EYELID SURGERY-BLEPHAROPLASTY
Introduction
Early signs of ageing of the eyelids are downward shifting of the brow and fullness of the upper eyelid skin. The swelling of the eyelids increases progressively and eye shadow makeup becomes smudged at the lid folds. The upper lid fullness may eventually result in overhanging skin folds.
In addition "eye bags" become evident in the lower eyelids and at the inner corners of the upper eyelids. Eye bags result from the protrusion of excess fat in the orbit. In some cases this fatty protrusion is inherited and becomes noticeable at a much younger age.
Nature of operation
The patient is admitted to the clinic on the morning of surgery. The procedure is usually performed under sedation and local anaesthesia although a general anaesthetic is sometimes preferred for an exceptionally nervous patient.
In the upper lid the incision is made in the lid crease. In the lower lid the incision starts at the outer side in a crow's foot and extends under the eyelashes. Fig. below. Through these incisions, excess fat, skin and if necessary, muscle can be appropriately removed. Sutures are usually removed between three and five days.
Incisions for Blepharoplasty.
The incisions are made in pre-existing skin creases and are not necessarily in exactly the same position on each side.
In the case where the lower eyelids have good skin tone but an excess of protruding fat, the surgeon may choose to perform a ' transconjunctival blepharoplasty' . Here the lower eyelid is pulled forwards and an incision is made on the inner surface of the lid, which allows access to the fatty pockets of the lower eyelids. The excess fat can be removed by this approach and no stitches are required.
Postoperative events
Swelling and bruising around the eyes is inevitable. The bruising usually subsides within ten days. Minor degrees of swelling may persist for a few weeks afterwards. Scars can usually be camouflaged by makeup after a few days. The scars will fade in time and become perceptible only on close scrutiny.
Watery eyes This can occur for a few days post operatively and generally subside spontaneously.
Dark skin Preoperative pigmentation of the lower eyelid skin will not be improved following this procedure. Indeed the condition may become more pronounced.
Bleeding Occasionally a small collection of blood may accumulate under the skin and require to be evacuated. Persistent bleeding in the deeper tissues of the orbit may temporarily increase the pressure in the orbit. This is extremely rare and may require inpatient treatment although a further operation is usually unnecessary.
Drooping of the upper eyelid This rarely occurs in unnoticed accidental trauma to the muscle that elevates the eyelid. A further operation may be necessary to correct this problem.
Drooping of the lower eyelid (Ectropion) This sometimes occurs in the immediate postoperative period as a result of swelling and rectifies itself in a few days. Sometimes the condition can arise as a result of excess skin resection at operation or from contraction of the tissues during healing. Occasionally a further procedure is required to improve the situation.
Inability to close the eyes completely This can sometimes occur in the immediate postoperative period and treatment with eye drops is all that is required before the condition rectifies itself. In the rare instance that excess tissue has been removed a further procedure may be required.
Postoperative wrinkling can occur if the bags alone have been removed and the excess skin left forms creases or wrinkles. This is particularly more likely to happen with 'transconjunctival blepharoplasty' (see above) where a tightening procedure was not performed. Further surgery may be required to improve the situation.
Infection This can occur in the outer coating of the eye (conjunctivitis), incision lines (wound infection) and eyelid margins (blepharitis). These infections will require appropriate treatment.
Loss of eyelashes is very rare. The lashes however usually regenerate.
Dry eyes Patients suffering from this rare condition called the Dry Eye Syndrome (keratoconjunctivitis sicca) should inform the surgeon as lid surgery may worsen the situation.
Asymmetry Many patients who complain that their eyes are different from each other after the operation are noticing for the first time a situation that existed before. If the asymmetry has been caused by the operation it can usually be corrected without difficulty.
Change of shape Sometimes eyelid surgery causes the eyes to be rounder in shape than they were before. This is most likely to happen if a considerable amount of skin is removed.
Blindness This extremely rare complication causes concern to many patients. Although this complication has been reported in the medical literature the reason for it is unclear. It has not occurred in our experience.
Postoperative management
Alcoholic drinks and aspirin containing drugs should be avoided for two weeks pre- and post-operatively. Quick movements should be avoided initially. Individual surgeons will have their preferences with respect to treating bruising and swelling.
Cold water compresses should be applied to the eyes for five minutes every hour for the first twelve hours, thereafter three times daily for three days in order to reduce the swelling and bruising.
Ointment and eye drops can be applied at the discretion of the surgeon. Contact lenses should not be worn for at least two weeks afterwards. Normal activities can be resumed in seven to fourteen days.
Result
The result of a successful blepharoplasty can be dramatic and extremely pleasing for the patient as well as long lasting. The best result is obtained if a facelift is performed as well. Eyelids without creases and bags will look much younger and the eyes will often look larger.
