Fundamentals of upper eyelid plastic (blepharoplasty)

The success of the plastic surgery of the upper eyelids begins with the artist's understanding of the relationships of the upper eyelids, eyebrows, forehead, ophthalmic bone boundaries, and also with the general idea of the concept of a beautiful American face. The last one can be seen on the covers of many magazines. Today's beautiful faces are determined by model agencies that select them, photographers, filmmakers, advertising agents, hiring them, and customers of products recommending them. Beautiful eyelids are a very static concept. Although they are influenced by fashion trends, it is not a rapidly changing fashion.

Today's view is the result of a process that has been slowly developing over the past 30 years. Today's view of the female eyebrow and eyelids includes a relatively full eyebrow, located at the edge of the orbit, at the center or slightly above the edge of the orbit, laterally displacing above the edge of the orbit. The fold of the upper eyelid is usually less than 10 mm above the edge of the eyelid. The furrow under the edge of the eye socket does not correspond to the bone margin. The lateral part of the eyelid does not have a hood or crawling of the skin from the lateral edge of the orbit. The general appearance of the eyelids is one of the signs of a healthy, positive youth. There are no tall, thin, arcuate eyebrows, located entirely above the osseous edge of the eye; high, pronounced folds of the eyelids; and deeply embossed furrows of the eyelids. The elongated, refined, haughty appearance became mandatory in the late 80s of the last century and remains so at the beginning of this century. New York manufacturers of mannequins have remodeled the standard image of a beautiful American woman in order to give her a more dense, healthy and assertive look. Individuals and individual taste allow some freedom. For example, a young face with a particularly thick, ruddy skin, relatively low eyebrows and a weak cervico-podbortochnom complex often looks much better than raising the frontal-eyebrow complex at a relatively high level. Assessment of potential patients for blepharoplasty includes assessment of motivations, collection of anamnesis, examination of the eyebrow complex and eyelids, discussion of the proposed operation, pre-operative and postoperative period, possible complications, and photodocumentation.

Motivation

The ideal candidate for upper eyelid plastic surgery has a relatively long-standing desire to reverse the progressive deterioration of the species of the eyelids. The patient is in the working or social situation that requires an attractive person and really refers to a possible outcome. There should be no expectation of changes in the surrounding world as a result of the operation (for example, the resumption of an end of a novel or the receipt of hard-to-reach work). Questions, answers, intentions, clothes and manners of patients should look correct and "correct" from the point of view of the plastic surgeon talking with them. Interestingly, almost all patients who receive blepharoplasty are usually good candidates. Psychological and motivational problems that arise in patients seeking rhinoplasty and facelift are much less common in candidates for blepharoplasty.

Disease history

Usually, general medical problems, which are contraindications to the planned operation, also serve as contraindications to blepharoplasty. Particular attention should be paid to any condition that may be exacerbated by the use of a local anesthetic with adrenaline. Many of the new psychotropic drugs interact with sympathomimetic amines, and their reception must be discontinued before surgery. Homeopathic remedies have become an ordinary part of many American daily food supplements. St. John's wort, yohimbe and licorice root can inhibit monoamine oxidase. Gingko, used for short-term memory loss, is a strong anticoagulant. It is better that patients report all drugs, including drugs used in alternative medicine.

Any condition that causes fluid retention, including myxedema in hypothyroidism, should be carefully considered before surgery. Allergic dermatitis, especially on the skin of the face and eyelids, must be cured before blepharoplasty to prevent bad scarring and delayed healing of wounds.

Ophthalmological history is very important. It is necessary to fix the use of glasses, contact lenses or eye preparations. Any sign of dry eye syndrome (for example, burning, stinging, using artificial tears, awakening at night due to burning pain in the eye or sensitivity to windy weather) requires a thorough examination. Personally, I do not do plastic surgery of the upper eyelid to patients with any severity of dry eye syndrome. Even the minimal plastic of the upper eyelid can lead to a disruption in the closure of the upper eyelid, exposing the corneal tissue and aggravating dry eye syndrome with potentially serious complications. In the presence of dry eye syndrome, it is possible to make reasonable plasty of the lower eyelid and much less to care for serious consequences. The development or aggravation of dry eye syndrome in a patient after plasty of the upper eyelid creates one of the permanent problems in facial plastic surgery. It completely outweighs even a magnificent, from an aesthetic point of view, surgical result.

You should always ask about visual acuity. The study of visual acuity (reading) can easily be included in the questionnaire, which is suggested to be completed for all patients prior to consultation.

It is important to anamnestic indication of the plastic surgery of the upper eyelids, carried out earlier, even many years ago. These patients are always lagophthalmic, and economical re-surgical intervention is strongly recommended. In such cases, there may be a significant apparent excess of the skin of the upper eyelids. However, when the eyes are closed, the volume of excess upper eyelid skin that can be removed without the appearance of lagophilus is usually minimal.

[1], [2], [3], [4], [5], [6], [7], [8], [9]