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BLEPHAROPLASTY




THE EYES, THE EYELIDS, AND THE FACE’S AESTHETIC APPEAL


The eyes occupy a central position upon the face, and may be its most important cosmetic feature. When we are conversing with a person or even just looking at them, we tend to look at their eyes. Therefore, it is the first feature we notice in a person, as well as the most expressive part of the body, which betrays our emotional state. For this reason the eyes and, by extension, the eyelids, play a primary role in terms of the face’s aesthetic appeal.

At the same time, the eyelids are the first part of the face to be worn down. Often, the eyelids will appear much more aged in comparison to other facial features. This is because the skin of the eyelids is very thin and is much less elastic; as such, it tends to loosen much quicker than skin throughout the rest of the face.

It may be considered truly unjust for a face that in general shows little to no signs of wear to have its aesthetic appeal compromised only by the state of the eyelids. Observation shows that this is a frequent occurrence.
When the eyelids begin to appear worn, they create the impression of a sad or tired face. The operation which aims at correcting signs of wear in the upper and lower eyelids is known as blepharoplasty (otherwise known as ‘eyelid plastic surgery’).


WHAT CAN A BLEPHAROPLASTY REPAIR?





Blepharoplasty aims at correcting two main problems:

•    Loosening in the eyelids’ skin
•    ‘Bags’

Loosening mainly occurs in the upper eyelid, while ‘bags’ mostly appear in the lower eyelid. In some cases, of course, they may also appear in the upper eyelid, and may very well be quite pronounced.

The term ‘bag’ refers to protrusions which may appear on the eyelids, and are caused by fat. Periocular fat is naturally present around the eye, but as time passes may begin to protrude outward. This protrusion is caused by a reduced endurance in the tissues which are supposed to hold it in place. Instances of such protruding fat are commonly referred to as ‘bags’.


BLEPHAROPLASTIC TECHNIQUES:

There are various types of blepharoplasty techniques. The type of techniques that is employed should depend upon each patient’s particular problem. There is no technique that covers every type of problem.

1.    STANDARD BLEPHAROPLASTY:
During this operation, the plastic surgeon will make an incision in the upper eyelid, upon the exact spot where it folds, and remove the excess of skin from it. He or she will then proceeded deeper to remove the excessive fat. In the lower eyelid, the incision is made just underneath the eyelashes; once the skin has been detached along with the muscles, the ‘bags’, which are accumulations of fat, are removed. Once the excessive skin in the lower eyelid has also been removed, the plastic surgeon will suture the incision. When the incisions heal, they leave very discreet marks which in most cases are almost invisible. This is because eyelid skin has a very thorough ability to heal. The sutures are usually absorbed after 4-5 days.






2.    TRANS-CONJUNCTIVAL BLEPHAROPLASTY:
This method is applied to the lower eyelid, wherein the plastic surgeon does not perform an incision on the outer eyelid, but rather removes and repositions the fat to a better position via the interior of the eyelid, i.e. that part of it which is in contact with the eye. The incisions there are, of course, indiscernible. This type of blepharoplasty is mainly aimed at patients suffering from ‘bags’, but do not present any particular loosening in the skin of their eyelashes.

3.    LASER BLEPHAROPLASTY:
The plastic surgeon begins with a trans-conjunctival blepharoplasty, as described above; once this procedure is complete he or she smoothes the skin of the lower eyelid using a laser. Apart from smoothing thin wrinkles out of the skin, this also tightens the skin to some degree, thus correcting low degrees of sagging. This method, of course, is not aimed at patients who suffer from a greater degree of loose skin.

4.    BLEPHAROPLASTY VIA CANTHOPLASTY OR CANTHOPEXY:
This procedure, aids not only in correcting aging eyelids, but also in altering the shape of the eyes. ‘Canthopexy’ as a term refers to operations upon the underlying supports of the outer corner of the eye. Such an operation can be useful when the lower eyelid has loosened to the point where the whites of the eye under the pupil are constantly visible. In such cases, the plastic surgeon makes a suture at the corner of the eye, in order to pin it to something steady, usually the bone. The term ‘canthoplasty’ refers to adjustments in the position of the outer corner of the eye. This is usually employed to deal with cases wherein the corner is at a low angle, causing the eyes to appear sad. In general, eyes are considered more aesthetically pleasing when their outer corners are higher than their inner corners. When this is not the case, it can be remedied via canthoplasty, which has the ability to alter the position of the outer corners. The plastic surgeon will completely sever the outer corner’s support and create a new support, at a higher point and using a more stable surface, which is, again, usually the bone.

5.    FAT RETAINING BLEPHAROPLASTY:
This is a relatively new technique, wherein the fat from the ‘bags’ is not removed, but uniformly redistributed throughout the area of the eyelid, so that no deficiencies are left. Deficiencies in the eyelids are unsightly even if they have been corrected of loosening and ‘bags’.

Localized anaesthesia is usually administered for such operations; its combination with drugs is optional. If a patient wishes it, they may even undergo a general anaesthesia.


AFTER BLEPHAROPLASTY

The patient may return home immediately after the operation; they are not required to remain at the hospital. Pain does not generally follow a blepharoplasty, and does not even require the use of painkillers. Even in the unlikely event that there is some irritation, painkillers will be more than adequate to deal with it.

After the operation there will be some bruising around the eyes, which will require approximately 15 days to recede. After a period of 7 to 10 days, however, this bruising will have receded to the point where, with the application of a little makeup, the patient should be able to appear in public.





The stitches can be removed after 4-5 days. This does not mean that the patient will not be able to return to their regular activities beforehand; indeed, this is feasible even on the very next day after the operation. They will simply be unable to appear in public without making it apparent that they have undergone a blepharoplasty.

The final results should become apparent after approximately 6 months, once the healing period is over, yet even after only 15 days the patient should no longer carry the marks of the operation, and should be able to appear in public. The incisions heal very well, and become almost completely indiscernible once they have fully healed.
The results have a very long duration, certainly longer than a decade. There have only been very few cases wherein a patient has been required to undergo a second blepharoplasty over the course of their life. Once might even say that blepharoplasty is one of most long-lasting types of plastic surgical operation.

WHY AND WHERE IS CAUTION NEEDED IN BLEPHAROPLASTY?

Particular caution should be exercised when selecting the surgeon who will be presiding over the blepharoplasty operation based on their specialization. The only specialization the Ministry of Health authorizes to perform such operations is that of Plastic Surgery. Specializations such as ‘Ophthalmoplasty’ or ‘Facial Plastic Surgery’ are not recognized by the relevant authorities; these self-professed ‘experts’ do not have the knowledge, specialization, experience, or rights to practice corrective surgery upon the eyelids, in direct contrast to authorized plastic surgeons.

In addition, it is important that the plastic you address has knowledge of cosmetic surgery upon the face in general. This is because in many cases the problem does not only concern the eyes, but may also stem from other facial features; it may even be deceptive, appearing to be an eyelid problem while actually being of an entirely different type which nevertheless manages to affect the eyelids. For example, a deficiency in the lower eyelid may not require a blepharoplasty, but a lift of the middle part of the face. In addition, another area may need to be operated upon simultaneously with the eyelids in some cases.

Other practices with which blepharoplasty can be combined are eyebrow lifts, cheekbone augmentation, or the filling of certain areas using fat or hyaluronic acid. In several cases, a blepharoplasty incision may be used by the plastic surgeon to reduce wrinkles on the forehead, as strange as this may seem. Very frequently, blepharoplasty may be combined with a cheek-and-neck or forehead lift.
 
The eyes are a vital facial feature, and as such the results of blepharoplasty can result in a very high degree of improvement in the face’s general appearance. This fact, combined with the satisfactory duration of the results, makes blepharoplasty one of the most popular and prominent cosmetic facial operations.