : the severe form is extremely rare following this procedure
  when it is carried out correctly. The minor form can occur when lax tissue is affected by excessive scar retraction; it usually recedes after several weeks of regular massage which improves the tonus of the eyelids.

All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors.