Eyelid surgery at our center is performed only with the latest techniques and technology, because surgeons understand that the eyes are responsible for an important part of facial expression; they project the feelings and emotions of happiness, sorrow, anger and fear. Many feel the eyes are the "windows to our soul." Yet, the eyes themselves are essentially expressionless structures.
In actuality, it is the contour of the skin, muscle, fat, brow and lashes around the eyes that produce expression. Wrinkles, lines, loose skin and fatty bulges slowly develop and become more prominent as time goes on. Sun exposure, genetic predisposition, weight fluctuations and smoking can also be contributing factors that together produce a tired and older appearance.
Eyelid surgery, technically known as blepharoplasty, can correct conditions that produce an aged, tired appearance by removing pouches or "fat bags," sagging eyelids, and excess folds of loose skin around the eyes. With skin folds, fat bulges removed, and eyelid creases improved, a more youthful and rested appearance can be achieved through eyelid surgery.
The fat in the eyelids is positioned behind a thin fibrous septum that, for various reasons, may become lax and allow bulging of orbital fat (the fat that surrounds and supports the eye). This is often seen as "bags" under the eyes that give that tired appearance. This fatty tissue can be removed or at times repositioned through eyelid surgery, which tightens of the lax fibrous septum. In other instances, the fibrous septum is opened and the fat is repositioned down and over the bony rim below the eye to conceal hollowness if present.
Plastic surgeons will understand that every patient has individual requirements and will formulate a procedure specific to each patient to ensure the best possible results. A comprehensive consultation and examination is needed to decide which procedure or combination of procedures is required to obtain the desired results.
Upper Eyelid Surgery (Upper Blepharoplasty)
The incision for upper eyelid surgery is generally made in the natural crease of the upper eyelid and extended laterally to the side for a short distance. The excess skin and fat is then removed, and the incision is closed with sutures (stitches), which are removed over a five to seven day period.
When considering eyelid surgery, it is important to note that "heaviness" or excessive sagging skin of the upper eyelids can also be caused in part or even solely by a sagging forehead or brow. In this care, a brow lift may be recommended, in addition to the eyelid surgery to be performed at our Florida facility.
Lower Eyelid Surgery (Lower Blepharoplasty)
For lower eyelid surgery, there are three principle approaches:
Lower eyelids with excess skin:
The incision is generally made just below the eyelash margin and extended laterally to the side for a short distance. Depending on individual requirements fat may be removed or repositioned and secured in place. The excess skin is then removed and the incision closed with sutures (stitches), which are removed over a five to seven day period. At times, self-dissolving sutures are used.
Lower eyelids without excess skin:
This eyelid surgery approach is called a transconjunctival approach in which the incision is made inside the eyelid so as to avoid an extended scar. The fat is removed or repositioned and secured in placed. In this procedure, sutures are self-dissolving and no sutures need be removed.
In certain instances, your surgeon may recommend laser skin resurfacing or a skin peel concurrent with transconjunctival blepharoplasty, or at a later date, to reduce fine lines or creases, which would not be addressed by this blepharoplasty procedure.
Lower eyelids (advanced approach):
This approach is aimed at blending the eyelid-cheek junction, allowing a more youthful appearance. In youth, there is generally a smooth contour/transition between the eyelid and the cheek. As aging progresses, the eyelid-cheek junction often appears as a trough or hollow below the eyelid fat bags.
This eyelid surgery approach reduces fat from a transconjunctival approach (incision inside the eyelid) and reduces excess skin from the more standard external incision. An eyelid tightening procedure called canthopexy is performed and the thin muscle supporting the lower eyelid is elevated and secured.
Many eyelid surgery patients have excess laxity in the lower eyelid itself, which reveals too much white of the eye and can cause dryness or irritation. At times laxity of the eyelid can resemble skin laxity. However, the correct treatment is tightening the eyelid and not removing skin, which can cause postoperative malposition (pulling down of the eyelid). Either canthopexy or canthoplasty eyelid-tightening procedures may be recommended and can be performed through the same eyelid surgery incisions.
Where external incisions are made, scars always occur, but generally are easily hidden in the natural lines and folds around the eye. Both upper and lower eyelids can be operated upon at the same time or independently as well.
Eyelid surgery is frequently performed with facelift and brow lift procedures. Bandages are generally not applied over the eyelid area. Cold compresses are applied to the surgical areas as tolerated for a 48-hour period.
Procedure time for the upper eyelid is approximately one hour. Time for the lower eyelids, depending, on which technique is used, will range from one to two hours.
Eyelid surgery can be performed using local anesthesia with intravenous sedation or general anesthesia.
After surgery varying degrees of swelling and bruising of the operated eyelids will occur and at times extend down to the cheek area. It generally takes one to two weeks from the day of eyelid surgery for most of the bruising and discoloration to subside. This condition generally subsides more rapidly in the upper eyelid area than in the lower eyelid area. Irregularities along the suture line may be present for several weeks. You may experience swelling, tingling, itching, numbness, and irritation with a feeling of tightness and dryness as you heal. This will last for a variable length of time.
Sutures are removed in five to seven days after eyelid surgery. At times, dissolvable sutures are used. Eyelid surgery patients do not generally complain of pain after this procedure. Any discomfort is easily controlled with medication. Light exercise can generally be started three to four weeks after surgery.
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