Blepharoplasty
This fact sheet was developed under the aegis of the French Society of Plastic Reconstructive and Aesthetic Surgery (SOF.CPRE) as an addition to your initial consultation, to try to answer all the questions you can ask yourself if you plan to use a blepharoplasty. The purpose of this document is to provide you with all the necessary and essential elements of information to help you make your decision with full knowledge of the facts. Also you is it advisable to read with the greatest attention.
• DEFINITION OBJECTIVES AND PRINCIPLES
The "blepharoplasty" means the cosmetic surgery of the eyelids, which aim to remove these misfortunes, whether hereditary or due to age.
They may involve only the upper or lower, or four eyelids both eyes. Blepharoplasty can be performed alone or combined with other aesthetic surgery of the face (forehead lift, temporal lift, lifting head and neck) or a medical-surgical therapy (laserbrasion, peeling, dermabrasion). These actions are likely to be made during the same operation or during a second operation.
Blepharoplasty proposes to correct the signs of aging present in the eyelids and replace the look "tired" of the eye with a more rested and relaxed.
Disgraces the most commonly involved are the following:
• heavy and drooping upper eyelids with excess skin forming a more or less marked decline,
• Lower eyelids drooping and wilted with consecutive small horizontal wrinkles in skin distension,
• Hernias fat, responsible for "bags under the eyes" at the lower eyelids or upper eyelids "puffy".
The intervention aims to correct these misfortunes sustainable way, surgically removing the skin and muscle and excess fat protrusions, and, of course, without altering the essential functions of the eyelids. It should be noted that many other changes may êtreprésentes, but their treatment is only possible using more complex techniques than just classic blepharoplasty, or using additional surgical procedures. This is the case of sagging forehead and falling eyebrows, wrinkles "lion" between the eyebrows, wrinkles, "crow's feet" around the eyes, the
"Circles" eye "hollow" eyes "sad" corner with droopy eyes and small surface imperfections
skin (scars, spots ...). The operation, performed as well in women as in men, is commonly done at the quarantine.
However, sometimes it is done much earlier, when misfortunes are constitutional (hereditary factors) and not related to age, as some "fat pockets".
• BEFORE THE OPERATION
An examination followed by an examination of the eyes and eyelids have been made by the surgeon looking for abnormalities that may complicate the procedure, even against-state. Specialized ophthalmologic examination is frequently requested in addition to detect any ocular pathology. A preoperative assessment is conducted in accordance with
requirements. The anesthetist will be seen in consultation at least 48 hours before surgery.
No medication containing aspirin should be taken within 10 days before surgery. Depending on the type of anesthesia, you may be asked to remain fasting (nothing to eat or drink) 6 hours before surgery.
• TYPE OF ANESTHESIA AND CONDITIONS OF INTERVENTION
Type of anesthesia:
Three methods are possible:
Local anesthesia pure analgesic where a product is injected locally to ensure the insensitivity of the eyelids.
Local anesthesia depth by tranquilizers administered intravenously (anesthesia "vigil").
classic General anesthesia, in which you sleep completely.
The choice between these techniques is the result of a discussion between you, the surgeon and the anesthetist.
Terms of admission:
Usually the procedure is done in "outpatient", that is to say, on an outpatient basis, with a registered the same day after a few hours of monitoring output.
However, in some cases, a short hospital stay may be preferred. The input is then carried out in the morning (or sometimes the day before in the afternoon) and the output is usually permitted the next day.
• INTERVENTION
Each surgeon adopts a technique of its own and it adapts to each case to obtain the best results. However, it may hold common basic principles:
Incisions:
- Upper Eyelids:
they are concealed in the groove located at the mid-height of the lid, between the movable part and the fixed part of the eyelid.
- Lower eyelids:
they are placed 1-2 mm below the eyelashes, and may extend a little outside.
The layout of these incisions is of course the location of future scars, which will therefore be hidden in natural folds.
Note: For lower eyelids, where "pockets" alone (without excess skin to be removed), we can perform a blepharoplasty by trans-conjunctival, that is to say using incisions placed inside eyelids and leaving no visible scar on the skin.
Resections: from these incisions, unsightly fat bulges are removed and excess muscle and skin is removed released. At this stage, many technical refinements can be made,
to adapt to each case and depending on the surgeon's habits.
Sutures: they are usually made with very fine nonabsorbable son (to be removed after a few days).
Depending on the surgeon, the number of eyes to operate, the extent of the improvements and the possible need for additional procedures, the procedure can take half an hour to two hours.
• AFTER THE INTERVENTION: THE OPERATING SUITES
There is no real pain, but possibly some discomfort with a feeling of tension of the eyelids, slight irritation of the eyes or some visual disturbances.
The first day, we must stand up and avoid exertion. The postoperative course is essentially marked by the appearance of edema (swelling) and ecchymosis (blue) whose magnitude and duration are highly variable from one individual to another.
Sometimes observed during the first days impossible to completely close the eyelids or a slight detachment of the outer corner of the eye that no longer applies perfectly to the world. We should not worry about these signs are generally rapidly reversible.
The son are removed between the 3rd and 6th day after surgery.
The stigma of the intervention will reduce gradually to return to normal social and professional life after a few days (6-20 days depending on the size of the suites).
The scars may remain slightly pink in the first weeks, but their makeup is quickly authorized (usually from the 7th day).
A slight induration of the detached areas may persist for several months, but is not noticeable by the entourage.
• THE RESULT
Within 3 to 6 months is required to appreciate the result.
This is the time required for tissue have regained their flexibility and the scars are blurred at best. The intervention will be most often used to correct sagging skin and remove fat bulges, thereby rectifying the aged and tired appearance of the eyes.
The results of a blepharoplasty are generally among the most durable of cosmetic surgery. The removal of the "pockets" is virtually definitive, and they do not usually recur. Against the skin continues to age and the resulting laxity may, in the long run, reproduce wrinkling of the eyelids. However, it is rare that a new intervention is considered before a dozen years.
• FAULTS OF THE RESULT
They may result from a misunderstanding of what we can reasonably expect. This is the collapse of the forehead and eyebrows fall that can not be corrected by a facelift frontotemporal. They can also occur due to unexpected reactions or scar tissue unusual phenomena. We can see some of the changes persist (fine lines in particular) or get a little too deep (bony rim of the orbit visible) or observe a slight retraction down lower eyelid eye or detect a small asymmetry or scars too "white."
These imperfections can be corrected, if necessary, by a small "touch" that will mostly under local anesthesia, from the sixth month after the initial procedure
• POSSIBLE COMPLICATIONS
Blepharoplasty, although carried out mainly for aesthetic reasons, are nevertheless a real surgery that involves risks associated with any medical procedure, however small it may be. We must distinguish the complications of anesthesia and those related to the surgery.
For anesthesia, during the consultation, the anesthetist inform himself the patient anesthetic risks. You should know that anesthesia in the body sometimes unpredictable, and more or less easy to control: the fact of using a fully qualified anesthetist, working in a surgical context, that the risks are now almost statistically insignificant. You should know, indeed, that the techniques, anesthetics and monitoring methods have made tremendous progress over the past twenty years, providing maximum security, especially when the operation is performed outside of the emergency and in a healthy person.
Regarding surgery: choosing a qualified and competent plastic surgeon, trained in this type of surgery, you limit these risks, without removing them completely. Fortunately, real complications are rare after blepharoplasty performed within the rules. In practice, the vast majority of happens without any problems and the patient (s) are fully satisfied (s) of their income.
However, despite their rarity, you should be aware of possible complications:
hematomas: mostly harmless, they can be removed if they are too large.
Infection: outstanding during a blepharoplasty, apart from a few micro-abscesses developed on a stitch and easily handled by small local care. A simple conjunctivitis be prevented by systematic prescription eye drops the first day.
Abnormal healing: very few of the eyelids where the skin is very thin and usually heals in an almost invisible, however, it may happen that the scars are not ultimately as discreet as expected.
Epidermal Cyst: they may occur along the scar, often spontaneously eliminate otherwise are easy to remove and do not compromise the quality of the final result.
Impaired secretion of tears: a persistent watery is rarer than just sometimes decompensate a preexisting deficit in tears "dry eye syndrome".
Ptosis (inability to fully open the upper eyelid): very rare, except in over 70 years that a preexisting deficiency can sometimes be increased by the intervention.
Lagophthalmos (inability to completely close the upper eyelid) can the first few days following the procedure, its persistence beyond a few weeks should not meet.
Ectropion (shrink down the lower eyelid) is the most rare form the waning of blepharoplasty performed correctly. The minor form ("round eye") sometimes occurs on the eyelids
little tonic subject to inadvertent scar retraction, it ends mostly by fade after a few weeks pluriquotidiens massage for easing the eyelid.
Finally, quite exceptional case of diplopia (double vision), glaucoma (ocular hypertension) and even blindness after blepharoplasty have been reported in the international literature.
In total there should not overstate the risks, but just be aware that surgery, even seemingly simple, still a small share of hazards.
The use of a qualified Plastic Surgeon ensures that it has the training and skill required to avoid these complications, which effectively treat as appropriate.
These are the pieces of information that we wanted to bring you in addition to the consultation. We recommend that you keep this document, read it again after the consultation and reflect "a clear head." This reflection may raise new questions for which you wait for additional information. We are available to talk during the next consultation, or by phone, or even on the day of surgery when we meet in any way before anesthesia.
EYES
AESTHETIC PLASTIC
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© Docteur Garson MAJ 2013