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EYELID SURGERY

What is an Eyelid Lift (Blepharoplasty)?


Commonly known as an Eyelid Lift, blepharoplasty is surgery to restore youthful eyes, to look brighter and allow better function of the sight. It involves removing excess skin and addressing the change in fat distribution around the eye that happens with age.
 

What Happens Around Our Eyes As We Age?

Upper eyelids– The “soft tissue” from the top of your scalp down through your your hairline, your forehead, your brow and upper eyelid gets pulled down with gravity over time.  This excess skin created begins to “hood” over your eyelids.

People often do not notice that their peripheral vision has diminished as these changes happen slowly overtime. They can’t see as well as they used to because the hooding obstructs peripheral vision.

As less light gets through to your eyes your brain detects this change and, without you being aware, causes you to open your eyes wider and raise your eyebrows to let in more light.  This can also have the effect of producing wrinkles on your forehead.

There are also two fat compartments in your upper eyelids that change over time, one becomes larger and bulges out,  the other recedes, making your eyes often look hollow and gaunt if extreme.

Lower eyelids– Bone structure also changes slowly over time and gravity causes soft tissue to migrate south.  As skin loses its elasticity this steady pull causes wrinkles around the eyes  and “bags” or “dark circles” can also develop below the eyes. A comment we often hear from patients who come in is “I look tired all the time”, “I hate these bags under my eyes”.

 

This loss of elasticity in your skin and stretching of the ligaments below your eyes  act much like a hammock that stretches and sags as it holds the fat that has migrate south.

How Does Blepharoplasty Correct These Changes?

If the changes are early, one may be able to tighten the skin without surgery. There are non surgical methods that may allow for less down time and less risk. Also if the skin quality is good we might use fillers to camouflage the changes  and give more youthful look.  However, beyond a certain level the upper eyelids and lower eyelids need to be addressed with specialized operations.

Upper Eyelid Revision– Our faces and bodies are asymmetrical (no two eyes, breast and ears are exactly the same)   Excess skin is precisely measured to allow for this asymmetry. Skin may be taken away with an incision and depending on the situation fat may be “reallocated”  Taking fat from an area that is bulging due to excess fat and using it to reverse this “gaunt look” can be very effective.  This re-balancing is crucial in restoring youthful volume to make you look brighter and eliminating the appearance of having had surgery.

Depending on what can be addressed, this procedure can be done under local anaesthetic in an office setting.  It is extremely rare for an upper eyelid incision to be noticeable- best part of the body to have a scar, no one sees it eventually provided recovery is uneventful.

 

Lower eyelids Revision – There are largely 2 ways.
   Scarless approach– incision is made inside your lower eyelid (it’s actually not as scary as it sounds!) so there is no scar on the outside. The fat below your eyelids are addressed  through this approach but this method does not address the skin- so this might be for someone who’s skin tone is good and little or no excess but the chief complaint is about the fat.

   Open approach– hairline incision is made below the eyelashes (scars around eyelids for some reason heals extremely well, so much so that months down the line it is almost imperceptible provided there were no complications) so that excess skin and fat are sorted.

As mentioned above, some times the loss of volume around the eyes are best addressed with right amount of additional volume. This can be temporary solution like a filler (An office based procedure, with no downtime, which if you don’t like can be left to disappear within 3-6 months) or permanent like a fat injection (sucking fat from an unwanted area and injecting it into places that need filling)..

Brow Lift - Why We Often Suggest This

Often patients come in wanting an eyelid lift but the bigger problem (apart from the eyelid) is the eye brow position. This is because the soft tissue migrating south from the top of your scalp down to your upper eyelid stretch due to gravity. You may already compensating for your blocked vision by unconsciously raising your eyebrows. This can be why some people have wrinkles on their forehead.

For most people the issue can be dealt with by addressing the eyelids. If the biggest problem you have is brow migrating south, doing your eyelids then will help make your brow relax, and your eyelids sit more naturally again. Patients are often surprised to find that their eyelid lift solve the eyebrow problem?

 What are different ways of changing the eye brow position?

   Endoscopic- A technique using a camera and sutures.

   Open incision technique- This is a more direct approach, and also the simplest, most direct way to change position of the eyebrows. 

   Limited incision technique- Which is a mix of the above two techniques

Can Eyelid Lifts Be Done Under Local Anesthetic

For selected cases, after examination and in depth discussion in person, will can determine whether this is appropriate for your situation.

This may be relevant if you are a self funded patient with no private health insurance coverage as the additional operating theater cost can be expensive.

Ask Us to see if you are suitable to have this done in an office setting with local anaesthetics.

Risks of Blepharoplasty

Any operation comes with risk. These risks will be discussed with you in detail at your consultation.  Thankfully these risks are extremely low but it is important that you understand them and accordingly follow all post operative care instructions completely.

Chemosis– This is the commonest complication after blepharoplasty. It is when swelling of the red mucosa inside of your eyelid persists after surgery.  The condition is usually temporary and is thought to be due to a blockage of the lymphatics.  If it does occur it can be treated effectively topical medications and rarely needs any other intervention.

Injury to the eyes– Eye protectors and lubricants are used to minimise this and incidents of injury to the eye are extremely rare.

Poor Scar Healing – Tissue around the eyes generally heals very well and noticeable scaring is extremely rare. Virtually unheard of if postoperative scar advice are followed closely.

Ectropion– This is a potential risk of lower lid surgery when the eyelid margin no longer sits on the eye itself.  To prevent this proper examination and discussion of tailored plan including manipulation of eyelids will take place.

Asymmetry– Because no two eyes are exactly the same existing difference between right and left may remain and in rare circumstances be exaggerated.

Infection– You will be covered with the right antibiotics and also provided with topical ointments and drops.  Following postoperative care procedures is the best way of avoiding this.

BLEEDING - SPECIAL ATTENTION

Some bruising and oozing is expected and normal. This will settle down in a couple of weeks. What we must attend to is any excessive bleeding in the wrong place and the collection of blood near the eye itself. This may cause:

 Strong Pain– Some pain or discomfort is to be expected after any operation. Under normal circumstances pain should fade away rather than worsen.

 Decrease in night vision.  This has been known to occur in rare cases, and permanent loss of vision has been reported in medical literature. Thankfully the incidence of this happening is between 1 in 5,000 and 1 in 50,000 so extremely rare.

Slightly blurred vision and some light sensitivity is normal and your eyes may be a little more teary than normal.  This usually clears up as you heal.   To further protect your eyes after surgery we apply eye ointment which will make your eyes seems blurry but this should soon get better.

 

Monitoring is important to ensure successful outcomes. – Be vigilant if there is any excess bleeding or symptoms that you are concerned about call immediately. 
You will have direct access to Dr Kim who will undertake immediate treatment should it be necessary.  We are here to look after you.

We tend to nag a little on some of these things, so these special precaution will be repeated with you at consultation, before you go into the operation and after your surgery. Not because we’re expecting it but because we want to guard against all possible issues however remote. Surgery around the eyes must be undertaken with skill and caring and all precautions taken.

The risks are outlined here to help you make an informed decision but more importantly to increase your awareness so that if there were to be an unexpected complication we can capture this early and act upon it in a timely manner. Your uneventful recovery is our absolute priority.

What Increases My Risk of Bleeding

Many factors can predispose you to bleed more easily and for longer.

Medication – Blood thinning medication can increase your risk of bleeding. This type of medication is frequently prescribed because of heart problems, previous strokes, blood clots and more. Any blood thinning drugs such as Warfarin, Clopedigrel (Plavix) and Eloquist can cause complications during surgery. So please inform us of any medications you are using.

Smoking – If you’re a smoker and cough frequently or hard, this can drive up your blood pressure and lead to a bleed.

Heavy lifting or strenuous activity too early- again, these drive up your blood pressure and may set off a problem bleed. This is best avoided until further instructions.

Haemophilia: If you have inherited this predominantly male bleeding condition you would know from family history and previous episodes of excessive bleeding.  It is important to inform us if this applies.

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Is Blepharoplasty Painful?

Blepharoplasty is generally not painful.  You can expect minor discomfort along with some swelling and bruising after surgery.  However, this should settle down at around two weeks if not earlier. We will provide you with a detailed postoperative plan and begin to see how the final result will look in around six weeks.

For upper blepharoplasty you will need to take it easy for the week afterwards, swelling and bruising should be all settled enough to go back to work at about two weeks.  Lower blepharoplasty has a similar timetable but depending on what you need done you may need a further week.  You must not do any heavy lifting or straining during this time.  More couch time and Netflix and no house work.

Will I Be Asleep for Surgery and How Long Does it Take?

 Full Anaesthesia may not be necessarily for upper blepharoplasty but each person needs to be assessed individually.  If excess skin is the major concern it is often possible to do it under local anaesthetics with some oral sedation.

Upper and lower blepharoplasty each take about 2-3 hours, however if fat is to be relocated more time may be needed.

Are There Alternatives to Surgery

Yes, we do perform office based procedures such as injection of fillers to restore volume and laser can also be used to tighten the skin.   There are some of good maintenance methods to improve the appearance of your eyes. When introduced early these methods may enable us to delay surgery for quite some time and also keep your down time to minimum.  Each patients need to be assessed individually though because there is a limit to what non-surgical options can achieve.

Does Private Health Insurance Cover The Cost of An Operating Theatre?

Theatre costs for upper blepharoplasty may be covered if your skin excess is in contact with your lashes. The operation may then be deemed “medically” necessary as far as your insurance fund is concerned.  If this is the case, the cost of operating theatre and overnight bed will be covered.  However, lower blepharoplasty is considered “cosmetic” and is not covered unless there are other medical reasons why, such as a long standing facial nerve injury.

If you do not have private health insurance but are self-funded, talk to us about your needs, it may be possible to bypass the operating theatre costs.

Before Surgery

You will be seen at least twice with ample thinking time in between and we encourage you to come with your loved ones- to ask plenty of questions and go over how we’re going to look after you after the surgery. We take plenty of time so that you’re making a considered decision.

Before your surgery ensure you read this section about general preparation.

It is necessary to have “cooling packs” ready as you will be instructed to apply cold compresses on your eyelids for about 15 minutes every hour especially on the day of surgery and the following day. This is stopped after 24-48 hours depending on your progress. You will be given prescriptions of all eye ointments, drops and antibiotics prior to your surgery so make sure you fill them before surgery so that you have them ready to go.

What happens during surgery?

The marking is the crucial part of this operation- ever so carefully your skin marking will be made, measured and your fat distribution marked on skin.

Upper blepharoplasty. Excess skin is excised and some muscle may be altered if needed.  Fat is dealt with next and either excised or contoured carefully or it may be repositioned elsewhere to restore volume. Other additional techniques may be required depending on your situation. Your wound is then carefully brought together with fine sutures.

Lower blepharoplasty. The correct dissection “plane” is created to minimise complication and the fat is dealt with by a combination of excision and repositioning. Additional procedures designed to safe guard against complications and maximise the youthful appearance are undertaken as the operation proceeds.   Trimming away excess skin is only done if needed. Your wound is then carefully brought together with fine sutures.
Eye ointment is applied into your eyes which will temporarily cause blurred vision and we will place a gentle protective pad over your eyes. This can come off a couple of hours later.

 

Aftercare Following Your Eyelid Surgery

WHAT CAN I DO TO REDUCE THE SWELLING?
First thing you may notice when you get up in the morning is that your eyes are puffy- this is the fluid in your body rebalancing as a result of sleeping flat and this goes away as you get on with your day. The same things happens after eye surgery and with the additional bruising the puffiness will be worse.
To minimise the puffiness as much as possible please follow the steps below.

 

  1. Monitoring is Crucial for the first 24-48 hours.
    Monitor for Pain that is getting worse and or any decrease in your vision. Some discomfort and blurred vision is normal but not being able to see is not normal, call us for help immediately if you experience either of these.

You will be provided with immediate access to Dr Kim after surgery, we are here to look after you.   This is in case of a very very remote possibility of bleeding in the wrong place. Note that small amount of oozing and spotting is normal.

Large bleeding near the eye will be obvious and must be acted upon it quickly should it ever happen.

Be aware that you’re likely going to be more light sensitive and little tearier than normal but this will steadily improve.  At night before you head to bed apply eye ointment instead- ointment during the day can make it difficult to get about your day for obvious reasons.

  1. Sleep with your head and shoulders propped up on at least a few pillows. You don’t need to be upright, but more your eyes and head raised above the level of your heart the better.
    The simple logic here is because of gravity, water flows down and if you sleep with your head flat as you normally would your swelling will be worse and takes longer time for it to go away.
  2. Apply cold packs to your eyes for about 15 minutes every hour in the first day or so.
    Do this at least in the first 5 days and as directed by Dr Kim.
    Preliminary results can be seen at about 6 weeks mark so expect a little bit of swelling to persist initially but know that it will gradually improve.
  3. While awake but lying down keep your head and upper body propped up with a few pillows. Keeping your head above your body is extremely important for the first 24-48 hours after the surgery.
  4. Apply eye drops 4 times a day for the first few days to keep your eyes lubricated and stop them from becoming dry.

Your sutures will be removed in the first week. This appointment will have been already made for you so note the date and time.

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What is an Eyelid Lift (Blepharoplasty)?

Commonly known as an Eyelid Lift, blepharoplasty is surgery to restore youthful eyes, to look brighter and allow better function of the sight. It involves removing excess skin and addressing the change in fat distribution around the eye that happens with age. 

 

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© 2019 Dr Leo Kim info@specialistdrkim.com.au