Plastic Sugery - Bleparoplasty



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Plastic Surgery

Eyelid operation (blepharoplasty)

The eyes and their exposure have significant importance to a person's beauty and personal charisma. With ageing the elasticity and stability of the soft tissues and skin diminishes and the skin appears loose and wrinkled. Some individual properties and personal habits such as smoking and extensive sun exposure can accelerate this ageing. The lowering of the eyebrows by age renders a hooding to the upper eyelids. The attenuation of the connective tissues and the orbital muscle makes the orbital fat protrude like bags.

Principle: Principally the aim of the operation is to stretch the skin and to remove bags. The skin does not regain its elasticity and the operation neither accelerates nor prevents continued ageing. The longevity of the operation can never be estimated. A timid look will disappear.

Technique: On the lower eyelids the incision goes just below the eyelashes extending into a natural wrinkle at the sides for a short distance. Depending on the deformity, either the skin alone or the skin and muscle are elevated and shortened. In cases of fatty components, these are either repositioned or removed. On the upper eyelids the estimated excess is marked and removed correspondingly. Fatty components are removed if necessary and the wound is closed leaving a tiny, almost invisible scar in the reconstructed globus line extending out over the orbital rim depending of the looseness at the sides of the eyes. If an eyebrow-lift is needed, this is described elsewhere. Sometimes it is more suitable to do a lower eyelid correction with invisible scars by altering the fatty component only from the inside of the eyelids combined with a light peeling of the skin.

Anaesthesia: Conscious sedation and local anaesthetic.

Operating time: 1 - 2 hours.

What happens afterwards?

	When the anaesthetic subsides, a short intensive pain can be felt about ½ an hour. After that there is no pain.
	Ice bags are placed on the eyes to decrease the swelling and the bruising. You should continue this 2-3 times, in periods of ½ hours, during the two first days.
	The eyes are swelling during the two first days. The swelling gradually decrease and vanish after 7-10 days. It can take additional days before eventually bruises disappear fully.
	To speed up the dissolving swelling, you should sleep in a supine position and have your head in high position (two or three pillows) during 14 days.
	The stitches will be removed after 3-5 days.
	You can start to use make-up after 10 days.
	You can usually return to normal social activities after 10 days.
	You can return to physical training after 3-4 weeks.
	You will be on the sick-list in average 7-10 days.
	You should not take a sauna or sunbathing the face for 4-6 weeks (The swelling remains for a long time)
	The scars should not be exposed for direct sun beaming the first 6 months. Use high sun protection factor or opaque colour make-up.
	The area around the eyes feels numb in 1-2 months. This is not visible!
	The eyelashes feel numb in 1-2 months. It will disappear spontaneously!

Complications
Referred unwanted biologic events can occur with a certain low frequency and must be regarded as calculated risks. Other risks not mentioned can also occur. For patients this must be considered before a decision for plastic surgery is set.

Bleeding: All operations can cause postoperative bleeding. These risks increase by the intake of analgesics and Vitamin E. These should be avoided 2 weeks prior to the planned operation.

Infection: All operations can cause infections that in case it happens will be treated with antibiotics.

Scars: Scars are normally very discrete. Even in persons with a tendency to get hypertrophic scarring on other parts of the body, usually get discreet scarring in the face. The scars behind the ears have a tendency to get somewhat elevated in the beginning. All scars are red for 3-4 months and bleaches gradually. The scars should be protected against sunlight and solarium for half a year.

Pendulous eyelids: On the under eyelids you should avoid to take to much skin to avoid that the eyelid pulls down (like eyes of a cocker spaniel). Great carefulness should be provided and this could result that the patients do not feel that skin is tighten enough. Rather that than the opposite!

Smoking: Smoking does compromise blood circulation and healing. Smoking should be abandoned prior to a planned operation.

This text is edited and controlled by Dr. Per Gunnar Opitz, Opitz plastikkirurgiska klinik i Malmö Sweden

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