Upper eyelid surgery- blepharoplasty

Over the years, the skin on the eyelids becomes flaccid and forms a characteristic fold well visible especially on the side of the eyelids. This results in a sad and tired face. It happens that the skin of the eyelids is so limp that it limits the field of view.

Benefits of upper eyelid surgery

• rejuvenating the appearance of the area around the eyes and the entire face,
• reduction of excess skin on the upper eyelids,
• circular muscle of the eye,
• reduction of fat accumulated in the medial part of the upper eyelid (reduction of fat hernias), which reduces the convexity of the upper eyelid located near the nose,
• reduction of fat located above the eyeball, which deepens the furrow over the eyeball
• during the upper eyelid plastic surgery, you can slightly raise the outer corners of the eyes, thanks to which the face looks smoother,
• upper eyelid plastics the face gives the impression of being rested (it is a subjective feeling, difficult to measure unequivocally),
• in some cases, improvement in the field of view,
• during upper eyelid blepharoplasty one may perform arthrosis of the diminished lacrimal gland, which reduces the convexity on the lateral part of the upper eyelid,
• during the upper eyelid plastic surgery, you can cut / cut some of the brow wrinkles, reduce wrinkles between the eyebrows (lion wrinkles),
• during upper eyelid plastic surgery, you can cut / cut the part of the eyebrow lowering muscles, which causes the eyebrows to lift slightly.

Indications for upper eyelid plastic surgery
First of all, two situations should be distinguished. The first is eyelid drooping - it occurs when the entire eyelid is lowered. From the center of the pupil to the eyelash line is less than 2.5 mm. It may be a symptom of systemic diseases, eg myasthenia gravis or it may be the result of isolated damaging of the upper eyelid levator muscle. The second situation is laxity of the eyelids (dermatofacial insufficiency of the upper eyelids, dermatochalasis). The edge of the eyelid (lash line) is in the correct position, ie more than 2.5 mm from the center of the pupil. The skin on the eyelid is arranged in a characteristic fold, which can be of various sizes. In this situation, you can measure the distance between the eyelash line and the fold of the eyelid skin. This gap in young people is greater, with age it becomes smaller and can take negative values. There is then the slackness of the eyelid skin with limited visual field. The maximum distance between eyelashes and the fold of the eyelid skin in which upper eyelid plasticity can be performed is not defined. Upper eyelid plastic surgery gives a much better effect in the second situation.
Upper eyelid fat herniation occurs when a convexity occurs in the medial part of the upper eyelid (near the nose). In addition, after a slight pressure on the eyeball, the bulge increases. A fat hernia may also appear in the central part of the upper eyelid, but it is less common there.

Comparing the face of a young and old person, it can be noticed that the outer corners of the eyes decrease with age. Such a face is perceived as sad. When putting on a pre-operative consultation, it is worth to bring your own picture from earlier years to see if the side-angles have decreased.
In the lateral part of the upper eyelid (closer to the temple) there is a lacrimal gland. It produces tears that are secreted to the eyeball (moisturize the eyes), then tears flow to the nose through the tear ducts connecting the medial angle of the eye with the nose. In some people, the lacrimal gland may decrease causing a bulge in the side of the upper eyelid. This affliction is rare.

Wrinkles between the eyebrows and slight lowering of the medial part of the eyebrows can be corrected during upper eyelid plastic surgery. However, the reduction of the lion wrinkles can be successfully removed with the injection of botulinum toxin (Botox). Lowering the eyebrows is well corrected by lifting the forehead and eyebrows, which gives a definitely better result than cutting the eyebrow lowering muscles during upper eyelid surgery.

Contraindications to upper eyelid surgery
Lowering eyebrows is not an absolute contraindication to upper eyelid plastic surgery. However, the result of the upper eyelid plastic surgery may be weaker. It is good to first take a forehead and eyebrow lift. How to recognize it? In a situation where the eyebrows are below the bones (the upper edge of the eye socket). If the hair (eyebrows) are less visible or depilated as the site of their original occurrence, the transition of thin skin of the upper eyelids to the thicker brow skin should be considered.

Tell your doctor about aesthetic medicine procedures, especially botulinum toxin injections (Botox) on the forehead. Botulinum toxin can lift eyebrows and with them upper eyelids. Performing surgery in the period of botulinum toxin will result in a small excision of skin on the eyelids. After the period of action of botulinum toxin (6 - 9 months) it may turn out that the effect after the operation is not satisfactory.
Contraindications are active phases of autoimmune and endocrine diseases resulting in eyelid dysfunction and accumulation of connective tissue around the eyeball.

Patients with allergic diseases, especially those that manifest with conjunctivitis and tearing, should be operated during the period in which they are not exposed to allergens.

Tell your doctor about eye diseases, some of their stages may be a contraindication to surgery. Eye specialist consultation may be needed.

A patient who wants to remove wrinkles on the side of the eyes (crow's feet) should not be qualified. Upper eyelid blepharoplasty has little or no effect on wrinkles on the side of the eyes.

Upper eyelid surgery is not a curative and life-saving treatment, and should not be performed at any price. If the patient has a large number of other diseases and low physical capacity then the risk of surgery is too high.
A patient reporting for surgery should not be during or shortly after respiratory infection or herpes infection.
Local skin and conjunctivitis.

Patients with chronic diseases that increase the risk of surgery may be disqualified or asked to perform additional consultations and preparation with a specialist in a given field.

Before the surgery of upper eyelid plastic surgery
Before the operation, you should report to a doctor who will operate. It is good to prepare for consultations. It is worth to write down on a sheet of paper:
• other diseases - current and past
• operations carried out
• cosmetic and aesthetic medicine treatments performed in a given region of the body
• a list of medicines (including those without a prescription) including dosing. e.g., Piramil 2.5mg 1-0-1 (morning and evening after one tablet). You can also deliver packaging from the medicines you are taking. You should also replace eye drops here.

During this consultation, the patient is examined and qualified for surgery. The plan and scope of upper eyelid plastic surgery is presented. Often the patient in front of the mirror together with the doctor assess the laxity of the eyelids and the possible scope of correction. If necessary, the doctor will commission additional tests and consultations if necessary. This is a very good time to ask questions and raise concerns.

Consultation with a physician performing an operation should take place several days to a few weeks before surgery. The interval between consultation and surgery is beneficial, because at that time the patient "calmly" can rethink everything, talk to family or friends.

Reporting to the operation:
• the patient should provide the results of tests commissioned during the consultation. In some clinics, tests carried out on the spot, after the patient has applied to the clinic, however, it extends the time from coming to the surgery.
• 6 hours or more should pass between the last meal and surgery. Most often you can eat a light meal before leaving the house. The operation is most often carried out under local anesthesia, so this time will not have to be strictly adhered to.
• in the morning you should take medications taken permanently (unless the doctor recommends otherwise during consultations).
• apply without applying a cream or make-up on the face or wash it after reporting to the clinic.
• it is good to report without glued eyelashes or you should expect to be partially removed during surgery.
• Avoid sunbathing and tanning for 2 weeks before surgery.
After coming to the clinic:
• it is good to take a shower,
• remove the jewelry,
• it is good to use the toilet just before surgery.

The next medical consultation takes place on the day of the surgery. During the consultation, the patient is examined, the treatment is discussed in detail. On the eyelids, a skin area is marked with a marker, which will be removed. Eyelid asymmetries are marked (asymmetry can be corrected during surgery). Photographic documentation is made. This is a very good time to ask questions. During this consultation, the patient should sign consent to the operation.

Type of anesthesia for upper eyelid plastic surgery
The surgery is usually performed under local anesthesia or in analgosedation with local anesthesia.
Local anesthesia involves injecting a local anesthetic (lignocaine) with adrenaline in the upper eyelid. Lignocaine eliminates pain during surgery, epinephrine is constricted by blood vessels, which limits bleeding.

During analgosedation, the patient is hypnotic, confused and usually does not remember the course of the operation.

He's breathing alone. During the course of anesthesia, the anesthetist and anesthesiologist nurse supervises the patient's safety.

Upper eyelid blepharoplasty can also be performed under general anesthesia (narcosis). Most often this happens when upper eyelid plastic surgery is performed with other operations requiring general anesthesia. It should be noted that the recovery from general anesthesia is "mild", because otherwise it increases the risk of hematoma around the eyelids.

What does the upper eyelid plastic surgery look like?
Before the operation, the surgeon again marks the skin to be removed. The bottom line should be at the furrow (depression) above the knob. In the central part it is about 10 mm above the eyelash line in men and about 8 mm in women. Medially and closely around 6 mm. The upper line should be below 10 - 15 mm eyebrows. The lateral part is directed up to the border of the eye socket. The area of skin left between eyebrows and eyebrows should be at least 20 mm. The amount of skin removed is variable and increases if the laxity of the eyelids is greater. The fold of skin on the eyelid can be easily caught with tweezers to check how much skin can be removed. Removal of too much skin will result in closing of the eyelid and drying of the eyeball. Removing too little skin will result in unsatisfactory postoperative effects.

Then the surgeon gives local anesthesia and cuts out the selected area of the skin. Small bleeding is stopped by means of bipolar tweezers or diathermy (an electrical impulse locally raising the tissue temperature and closing the blood vessels).

The part of the ocular muscle of the eye is then removed. As a guide, this is a 40 x 7 mm muscle fragment. Cutting out part of this muscle results in a longer postoperative effect.

If fat hernias have been diagnosed before surgery, they will now be removed. The tissue in the medial corner of the wound slightly opens. After pressing on the eyeball, the adipose tissue that causes the hernia is visible. Then part of this tissue is removed. It is important to perform thorough haemostasis at this point (close all blood vessels thoroughly), because bleeding in this place can be difficult to control. The fat tissue located centrally above the eyeball is rarely removed. Sometimes the tissue located above the eyeball is coagulated, it increases the furrow (depression) above the eyeball.

If the lowering of the lateral angle of the eye has been diagnosed before surgery, it can be moved upwards. A surgical suture is assumed including the ligaments of the lateral angle of the eye (especially the lower ligament) and the periosteum. This seam makes the side angle of the eye fix in a fixed position.

During the operation, a lower tear gland may be performed. For this purpose, several sutures are put on the surrounding tissues to move the gland upwards. It is important not to remove the lacrimal gland, because it will impede the secretion of tears.

In the medial corner of the wound there are muscles that wrinkle your eyebrows and lower your eyebrows. Cutting and removing the part of the brow-wrinkling muscle will reduce wrinkles between the eyebrows - lion wrinkles. Such procedures give a much longer effect than after botulinum toxin injection (Botox). However, the effect may be weaker compared to botulinum toxin. A subcutaneous scar that forms between the ends of the muscles may partially restore its function.

The intersection and excision of the part of the lowering eyebrow muscle results in its slight increase, especially in the medial part. The effect is small, much smaller compared to the face and brow lift. Performing numerous treatments in the medial part of the wound increases the risk of bleeding.

Finally, the skin is sutured together with the ocular muscles of the eye with thin surgical sutures. A cold compress is put on the eyelid. The plastic surgery of the second upper eyelid is performed.

Time and course of convalescence after upper eyelid surgery
Immediately after the operation, cold dressings, lightly compressible, will be put on. This reduces the risk of bleeding. If the operation was performed in analgosedation, the patient may be sent to the post-operative room. After the surgery performed under local anesthesia, it can be found in the usual room. The next day the patient changes the dressing. He can easily move and eat meals. If necessary, he or she gets painkillers. On this day the patient is discharged from the clinic. In some clinics, the patient is discharged on the day of surgery. On the day of discharge, the patient receives recommendations, instructions on how to proceed, dates of the inspection. Swelling and bruising pass after 1 - 2 weeks. You can return to work after a few days.

Effects after upper eyelid plastic surgery
• rejuvenating the appearance of the area around the eyes and the entire face
• reduction of excess skin on the upper eyelids
• round muscle of the eye
• reduction of fat hernias
• raising the outer corners of the eyes, thanks to which the face gives a more cheerful impression
• in some cases, improvement of the field of view
• during upper eyelid blepharoplasty one may perform arthrosis of the lacrimal gland, which reduces the convexity of the lateral part of the upper eyelid
• during upper eyelid plastic surgery, you can cut / cut some of the brow wrinkles, reduce wrinkles between the eyebrows (lion wrinkles)
• during upper eyelid plastic surgery, the part of the eyebrow lowering muscles can be cut / cut, resulting in a slight elevation of the eyebrows

Recommendations after upper eyelid plastic surgery
Recommendations given by surgeons differ and depend on the scope of operations, the course of the course, the course of the postoperative period and the experience of the operator. Recommendations should be followed and not modified without contacting the clinic.

Examples of recommendations:
• rinse eyelids with water every day,
• use cool wraps,
• remove seams in the 5th - 7th day,
• before removing the seams, do not apply makeup to the eyelids,
• apply arnica ointment to the skin of the eyelids,
• eyes can be dripped with soothing drops, eg Sulfacetamide,
• you can return to work after a few days,
• swelling and bruising pass after 1 - 2 weeks,
• for 6 weeks to give up the sauna and solarium,
• in doubtful situations, contact the clinic.

How long do the effects after upper eyelid plastics last?
The duration of the effect depends on many factors. It can be assumed that this effect lasts for 10 years.

How to avoid complications after upper eyelid plastic surgery?
Completely avoiding complications (in all patients) is not possible. It is important that in such a situation the doctor should take special care of the patient.

From the patient's point of view, to avoid complications, two basic principles must be observed:
• tell everything about your health before surgery;
• follow the instructions after surgery.
You should report to designated inspections.
Do not modify the instructions without contacting the clinic.

Possible complications - upper eyelid plastic surgery
During each surgery and surgery, complications are possible. They happen rarely, it is worth asking a doctor who performs the procedure, for which we are more susceptible to exposure, and for which less.
Possible complications include: haemorrhage, hematoma, surgical site infection, delayed wound healing, hypertrophic scarring and keloids, deterioration of eyelid function (blepharoplasty, eyelid inversion), skin necrosis, skin discoloration, bony skin irregularities, tear leakage disorders, correctional need .
It should be remembered that it is not possible to predict and list all possible complications.

Recommended additional treatments

• Lower eyelid surgery
• Forehead and eyebrow plastics
• Face lift
• Filling the "valley of tears" the area below the lower eyelid, eg with a fat graft
• Injection of botulinum toxin to the wrinkles on the side of the eyes (crow's feet)