BLEPHAROPLASTY (COSMETIC SURGERY OF THE UPPER AND LOWER EYELIDS)
Blepharoplasty, or eyelid “rejuvenation” surgery, is the most frequently performed surgical procedure on the eyelids and one of the most common facial cosmetic operations. It is advised for all patients over 45 years of age, as well as for younger individuals who have functional problems due to excess skin on the upper or lower eyelids. In fact, the procedure for cosmetic reasons can be performed before the age of 45, but patients must be prepared that they will probably have to repeat it at least once during their lifetime, as the effect of the operation is visible for 10-20 years.
The surgical procedure itself is completely painless for the patient, whether it involves surgery on the upper or lower eyelids. The procedure is performed under local anesthesia, with the application of an anesthetic beneath the skin to be removed. Sometimes, at the patient’s request, anesthesia can be in the form of analgosedation (“you are dazed, but breathing on your own), but also general anesthesia (you are completely asleep and a machine is breathing for you).
Upper Eyelid Blepharoplasty
For this surgical procedure, the exact excess of skin that needs to be removed is first determined. The procedure and assessment are very important because the functionality of the eyelid cannot be compromised, i.e., the eye must normally open and close after the operation. A local anesthetic is injected under 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 self-dissolving and do not need to be removed after surgery or those that are not self-dissolving and need to be removed 7-10 days after the procedure. In the postoperative period, which usually lasts about 7 days, the patient is advised to put cold compresses (usually ice) on the eyelids several times a day, and to rest more for the first two days after the procedure, i.e., not to be exposed to heavier physical exertion. Follow-ups after surgery are often not necessary.
Lower Eyelid Blepharoplasty
Unlike upper eyelid surgery, lower eyelid surgery can involve removing only the excess skin, excess skin, and fatty tissue (“bags” under the eyes), or just the fatty tissue. In the first two indications for surgery, the incision is made from the outside of the eyelid, i.e., on the skin itself, while when removing only fatty tissue, the incision is made from the inside of the eyelid. The first two indications require suturing, while the third one heals by itself, the incision is invisible and does not need to be sewn. The operative and postoperative course is the same as in the case of upper eyelid surgery.
Ptosis (Drooping Eyelid)
Ptosis is a medical term that indicates drooping eyelids, i.e., eyelids that are not in a normal anatomical position on the eye. If it is a minor degree of ptosis, it is considered only cosmetic, but if the eyelid is so droopy that it covers the pupil and obstructs the vision of the affected eye, it is referred to as functional ptosis. This condition can occur at any age, even at the birth of a child, when it is most often referred to as traumatic ptosis that can occur during childbirth itself. On the other hand, acquired ptosis occurs as a result of injuries or degenerative changes in the muscles or tendons of the eyelids caused by aging, as well as damage to the cranial nerve that lifts the eyelid.
Ptosis can only be corrected surgically, regardless of the patient’s age. Depending on the degree of ptosis and the patient’s age, the technique may include shortening the tendon of the eyelid lifting muscle or fixing an elastic silicone strap under the skin to the frontal muscle. Regardless of the technique by which ptosis will be corrected, all procedures are performed under local anesthesia, without the need for sedation, except in cases where ptosis is corrected in children when surgery under general anesthesia is recommended. Patient recovery is usually 7-10 days, after which the full effect of the performed surgery can be seen.
Ectropion and Entropion?
Due to changes in the structure of the eyelid tissues, usually caused by aging but sometimes also by scarring or innervation disorders, disorders of the eyelid position occur. These can manifest as turning the eyelid outward (ectropion) or inward towards the eye (entropion). The onset of ectropion is often accompanied not only by poor eyelid aesthetics, but also by chronic conjunctival irritation (conjunctivitis), and inflammation of the cornea of the eye (keratitis). These conditions occur because the abnormal position of the eyelid prevents tears from staying on the surface of the eye, thereby reducing or completely nullifying the protective function of the tear film.
In contrast to ectropion, entropion involves the inward turning of the eyelid. Patients often complain of eye irritation and vision deterioration which can be caused by damage to the corneal epithelium (epithelial erosion), or inflammation caused by the eyelashes touching the cornea of the eye.
Correction of Eyelid Position Disorders?
Surgical intervention in both cases is simple, quick, and effective. It strengthens the eyelid muscles and returns the eyelid to its normal anatomical position. Regardless of the technique used, all procedures are performed under local anesthesia, and the patient can return to their everyday activities just a few days afterward.