Eye surgery
Eye surgery
If you have been struggling with puffy or baggy lower eyelids or sagging skin behind your eyes, you may feel tired, swollen, and self-conscious. However, there is a solution that can help improve your quality of life and boost your confidence.
Lower blepharoplasty is a surgical procedure designed to enhance the appearance of the lower eyelids. While traditional lower blepharoplasty involved removing excess skin and fat, modern techniques focus on preserving tissue and may include relocating fat or using dermal fillers to restore volume loss due to aging.
Non-surgical options for lower blepharoplasty, such as laser treatments and light-based therapies, have also been developed as an alternative to incisional surgery.
Whether you opt for surgical or non-surgical lower blepharoplasty, the result will be smoother, more youthful-looking eyelids that can make you look and feel your best. Say goodbye to tired, baggy eyes and hello to a refreshed, rejuvenated appearance.
The eyelids are movable structures that are primarily made up of skin and muscles. Their primary function is to cover and safeguard the eyeball from mechanical damage. They also play an important role in maintaining the moist environment necessary for proper conjunctiva and cornea function.
The conjunctiva is a mucous membrane that lines the eyelids and covers the visible area of the eyeball. This transparent part of the eyeball that covers the iris and the pupil is also known as the cornea.
Each eyelid is supported by a fibrous plate called a tarsus, and various muscles move the eyelids. The meibomian or tarsal glands secrete lubricating fluids that help keep the lids moist. The lids are covered with skin and a mucous membrane and surrounded by a fringe of hair called eyelashes.
The circular lid-closing muscle, known as the orbicularis oculi, and the lid-raising muscle called the levator of the upper lid are responsible for moving the eyelids. Closure impulses are sent by the facial nerve (seventh cranial nerve), while opening impulses are sent by the oculomotor nerve (third cranial nerve).
The meibomian glands secrete an oily fluid called sebum that helps keep the lid borders moist. This fluid is incorporated into the tear film, helping to minimize tear loss due to evaporation.
Before undergoing a blepharoplasty procedure, the patient's pre-operative medical and surgical histories are evaluated, and a physical assessment of their periorbital area is conducted, which includes the region from the eyebrows to the cheeks and nose. This assessment helps determine whether the patient is a suitable candidate for the treatment and can safely undergo the procedure to address functional and cosmetic concerns.
Lower eyelid blepharoplasty is a successful surgical procedure that can correct anatomic issues such as excess skin, slackness of eye muscles and the orbital septum, excess orbital fat, lower eyelid malposition, and prominence of the nasojugal groove, where the orbit meets the slope of the nose.
Upper eyelid blepharoplasty, on the other hand, can correct the loss of peripheral vision caused by upper-eyelid skin drooping over the eyelashes. This condition can significantly impair peripheral and higher vision, making everyday tasks such as driving a car and reading a book challenging. Here are some common indications:
Patients who seek secondary benefits from cosmetic surgery, such as improving personal relationships, are not ideal candidates for the procedure. It is important that patients who undergo blepharoplasty do so with realistic expectations and a goal of restoring and reducing the signs of aging rather than solely seeking happiness.
Any pathological condition of the eyelids or orbital structures is an absolute contraindication for blepharoplasty. Additionally, any medical condition that could affect the patient's response to anesthesia or lead to complications during the procedure is considered a relative contraindication.
Unachievable patient goals/unrealistic expectations: Patients with unrealistic expectations or unachievable goals should not undergo blepharoplasty. It is important for patients to have a realistic understanding of the outcomes of the procedure and to be motivated by the restoration and reduction of age-related changes.
Coexisting severe or unstable medical conditions (e.g., uncontrolled DM, heart diseases): Patients with severe or unstable medical conditions, such as uncontrolled diabetes or heart disease, are not ideal candidates for blepharoplasty. Medical conditions that could affect the patient's response to anesthesia or lead to complications during the procedure should be closely evaluated before undergoing surgery.
Active thyroid ophthalmopathy (relative contraindication): Active thyroid ophthalmopathy is a relative contraindication for blepharoplasty. It is important to evaluate the patient's thyroid condition and determine whether they are suitable for the procedure.
Uncontrolled dry eye syndrome: Patients with uncontrolled dry eye syndrome should avoid undergoing blepharoplasty. Dry eye syndrome can cause complications during the healing process and can lead to long-term discomfort and visual problems. It is important to address this condition before considering blepharoplasty.
Before scheduling blepharoplasty, you will meet with a plastic surgeon and an eye expert or an oculoplastic surgeon who specializes in eye procedures.
During this consultation, they will discuss your medical background, including previous surgeries and current illnesses such as dry eyes, glaucoma, allergies, circulatory issues, thyroid problems, and diabetes. Your doctor will also ask about any medications, vitamins, herbal supplements, alcohol, cigarettes, or narcotics you may be taking.
Your expectations for the surgery will also be discussed in detail during the consultation. This conversation is essential to establish a solid foundation for a successful outcome. Your surgeon will explain whether the procedure is likely to be successful for you based on your expectations and specific case.
Before your eyelid surgery, you'll undergo:
And you'll be asked to:
A successful lower eyelid blepharoplasty procedure addresses the patient's complaints that align with the anatomic abnormalities detected during the assessment. The appropriate technique and details may vary among surgeons, and a single approach or a combination of techniques may achieve the desired outcome.
Markings are typically done with the patient sitting upright, and a surgical pen is used to delineate the steatoblepharon and hollowing borders. Local anesthesia is administered using a sterile preparation containing lidocaine and/or bupivacaine with epinephrine, and a corneal shield may be used.
The transconjunctival approach is a common technique used in lower eyelid blepharoplasty, particularly for patients with lower eyelid fat prolapse but not excess skin. The procedure involves using a desmarres retractor to access the area, making an infratarsal incision using conjunctiva and lower eyelid retractors, and debulking or mobilizing the orbital fat pads. Hemostasis is maintained using monopolar or bipolar cautery, and fat pedicles are secured using percutaneous or internal absorbable sutures.
The skin approach involves making an incision below the eyelash line or within an existing infraciliary crease and evaluating the degree of skin redundancy using a skin "pinch." The skin-muscle method is used to advance and trim the skin and muscle as a single unit or independently, while preserving the contour of the eyelid aperture.
Additional procedures that may be performed include canthopexy or lateral canthoplasty to address lower lid laxity, fat grafting to enhance volume, laser skin resurfacing or chemical peels to improve skin quality, and Botox to reduce dynamic wrinkles in the periorbital area.
In summary, the surgical approach used in lower eyelid blepharoplasty is customized to each patient's unique anatomy and goals, and may involve a combination of techniques and additional procedures.
After surgery, you will be monitored for issues in a recovery room. You may depart later that day to rest at home.
Following surgery, you may experience:
Your doctor will likely suggest you take the following steps after surgery:
Seek medical attention right away if you suffer any of the following symptoms:
Blepharoplasty has been found to be a successful surgery for many people, resulting in a more youthful and relaxed appearance and increased self-confidence. Some individuals may experience long-lasting effects, while others may develop recurring droopy eyelids.
The bruising and swelling usually subside within 10 to 14 days after surgery, and it is usually safe to resume normal activities in public. The scars from surgical cuts may take several months to fade, and it is important to avoid overexposing the delicate eyelid skin to the sun to prevent any damage.
Overall, blepharoplasty can be a highly effective procedure for addressing functional and cosmetic concerns in the lower eyelids, and it is important to follow post-operative instructions to ensure a successful outcome.
A non-surgical eye lift may be the preferred choice for patients who are unable or unwilling to undergo a surgical operation due to factors such as anesthesia, cost, or downtime. Additionally, younger patients who exhibit mild to moderate signs of aging may not deem invasive surgery necessary. In these instances, non-surgical blepharoplasty alternatives may prove to be effective.
Injectable dermal fillers like JUVÉDERM® and wrinkle relaxers like BOTOX® offer significant results with minimal to no downtime. The combination of fillers and neurotoxins can effectively treat various issues, including hollow under-eyes, dark circles, and wrinkles or Crow's feet around the eyes.
Another non-surgical alternative for rejuvenating the skin and achieving a lifted, tighter, more youthful eye region is radiofrequency microneedling. During RF microneedling, a specialized device creates microscopic micro-injuries on the skin's surface while using a topical numbing medication to minimize discomfort. This procedure destroys skin cells while stimulating the production of new, healthy skin cells, resulting in a firmer, more youthful, and radiant complexion. Additionally, radiofrequency energy stimulates cells deep beneath the skin to increase collagen and elastin formation, enhancing the benefits over the following weeks and months.
RF microneedling's intensity can be adjusted to be gentle enough for use on the delicate skin of the upper and lower eyelids, making it an excellent non-surgical alternative to blepharoplasty.
Another innovative option for rejuvenating the eyes without surgery is Platelet-Rich Plasma (PRP) treatment. This technique is often combined with microneedling to enhance its effects and achieve even more impressive and long-lasting outcomes. During microneedling with PRP, a small amount of blood is taken from the patient's arm and processed using a specialized centrifuge device to isolate the platelet-rich plasma from other blood components. Then, a microneedling device is used to create small punctures on the skin's surface, which stimulate the growth of new, healthy skin cells. Finally, the PRP serum is applied to the skin to promote the body's healing process and collagen and elastin production, resulting in firmer and more youthful skin texture.
Laser skin resurfacing is another effective option for treating a range of issues and achieving desired results for patients of various skin types, tones, and colors. With a wide range of highly advanced ablative and non-ablative laser therapy systems available, non-ablative treatments can help regenerate the skin and stimulate collagen synthesis for more moderate issues, while ablative treatments can address severe symptoms such as deep wrinkles and severe sun damage.
There are several complications associated with blepharoplasty surgery:
Lower eyelid retraction is a risk of lower blepharoplasty, particularly when the septum is broken from the anterior approach rather than the transconjunctival approach. Retraction occurs due to scarring of the middle and/or posterior eyelid lamellae, resulting in a low-positioned eyelid that is tied to the orbital rim.
Anterior lamellar deficit can occur due to overzealous skin removal, adverse contraction following surgery, or poor healing after eyelid skin resurfacing.
Ectropion is another potential complication of lower blepharoplasty, which can occur regardless of retraction or skin deficit if a lax lower eyelid is left untreated, or if postoperative tractional forces are unopposed in the presence of weak canthal support.
Lower blepharoplasty operations are typically more expensive than upper blepharoplasty procedures due to their complexity and the need for general anesthesia, which adds to the cost. This technique is commonly used to improve the appearance of under-eye bags by reducing puffiness or tightening the skin beneath the eye.
The cost of a lower blepharoplasty procedure can vary widely, typically ranging from $75 to $9,200, depending on various factors such as the extent of the procedure, the surgeon's experience and reputation, and the geographic location of the practice. It is important to note that the cost may not include additional expenses such as anesthesia fees, facility fees, or post-operative care. Patients are advised to consult with their surgeon to understand the specific costs associated with their lower blepharoplasty procedure.
The eyes play a significant role in a person's overall appearance, and sagging eyelids and wrinkles around the eyes can make someone look tired, angry, or older than their actual age. As a result, many people are turning to cosmetic eyelid surgery to rejuvenate their appearance and restore a more youthful look.
Lower blepharoplasty is a surgical procedure that addresses abnormalities, deformities, and cosmetic issues of the eyelids and the surrounding area. This surgery involves the excision and removal of skin and fat, as well as the strengthening of the appropriate muscle and tendon tissues in the periorbital region, which is the area between the brow and the top of the cheek. Lower blepharoplasty is more popular among women, accounting for 85 percent of blepharoplasty surgeries in the US in 2014 and 88 percent in the UK.
The primary goal of blepharoplasty is to improve the function of the damaged eyelid(s) and enhance the aesthetic appearance of the eye-region of the face. By removing excess skin and fat, strengthening muscle and tendon tissues, and correcting deformities, blepharoplasty can help restore a more youthful, refreshed, and rejuvenated appearance.
Natural results of surgery
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