Smile with your eyes
An upper eyelid correction or upper blepharoplasty is a short and satisfying procedure for both patient and practitioner. It targets rejuvenation of the upper eyelid.
The most important part is what comes before surgery: analysis of the original eye shape and its filling. I will always ask patients to bring photos from when they were younger.
The aging proces of the eyelids is due to 3 important factors :
- laxity of the skin, sometimes with fat bulging
- loss of volume
- bony aging
It’s crucial to analyse al factors in forehand. A blepharoplasty can easily solve number one, a strip of excess skin is removed and bulging fat is carefully removed or re-draped. But when there is extensive loss of volume and bone, the eyes will be set deeper and a hollow eye may appear after blepharoplasty when no careful analysis was done.
Whenever there is fat bulging it should be removed minimally, or re-draped in order to avoid this hollow look. When there is lots of number 2) and 3) secondary correction with fat grafting or hyaluronic acid fillers may be needed in order to achieve a truly perfect result. In some cases filling alone might do the trick.
It’s easy to understand that you want your practitioner not just to be technically skilled, but also to be able to have the “eye” to see and understand your specific needs.
Carefully performed blepharoplasty should not change the shape of the eye unless it is a desired change.
Actually i should ask a forth factor to my list…
4. drooping eyebrows
Sometimes skin excess is accentuated because of sagging of the brow, the distance between the brow and the visible edge of the eye become smaller. In females the eyebrow should be positioned on top or above the brow-bone. This should be corrected using a browlift.
The intervention itself is mostly performed under local anesthesia unless it is combined with more extensive surgery such as a deep plane facelift.
- While you sit upright the drawing is made using a surgical marker to determine the outline of the skin to be removed, excessive bulging fat is marked.
- You are installed laying on you back on the operation table, the face is desinfected using a water based desinfectant and surgical draping applied.
- Local anesthetic is administered using a canula in order to prevent bruising.
- After checking the anesthesia, incisions are made and the strip of skin to be removed is outlined. Depending on the eyeshape and volume, either only skin either a skin-muscle strip is removed.
- If there is excessive bulging the fat pad is opened and I either shrink the fat using a bipolar cautery, either I re-drape it in the crease when there is risk of hollowing.
- The muscle is adapted and attached using a very thin self resorbing thread.
- The skin is sutured using a running zip-stitch
A Thin wound closure strip is placed over the zip-stich, additional strips are given along when one would loosen. During the healing time the wound should be kept dry.
After one week the zip stitch is removed.
Make-up can be applied over the scar which is still red. During maturation of the scar a silicone gel with SPF can help support the process of healing. The silicone gel will also help avoid an elevated scar. Sun exposure needs to be avoided on any red scar, this can lead to dark pigmentation and visibility of the scar. A mature scar is a thin white line, hidden in the natural peri-orbital folds.