Cosmetic Surgery For The Eyelids
This operation has undergone modification with the advent of Laser Resurfacing. A few particulars:
- The Surgical Blepharoplasty as opposed to laser re-surfacing of the eyelid (marketed by some as "Laser Blepharoplasty") addresses excess fat ("Bagginess") and skin of the upper and lower eyelids.
- It is true that laser re-surfacing procedures address skin excess to a minor extent. The heat of the laser actually shrinks the skin. For patients with a good deal of skin excess however this is not adequate.
- The surgical procedure accomplishes its goals via incisions in the upper eyelid crease ("Upper Blepharoplasty") and/or beneath the lower eyelid lashes or inside the lower eyelid ("Lower Blepharoplasty"). Some surgeons have used the Transconjunctival (through the eyelid) approach to avoid the incision beneath the lower lid lashes and added laser re-surfacing of the lower eyelid to address the fine wrinkling seen in the skin here.
- The bottom line here is that the procedure can be varied to suit the patient's particular eyelid anatomy and goals.
The Procedure and Post-operative Care
The erythema following laser use can take months to go away in some cases. Therefore, if the surgery is performed without laser re-surfacing, recovery is more rapid. The bruising (variable) usually becomes barely noticable by 7-10 days. Swelling also resolves quickly in most cases in the same period, but a few patients can take 4-6 weeks to improve. Ice packs (or cool silicone gel treatments) may reduce this swelling and can be applied for a day or two post-operatively. Most patients can go back to work in a week although some patients will go back in as few as two days. Heavy lifting or straining is to be discouraged for one to two weeks as it could retard the resolution of swelling.
Poor outcomes in blepharoplasty are rare, but some can be serious. This is the factor which tempers the hand of the wise surgeon. Overly aggressive surgery may pre-dispose toward a poor result.
Dry eyes are not uncommonly seen after surgery. As people age, their lacrimal glands tend to tear less. This can be made worse (usually temporarily) by the surgery. Artificial tears can be used for a few weeks as needed as most cases resolve with time.
Ectropion is seen in cases in which the lower eyelid is too lax pre-operatively or too much skin is removed in the surgery. It can also happen in laser re-surfacing as a function of the heat treatment. It appears as an outwardly turned lower eyelid. It can sometimes resolve with time (a few months) or may require corrective surgery.
Asymmetry is always possible and frequently pre-operatively visible. I will discuss with patients pre-operatively that this can be addressed during the operation, but absolute symmetry is impossible and unnatural. This is where patient expectations come in. Those patients will less than realistic expectations are those for which an operation may not be warranted.
Other more serious complications occur extremely rarely. Bleeding in a worse case scenario can cause blindness. Cases of this are reported once a year or so in the journals (extremely rare), but underscore the importance of absolutely avoiding pain relievers such as Aspirin, Motrin, Ibuprofen, etc.. These medications should be discontinued at least 7-10 days prior to surgery as they increase the tendency to bleed.
Please note that this information (as well as that on all my pages) is offered freely to individuals considering cosmetic surgery. No rights are granted and it is not to be reprinted or copied without the author's prior written consent. Understand that some of the information presented may be a matter of professional opinion. Although efforts have been made to assure accuracy, no guarantees are expressed or implied.
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