The eyes are our gateway to communicate with the outside world and play a significant role in our social relations. Typically, in human relations, looking into the eyes of the others is the first step. For this reason, the appearance of eyes individuals plays a huge impact in the first impression of others towards a person and the self-confidence of the person themselves. With aging, some changes occur in the structure of eyelids causing the elderly to find an aged and exhausted appearance. A major part of these changes include:

  1. Development of subtle wrinkles around eyelids
  2. Stretching and loosening of the skin of eyelids, which sometimes lead the skin to hang from the eyelid edge.
  3. Accumulation of extra fat beneath the skin of eyelids
  4. loosened muscles of eyelids

The sum of these changes causes the face of the person to look aged and exhausted. In addition, if these states are severe, by blocking the lateral field of vision, they can also affect the vision performance of the person.

Blepharoplasty is a cosmetic surgery which is performed to modify these changes and develop a younger and healthier look. In this surgery which is one of the most common cosmetic surgery, with removal of the extra skin, fat, and muscles and modification of the eyelid position, the appearance of the person improves significantly, and they find a younger and healthier appearance. The beneficial outcomes of this surgery positively affect the person's face for years or even forever.

What are the suitable ages or groups for blepharoplasty?

The best candidate for this type of surgery are those who have at least 35 years of age, in whom ptosis or periorbital puffiness (in response to accumulation of extra fat) has caused unfavorable changes in their face. To perform the surgery, the person should be totally healthy and have no special disease. Concerning the progressive growth of cosmetic surgery, in order for the patient to achieve favorable outcomes, they should have realistic and reasonable expectations from the surgery and its outcomes. To achieve a proper view, the pre- and post-operation images in other individuals and sometimes consultation with those who have already been operated can be very helpful. It should also be noted that blepharoplasty does not improve the following conditions:

- wrinkles around eyelid, eyebrows, and on the forehead (injection of Botox is suitable for these conditions)

- the black rings around the eyes

- Brow ptosis

In any case, it should be noted that after all blepharoplasty is a type of surgery and its possible complications do not resolve easily. Therefore, to undergo this surgery, a precise and specialized consultation is essential.

Different types of Blepharoplasty

Blepharoplasty may either be performed alone or alongside other cosmetic operations such as stretching the face skin or lifting brows or Botox injection. Generally, blepharoplasty involves three major types of surgery, with each having its advantages and disadvantages:

Plasty of upper eyelid: in this surgery, the extra skin on the upper eyelid and adipose sacs (manifested as puffs above the eyelid) are removed. In addition, if there is also ptosis, it can be corrected during the surgery. This operation results in improved appearance and position of the upper eyelid. In addition, if presence of extra skin or ptosis has caused constraint lateral vision, this problem is also resolved, whereby a younger and sharper appearance develops in the person. Sometimes, the surgery of lifting the eyebrows is also performed alongside the upper eyelid plasty.

Plasty of the lower eyelid: this surgery is mostly performed for removing adipose sacs beneath the lower eyelid which develop a puffing state under the eyes. Typically, part of the skin of the lower eyelid is also removed. These changes overall develop a younger appearance in the person.

Transconjunctival Blepharoplasty: this method is mostly used in young individuals whose skin has still preserved its elastic properties and has a relatively stiff consistency. In this method, without manipulating the skin, through an incision behind the lower eyelid (on the conjunctive side), the adipose sacs beneath the eyelid are removed. The advantage is that there is no need to any incision on the skin.

What are the measures that should be taken before the surgery?

Before the surgery, a precise ophthalmology examination is essential. Measuring the vision and the extent of lacrimal secretion must be performed before the surgery (even individuals whose lacrimal secretion is lower than normal, this surgery can cause dry eyes and even sometimes serious and dangerous complications). if you have any special disease, consider special medications, or have sensitivity to anything, you must report it to the physician.

How is the procedure of the operation?

Blepharoplasty can be performed in the office, clinic, or hospital. Typically, the surgery is performed as outpatient and there is no need to hospitalization. The duration of surgery is variable and varies between 1 and 3 hours given the type of surgery (only on the upper eyelid, lower eyelid, or both). The surgery is usually performed through local anesthesia; nevertheless, given the status of the patient and if approved by the physician, the patient may undergo general anesthesia.

In the upper eyelid plasty, first an incision parallel to the natural creases of the eyelid is developed. Through this incision, the surgeon removes a crescent-shaped part of the skin as well as subcutaneous muscles and almost all extra fats. If there is also ptosis, at this stage it can be corrected through absorbable sutures. Thereafter, the site of incision is closed through delicate sutures.

In the lower lid plasty, incision is developed in the lower part of eyelashes parroted to the natural creases of the eyelid. The extra fat is removed and if there is also extra skin, a crescent-shaped slice of the skin is also removed, and the site of incision is stitched with delicate sutures.

Finally, in transconjunctival blepharoplasty, the incision is developed behind eyelid (from inside the eyelid) and the extra fat is removed from this very site. Thereafter, the site of incision is repaired through absorbable sutures.

Postoperative care:

At the end of the surgery, the site of incision and sutures is greased via an ointment, and if required and wound dressing is also used. Once the effect of the anesthetic agent subsided, you may feel that your eyelids are stretched and painful. This situation is usually mild and can be resolved by consuming typical painkillers. In case of incidence of any severe pain or diminished vision, do contact your physician. Typically, it is recommended that following the operation for several days use cold compress and keep your head up (stack several pillows on each other for sleeping). These measures significantly help in controlling the swelling and bruise of the site of surgery. The extent of swelling and ecchymosis of the site of surgery is different among patients. Ordinarily, the swelling and bruise reach their maximum after one week and resolve within 2-4 weeks. Up to one or two weeks after the operation, the eyelids have mild secretions or a sense of stickiness. Consumption of proper drops helps in resolving these states. In early weeks following the operation, tearing, photosensitivity, and transient changes in vision (such as blurred vision or diplopia) may develop which resulve gradually. In the first two or three weeks, you must be regularly visited by ophthalmologist. The sutures are usually removed 4-5 days up to one week after the surgery. Once they are removed, the swelling of eyelids subsides gradually and the person finds a better appearance.

Returning to typical routine activities

Most individuals can study or watch TV after one or two days. Typically, up to 2-3 weeks after the surgery one cannot use contact lenses and proper glasses should be used instead.

After one week up to 10 days, when all sutures have been removed and the site of wound almost healed, occupational activities can be performed again. From this time with physician discretion, one can use cosmetics for concealing the bruise and site of incision. Typically, up to 3-4 weeks after the surgery the eyes are extremely sensitive to sunlight, heavy winds, and debris or dust. During this period, a pair of large sunglasses a sunscreen lotion specific for around always should be used.

For 4-5 days, it is better for the person to limit their activities and rest as much as possible. In addition, for 3 to 4 weeks, the person should avoid heavy activities (such as bending, picking up objects from the ground, and strength sports). These activities elevate the blood pressure and increase the chance of bleeding at the site of surgery.

The complications of the surgery

When operated by an experienced surgeon, blepharoplasty complications do not occur very frequently. Nevertheless, as with any other surgery, complications such as infection at the site of incision or sensitivity to the anesthetic agent always exist. But following the physician's orders before and after the surgery, the probability of incidence of complications decreases.

Mild postoperative complications include: transient diplopia or blurred vision, swelling of the eyelids, asymmetry of the site of incision on both sides, small white pimples at the site of sutures. These complications are transient and resolve gradually over some weeks.

After the surgery, in some individuals especially when falling asleep, the eyelids do not close completely. This situation is usually mild and improves over some weeks. Usage of artificial teardrops and moisturizer ointments when sleeping can control this situation. However, if this condition is severe and causes the cover of cornea to remain open for a long time it can cause development of scratches or ulcers into cornea, which resulting severe vision complications and should be corrected with another surgery.

In very rare cases, following the operation, severe bleeding may occur and by pushing pressure on the optic nerve, it may result in severe and permanent vision impairment. To prevent this complication, the person should avoid bending the head and heavy activities, and in case of incidence of any severe pain or diminished vision, they should immediately refer to ophthalmologist.

Existence of some underlying diseases increases the probability of incidence of surgical complications. Diseases such as hyperthyroidism or ocular thyroid disease, dryness of the eyes, cardiovascular disease, blood pressure, and diabetes increase the risks of surgery. Further, history of retinal tear or glaucoma can also cause increased risks of surgery.

For precise understanding of the probability of incidence of these problems and for preventing them, the person should give information about all of their medical problems, drugs they use, and their diseases with the ophthalmologist and receive a precise consultation before the surgery.

The outcomes of the operation

Wound healing is a gradual process. The site of incision has usually a pink tint up to six months, after which it changes into a fine white line and almost disappears.

Blepharoplasty has usually different positive outcomes including:

- improved lateral field of vision

- increased self-confidence

- the positive effects of this surgery on that person's appearance are evident for many years and even forever.

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