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Blepharoplasty or eyelid surgery is carried out to counter the external signs of aging on the human face that usually begin to appear around the eyes. Blepharoplasty, through a combination of processes, serves to bring back the fresh look to the area around the eyes.
The procedures involved include, treating the upper eyelids by removing excess skin and fat, removing or repositioning the excess fat in the lower eyelids, removing the excess skin, using a chemical peel to smoothen the skin texture of the lower eyelid, and performing either one or a combination of the following processes: removing the muscles responsible for vertical furrows between the eyebrows, and lifting the eyebrows.
Each of these five procedures is optional. In other words, the treatment could involve all of these procedures or any one of them, depending on the desire of the patient. However, combining these procedures in an expert manner brings about the best results - a fresh and young look around the eyes without them losing their original shape or the face revealing any indications of a surgery having been performed. The resultant scars on the upper eyelid are not generally visible when the eyes are open.
Problems with the lower eyelid are mostly caused by fat pouches without loose skin. An incision inside the eyelid removes the fat pouches without leaving any scars on the outside. This treatment method is known as the transconjunctival approach. Patients having fat pouches in the lower eyelid along with loose skin are also treated by placing an incision under the eyelash for removing the excess skin.
In some individuals the corrugator muscles, due to over activity, cause heaviness of the inner eyebrows and vertical furrows between their eyebrows. This can be temporarily treated by administering Botox injections. By causing temporary paralysis of the muscles, the injection smoothens the area. However, these injections need to be taken every four to six months and are expensive as well as painful in some cases. Removing these corrugator muscles by placing an incision in the upper eyelid is a more permanent solution.
Hooded upper eyelids are caused by sagging eyebrows. Upper eyelid surgery, discussed earlier, combined with browlift is the treatment administered for this. Browlifts are of three kinds. Depending on the age and condition of the individual, the right kind of browlift technique is offered. The point of difference between the three kinds of browlifts lies in the location of the incision. Incision is done on the scalp either at the hairline, above it or, as in the case of "open" browlift, further up the scalp extending over the top of the head. In all cases the surgery basically involves loosening the forehead skin with the incision and then raising it. Plastic anchors are then attached to the bone through the incisions to hold the lifted skin of the forehead in place. As these small anchors get dissolved in a few months they don't need to be removed.
It's a very effective surgery and brings about the desired results though the open browlift technique doesn't always need to be performed except in the case of individuals above the age of 60. Open browlift is also not recommended for individuals with a high forehead or thinning hair.
Deep smile lines ("Crow's Feet"), another condition of the eyelids, is most commonly and effectively treated with Botox injections. A chemical peel of dilute trichloraecetic acid (TCA) could treat fine wrinkles on the lower eyelid skin. This results in the removal of the top layer of the skin, while the layers beneath regenerate a smoother and softer epidermis (skin). Following the TCA peel treatment the lower eyelid skin displays light crusting for about a week followed by a redness or pink color for another week, which can be concealed through make-up. A chemical peel can also, in certain cases, treat dark circles.
Weak lower eyelids could cause certain symptoms of dry eyes, as they reduce the protection the eye receives. The treatment for this involves removing excess skin and fat from eyelids along with a tightening process. This prevents the dry eyes symptoms, while also improving the shape of the eye opening.
Individuals with decreased tear production could develop chronic eye irritation following blepharoplasty. Individuals with such symptoms could be tested before the surgery, which can be performed in a conservative manner for those with minimum effects of the symptoms. But individuals having more serious manifestations of itching or tearing cannot be operated upon. Individuals with symptoms of dry eyes can undergo upper and lower eyelid surgery in two stages. Eyelid surgery is performed by Dr Spero Theodorou at Manhattan Eye, Ear and Throat Hospital.
Side effects following the surgery vary from individual to individual. In most cases it's a minor discomfort in the eye, or a mildly blurred vision for the first few days. The eyes are not bandaged following the surgery. Instead, ice compresses are applied to the area for 24 hours. More discomfort is caused by a browlift as it involves incision on the scalp. As a result tightness due to swelling can be experienced on the scalp. Numbness is also felt on parts of the scalp and the forehead. Swelling and discoloration on the eyelids or the portion operated upon generally occur after surgery, but by two weeks the matter is usually resolved. The eyelid sutures and browlift clips are generally removed in five days and one week respectively. Beginning a week after surgery, a light cover-up can be applied to the lower eyelids, and a chemical peel performed beginning two weeks after the surgery. Makeup can be used on the eyes a week after the surgery, but in a restrained and regulated manner.
Depending on the condition, blepharoplasty takes one to two hours, plus 45 minutes if a browlift needs to be performed. Patients can resume normal activity one to two weeks after surgery, with the exception of playing ball sports which can be resumed only after 6 weeks.