Eyelid Surgery for a fresh look | Goes Eye Centre

Eyelid surgery

Surgery

Aesthetic Eyelid surgery

Your eyes and eyelids are often the first thing others notice about you. Aside from their protective function, eyelids are undeniably an important part of your facial attraction.

Unfortunately, the skin of the eyelids over time, often “sag” and the fat pockets located in the orbit become more and more prominent. This is usually caused by the aging of the skin, as the subcutaneous tissues lose their elasticity.

This causes the classic full upper eyelids or bags under the eyes.

This condition may run in the family. Young people can also suffer from this condition, mostly due to family factors, such as the anatomical construction of the eye socket.

Too much and/or oily skin can affect the aesthetics of one’s face, which may make you look tired and older. In some cases this may even cause functional problems such as reduced vision, or “heavy” upper eyelids.

The eyelid surgery performed to correct this condition, is called “blepharoplasty”, and aims to improve the aesthetic appearance of the face.
Blepharoplasty is best done by someone who is specifically trained for this particular surgery. The surgery is usually done under local anesthesia and outpatient conditions, therefore without hospitalization.

When considering surgery, discuss your expectations openly with your ophthalmologist. Always keep in mind that the anticipated result is an improvement but not perfection.

The redundant skin and/or excess of fat tissue of the eyelids often occurs in conjunction with other eye disorders, such as a drooping eyebrow or eyelid. The correction of these different conditions sometimes takes place during one single operation, obviously the results will be dependent on the various anomalies involved. If several conditions are treated simultaneously, you should definitely read up on the available information about the associated diseases. Sometimes it is only after blepharoplasty that it becomes clear that there is an additional abnormality that needs to be corrected.

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When considering surgery, discuss your expectations openly with your ophthalmologist. Always keep in mind that the anticipated result is an improvement but not perfection.

The redundant skin and/or excess of fat tissue of the eyelids often occurs in conjunction with other eye disorders, such as a drooping eyebrow or eyelid. The correction of these different conditions sometimes takes place during one single operation, obviously the results will be dependent on the various anomalies involved. If several conditions are treated simultaneously, you should definitely read up on the available information about the associated diseases. Sometimes it is only after blepharoplasty that it becomes clear that there is an additional abnormality that needs to be corrected.

The preliminary consultation

To avoid high or unrealistic expectations, you will undergo a preliminary consultation prior to surgery. A thorough eye and eyelid evaluation will also be made. We also need to be up to date on your entire ophthalmic as well as general medical history, and whether you take any form of medication. Special attention should be taken in particular for thyroid disease, hypertension, smoking, diabetes, cardiovascular disease, use of anticoagulant medication and medication that may increase the likelihood of dry eyes. Any previous allergic reactions to medications or local anesthetics, are very important. You should also stop any homeopathic medication, as some plant extracts have anticoagulative characteristics. This is especially true for garlic, ginseng, gingko baloa, and others.
If in doubt, always consult your GP.

Anticoagulant Therapy

Blood thinning drugs, and drugs that contain acetylsalicylic acid , like aspirin, should not be taken for some time before the procedure. Always consult your GP, whether this is possible or not. If you still continue taking them without our knowledge, this could cause serious complications. You must also stop all non-steroid anti-inflammatory medical products. More information can be found in our information leaflet on the use of blood thinners in eyelid surgery. You may always contact us, or your GP to know which medication may or may no longer be taken.

If possible, and if your GP allows you to do so, we recommend that medication should only be re-started at least one week after surgery.

Some medications that are available in Belgium, and which are known to contain acetylsalicylic acid (= active ingredient in aspirin) include Aggrenox, Alka Seltzer, Aspirin, Aspro, Cardiphar, Dispril, Sedergine, Tampyrine, Acenterine, Asaflow, Cardio Aspirin, Afebryl, Duo aspirin, aspirin-C, Nogrimine, Perdolan compositum, Troc, Cephyl. This list is not complete. These should therefore be discontinued 14 days before surgery, with approval from your doctor.

Treatment

The surgical technique is obviously dependent on ones physical characteristics, and the amount of skin and subcutaneous fat tissue that needs to be removed. Therefore, no intervention is comparable.

General

 If you wish, you may be administered a mild sedative half an hour before the procedure. Once you arrive in the operating room, you will be marked with a pen to allocate which area of the skin will be removed and where the prominent fatty pockets are located. If possible, the incision is usually drawn at the location of the natural eyelid fold.

Then, the entire face is disinfected and your head is covered up to remain sterile. The whole face will remain completely free, to avoid any claustrophobic sensation , and so that we can keep an eye on the symmetry of the four eyelids. Then the eyelids are anaesthetised by a few injections on the outside and sometimes on the inside. This may feel slightly sensitive, similar to the anesthesia that you undergo at the dentist. As a result you will feel nothing during the surgery.

Top eyelids

Eight to nine millimetres above the eyelid margin a piece of skin is removed. Afterwards, if necessary the fatty pockets are also removed. The surgery itself takes about an hour.

After surgery the wound is closed with a continuous suture. If the stitch does not spontaneously release/dissolve, you need have it removed after five to seven days.

At the end of surgery, you may sometimes feel that your eyes cannot fully close. Not to worry, because the muscle that is used to close the eyelids, is still anesthetized. Once the anesthesia wears off, these symptoms will gradually decrease.

 

Lower Eyelids

 If there is skin excess present here as well, the incision will be made along the outside of the lower eyelid. This allows us to remove the excess skin directly. After a while, the scar will usually disappear under the eyelid almost completely. When this incision needs to be extended to the side, then it may still remain slightly visible. The lower eyelid may be a millimetre lower after surgery. It is also a very close call as to how much skin and fat should be removed.

If there is no skin excess present, the incision will be made along the inside of the eyelid. A major advantage then is the absence of a scar. Obviously in this case we cannot remove excess skin.

After Surgery

Once you arrive in the waiting room, you may have a cup of coffee if desired, then and ice mask will be applied over your eyes for fifteen minutes. After half an hour you may go home. Since you will not be allowed to drive, you should allow for someone else to make sure you get home safely. At home you do not need not wear a bandage. We do advise you to occasionally wear an ice mask over your eyes. If you wish, we will provide you with one at the centre. Your sight must remain normal at all times. If your vision suddenly decreases, this may be a warning sign, and you must contact us immediately. It is therefore important that you regularly check your vision.

Avoid wearing makeup the first 2 weeks, as the wound could get pigmented by it. Strenuous exercise should also be avoided the first three weeks.

In the first two weeks after surgery swelling and bruising will usually occur, sometimes this may also extend to the lower eyelids, even if they were not operated on. The first few days will be the worst. After the first week you will be reasonably presentable, but the final result will best be seen after two months.

Small scars are the result of any surgery where an incision is made in the skin. We will certainly try at all times to ensure that they remain as invisible as possible, especially by making sure they fall right in the natural skin creases. If these are disturbing to you in the beginning you may hide those away 2 weeks after the treatment by means of a mask e.g. “Dermablend” by Vichy. The scar ointment we use and recommend is ‘Dermatix’.

Check Up

The stitches may be removed after 5-7 days. You will receive an appointment at the centre. If you prefer, your GP may also remove the stitches. After surgery a letter will always be sent to your doctor so that he/she remains fully informed of the performed procedure.

After Care

The first week you need to apply and ice mask to your eyelids two to three times a day for 15 minutes. We prefer you to use an icepack through which you can see, with apertures for your eyes. If they are not available at your local pharmacy, we will gladly provide you with a pair. This reduces any swelling present. It is recommended to use artificial tears three times a day if your eyes feel ‘dry’ at any point.

Alcohol, activities where the blood pressure suddenly rises, or where pressure on the eyelids may occur, should be avoided for the first two to three days. These activities and habits can cause a dilation of the blood vessels, with an increased risk of bleeding and eyelid swelling.

As mentioned before, the scar tissue will heal better and faster if you refrain from smoking a few weeks before and after the surgery.

Contact lens use may be restarted one week after the operation. Make sure you do not pull to hard on your eyelid when applying or removing your lenses. For the first few weeks, the use of these lenses may be slightly annoying. Additional administration of artificial tears will relieve these complaints in most cases.

Avoid using make-up for the first two weeks after surgery: as the scar could become pigmented by it.
Showering, whereby water runs over your eyelids, is permitted from the third day onwards after surgery.
You may optionally clean the wound with “Blephadosis’ tissues.

After Surgery: what to feel

At first, a slight ‘pressure’ might be felt and perceived from the eyelids. It usually only lasts about two days. Pain after surgery is almost nonexistent. If you are nevertheless uncomfortable, a painkiller with paracetamol, but without aspirin, such as DafalganR may be taken. In doubt, please feel free to contact us at anytime.

Side effects and complications
Eyelid surgery has a very high percentage of satisfied patients. No surgery is free of side effects and/or complications. Among these complications are some rare but very serious complications, as well as some more common ones that are less severe. Stating every possible complication is impossible, therefore this list should not be considered exhaustive.

A common complaint after surgery is a gritty feeling in the eyes. In predisposed patients, this problem is discussed in advance. In all case, treatment includes artificial tears, and possibly punctumplugs. Any discomfort will disappear within a few weeks or months. A low positioning of the lower eyelid has also been discussed.

A difference in height and/or skin between the two eyelids is present in most people. Although we try to keep this difference to a minimum as much as possible after the surgery, it may sometimes still be present. If this asymmetry is disruptive, and still persists after several months, it may still be surgically corrected by removing an additional piece of skin.

Shortly after the surgery the eyelid is swollen due to fluid retention. Most of the swelling disappears after one to two weeks, but because during the operation some lymph nodes are severed, full recovery may take longer. In some rare cases after surgery on the upper eyelids, moisture may accumulate in the lower eyelids. Again the message is patience.

The sensation in the eyelid may be affected, as some nerves may have been cut. This may also take several months to heal.

Rarely blood seeps into the eyelid and may travel deep into the back of the eye socket, even behind the eye. You may notice this because the eye begins to bulge, usually causing a reduction in visibility. These are two alarm signs, whereby you should contact us immediately.

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