Also known as blepharoplasty, this procedure is applied to correct the excess skin on the eyelids that may give the appearance of looking tired, angry or old.
In the upper eyelid, the surgery corrects the excess of skin, sometimes associated to a localized suppression of the subcutaneous fat. In the lower eyelid, a treatment against “bags” can be performed, usually without the excision of skin.
The surgical treatment of the eyelids with a cosmetic and functional purpose is technically known as ” blepharoplasty”. Treatment can be applied either to the upper or lower eyelids separately, or they can all be treated at the same time. A blepharoplasty can be associated with other surgical procedures such as frontal, temporal or cervico-facial facelift or even with therapeutic laser resurfacing, peeling, and dermabrasion.
The aim of this surgery is to correct the signs of ageing present in the eyelids giving the false impression of a “tired face”. Most common imperfections are; heavy and falling upper eyelids, with excess of skin forming a more or less marked fold; faded lower eyelids, with small horizontal wrinkles and cutaneous distension; or upper and lower eyelids fat herniation or “eyelids bags”.
Before the surgery
During an appointment with Dr Xavier Tenorio, specialist in Plastic & Aesthetic Surgery, a full evaluation and careful examination of the eyelids will be performed. The fees of this first consultation will be completely refunded by deducting them from the surgical fees. In some cases, a specialized ophthalmologic examination will be required in order to detect a possible ocular pathology.
This procedure is normally performed under local anaesthesia, however in the need of a general anaesthesia, an appointment with the anaesthetist will be schedule at the least 48 hours before the surgery. Drugs containing aspirin should be stopped 10 days preceding the surgery.
Types of anaesthesia and hospitalization
Type of anaesthesia
Three options are possible:
- Pure local anaesthesia, where a product analgesic is locally injected in order to ensure the insensitivity of the eyelids.
- Local anaesthesia deepened by intravenous sedatives.
- Traditional general anaesthesia,
The choice between these techniques will result from the discussion between you, the surgeon and the anaesthetist.
The surgery can be practiced in a “day hospital” basis, including being discharged few hours after the surgery. However, in certain cases, a short hospitalization may be needed.
Upper eyelids: Incisions are dissimulated in the fold located at middle height of the eyelid, between its moving and fixed part.
Lower eyelids: Treatment of the lower eyelids “bags” exclusively, is done by a trans-conjunctiva incision (in the inner part of the eyelid). This results in no visible scar in the skin. In cases involving treating an excess of skin, the incisions are placed 1 to 2 mm under the lashes, and can be prolonged outwards. The layout of these incisions corresponds to the location of the future scars, which will be dissimulated in natural folds.
After the adequate technique has been performed, the skin is closed with very thin sutures that are withdrawn 7 days after the surgery.
According to the pre-operative plan, the surgery can last between one to two hours.
Pain is not always present but a certain discomfort characterized by the feeling of tension of the eyelids is often present. A light irritation of the eyes can also be seen. Rest and avoiding strenuous efforts are recommended during the first post-operative day. Swelling and bruises are always present and their importance and duration are variable from one individual to another. In some cases, it becomes impossible to close the eyelids completely but this is always rapidly reversed.
The marks of the surgery will gradually become less visible, allowing the return to a normal socio-professional life after a few days (6 to 20 days according to the type of surgery). Scars can remain visible during few days but make-up is quickly authorized (usually around the 7th day).
Final result can be observed by 3 to 6 months after the surgery. The results of a blepharoplasty are among the most durable in cosmetic surgery. The excision of the “bags” is practically definitive. It is rare that a new intervention is considered before a dozen years.
Imperfections of result
Can occur because of unexpected tissue reactions or unusual scaring phenomena. In some cases an excess of fat removal can develop hollow eyelid (osseous edge of the visible orbit). Small asymmetries can also be present. These imperfections can be corrected, if necessary, under simple local anaesthesia, at least 6 months after the initial surgery.
A blepharoplasty, although simple and primarily carried out for aesthetic motivations, it is a nevertheless surgical procedure, which implies the same risks as per others surgical acts.
Although extremely rare we have to distinguish the complications related to the anaesthesia from those related to the surgery.
Concerning the anaesthesia, the anaesthesiologist will explain the risk and answer the patient’s questions during a pre-op consultation. Today’s technology allows the practice of anaesthesia under the best safety conditions for the patient and the surgical team.
With regard to the surgical procedure: choosing a qualified surgeon minimizes any risk. Fortunately, the serious complications are very rare and the patients are fully satisfied with their result.
However, the possible complications are:
Post-operative bleeding, haematoma formation which often needs to be evacuated, infection (very rare), scar abnormalities, epidermic cysts: they can appear along the scars and are often eliminated spontaneously.
Lesions of ocular surface, often accidental and usually resolves without any important sequelae. Chemosis (edema of conjunctive which takes a gelatinous aspect), is rare after a simple blepharoplasty. It disappearance can take one to three weeks.
Disorders of the secretion of the tears, related with persistent whimpering rather than a “dry eye”. Ptosis (difficulty of opening the upper eyelid completely) is a very rare complication, seen in patients beyond 70 years with a pre-existent deficit. Lagophtalmy (impossibility of closing the upper eyelid completely) can be seen the very first day following the intervention, its persistence beyond a few weeks should be corrected. Ectropion (retraction of the lower eyelid), its major form is extremely rare, the minor form (” round eye”) occurs sometimes in eyelids that have lost their elasticity, subjected to an inopportune scar retraction; most of the time the problem is resolved after few massages intended to soften the tissues. In completely exceptional cases diplopia (double vision), glaucoma (ocular hypertension) and even of blindness have been reported in the international scientific literature.
To conclude, a blepharoplasty is a simple procedure, whose complications are very rare but present. The recourse to a qualified plastic surgeon decreases the risks and ensures you that any complication will be treated effectively.