Text author: Dr sc. Bojan Kozomara, M.D.
Blepharoplasty (aesthetic surgery of the upper and lower eyelids), or eyelid “rejuvenation” surgery, is the most commonly performed surgical procedure on the eyelids and one of the most frequent cosmetic surgeries on the face.
It is recommended for all patients over 45 years old, but also for younger individuals who have a functional problem with excess skin on the upper or lower eyelids. The procedure can be performed for aesthetic reasons even before the age of 45, but patients must be prepared for the possibility that they will likely need to repeat it at least once more in their lifetime, as the effect of the surgery is visible for 10-20 years.
The surgical procedure itself is completely painless for the patient, whether it involves the upper or lower eyelids. The procedure is performed under local anesthesia, with the anesthetic applied beneath the skin that will be removed. Sometimes, at the patient’s request, anesthesia can also be in the form of analgosedation (you are sedated but breathe on your own), or general anesthesia (you are completely asleep, and a machine breathes for you).
For this surgical procedure, the exact amount of excess skin that needs to be removed is determined beforehand. The procedure and assessment are very important because the functionality of the eyelid cannot be compromised; the eye must open and close normally after the surgery. Local anesthetic is injected beneath the excess skin to be removed, and additional anesthesia can be applied as previously mentioned.
After removing the excess skin, the wound is closed with sutures that can be either self-dissolving and do not need to be removed after surgery or non-dissolving and must be removed 7-10 days after the procedure.
In the postoperative period, which usually lasts about 7 days, the patient is advised to apply cold compresses (most commonly ice) to the eyelids several times a day and to rest more during the first two days after the procedure, avoiding heavy physical exertion.
Postoperative check-ups are often not necessary.
Nakon uklanjanja viška kože rana se zatvara koncima koji mogu da budu samorazgradivi i ne moraju se skidati nakon operacije, ili onim koji nije samorazgradiv i mora se skidati 7-10 dana nakon zahvata.
U postoperativnom toku, koji obično traje oko 7 dana, pacijentu se savjetuje da nekoliko puta na dan stavlja na kapke hladne obloge (najčešće led), te da prva dva dana nakon zahvata više miruje, odnosno da se ne izlaže težem fizičkom naporu.
Kontrole poslije operacije često nisu potrebne.
Unlike upper eyelid surgery, lower eyelid surgery can involve the removal of only excess skin, excess skin, and fat (“bags” under the eyes), or just fat. For the first two indications, the incision is made on the outside of the eyelid, on the skin itself, while for the removal of only fat, the incision is made on the inside of the eyelid. The first two indications require sutures, whereas in the third case, the wound heals on its own, the incision is not visible, and no sutures are needed.
The operative and postoperative procedures are the same as for upper eyelid surgery.
In recent years, there has been significant technological expansion of lasers in aesthetic medicine as well as surgery.
One such technology increasingly used in upper eyelid surgeries is the fractional CO2 laser. This laser technology enables “bloodless” surgery, where the laser beam simultaneously makes an incision on the skin and cauterizes blood vessels and capillaries. As a result, there are no bruises after the surgery, leading to a significantly shorter postoperative recovery time. Additionally, the precision of laser incisions allows for better wound healing, with almost imperceptible scarring after the procedure.
The fractional CO2 laser also has another important application in lower eyelid aesthetic surgery. Due to potential intraoperative and postoperative complications with lower eyelid blepharoplasty involving an external incision (incision through the skin of the eyelid), “laser skin resurfacing” procedures are increasingly being used. This procedure tightens the skin of the lower eyelids by creating micron-scale openings on its surface, which stimulate natural collagen production, leading to skin tightening. The effect is visible a few days after the procedure and can be repeated as necessary.
As mentioned earlier, laser blepharoplasty is becoming increasingly popular, with more and more patients opting for eyelid surgery using lasers. The precision of laser incisions and the absence of bleeding during the operation are the main reasons for this choice. Electrocautery remains a great option and does not differ significantly from lasers in the hands of an experienced operator, but the recovery time with this method is still somewhat longer, and patients may often experience bruising.
