Upper and lower eyelid lift: surgical technique

Age spares no one: the skin on the face, and especially around the eyes, gradually becomes thinner, loses elasticity, and is covered with first single and then multiple wrinkles. Of course, there are surgical and non-surgical ways to "rejuvenate" the upper and lower eyelids. We are talking about such a procedure as an eyelid lift. Below we will talk about what it is like and what you need to know about it.

What is an eyelid lift called?

When wrinkles appear, there is usually no need for surgical eyelid lift. It is enough to use hardware techniques, as well as all kinds of peelings, masks, massage procedures. Some experts advise doing contour plastic surgery using fillers - products based on hyaluronic acid. Injections are repeated annually, which ensures hydration and filling of the skin around the eyes.

The use of botulinum toxin A helps prevent the formation of skin folds around the eyes and in the forehead area. The effect of the injections lasts for about six months. Plasmolifting is no less popular: a person's own blood is taken and platelet-rich plasma is injected subcutaneously. This procedure accelerates the production of collagen and elastin fibers. Other non-surgical lifting procedures include radio wave lifting, non-surgical vaporization (laser lifting).

As for surgical methods, eyelid lifting in this case is called blepharoplasty. We are talking about a more radical, but 100% effective way to preserve and prolong the youth of the skin around the eyes. [ 1 ]

Is upper eyelid blepharoplasty dangerous?

When talking about eyelid lifting, they usually mean a restorative operation, during which the doctor removes "excess" skin and fatty tissue. This is the most radical method, and the effect of blepharoplasty will last for a long time - up to 10 years. However, the intervention can be different, without removing excess tissue, but only with its redistribution.

As a rule, eyelid lift assumes the achievement of a positive aesthetic result with the minimum possible tissue damage. A competently performed intervention helps to restore youth to the area around the eyes, and even improve the shape and eye incision.

Blepharoplasty is considered one of the most popular plastic surgeries on the planet. It is especially popular among patients over thirty years old.

Eyelid lift can be called a relatively simple procedure, with a minimal risk of injury. The operation is practically risk-free: according to statistics, the risk of complications is estimated by specialists at only 3%.

However, despite the favorable statistics, surgeons advise to seek surgical eyelid lift only if there are indications for the operation. If there are no such indications, it is better to wait with the intervention and try to solve the problem using non-surgical methods. [ 2 ]

Indications for the procedure

Corrective rejuvenating surgeries are performed in the vast majority of cases based on the patient's own desires - for example, if a person does not like something about his appearance. However, there are also medical indications for eyelid lifting:

• a very sagging upper eyelid or a drooping lower eyelid;
• a fairly large excess of skin in the periorbital area, causing discomfort to the person;
• fatty hernias;
• deformed changes in the eyelids, drooping corners of the eyes;
• different shaped eyes, skin asymmetry;
• pronounced age-related changes in the skin around the eyes;
• early but deep wrinkles.

Possible repeat lower eyelid blepharoplasty may be indicated in the following cases:

• in case of postoperative disturbance of the eye shape – for example, due to a surgeon’s error;
• if problems with skin deformation around the eyes occur during the rehabilitation period;
• to maintain the lifting effect in the previously operated area.

It is believed that the effect obtained with surgical eyelid lift lasts for a long time. But even in this case, doctors do not rule out repeat blepharoplasty in about seven or ten years. To delay the need for a repeat procedure, if possible, specialists recommend eating right, getting enough sleep, and getting rid of bad habits. Some patients may benefit from certain cosmetic procedures to maintain tissue tone.

The most common indication for surgical lifting is considered to be the correction of a drooping eyelid. The upper eyelid can sag due to natural anatomical features or age-related changes. This operation is performed on the eyelash growth zone.

Correction of eyelid ptosis – gravitational drooping on one or both sides – can be indicated for both elderly and young patients. For example, ptosis can be a result of age-related changes, congenital or acquired tissue hyperelasticity, or damage to the frontal branch of the facial nerve. Surgical correction of ptosis is a very effective and relatively easy-to-perform method, after which no additional scars are observed, and the operation itself does not require special equipment. Correction can be performed after upper blepharoplasty.

Blepharoplasty of heavy eyelids allows to eliminate upper sagging skin, to strengthen and restore elasticity to the area around the eyes. Often such “heaviness” is asymmetrical, more pronounced on the side of the face with decreased muscle tone. The reasons for such a decrease can be multifunctional disorders typical for age-related atrophic changes, or diseases of the blood vessels of the brain. [ 3 ]

Preparation

In order to assess the real need for an eyelid lift, you should first consult with a surgeon: the doctor will identify potentially problematic areas and, if necessary, prescribe preoperative diagnostics (for example, general blood and urine tests, a study of the blood coagulation system, a consultation with an ophthalmologist).

Approximately 7-10 days before the operation, the patient will be advised to stop taking any non-steroidal anti-inflammatory drugs, medications with hormonal or anticoagulant activity. Alcohol should be stopped 3-4 days before the procedure.

The intensity of the preparatory stage largely depends on the method of anesthesia during the operation. For example, if local anesthesia is to be used, then no special changes in diet are required. When preparing for general anesthesia, any food and water intake should be completed 8 hours before the intervention. [ 4 ]

What tests are needed for eyelid blepharoplasty?

Before undergoing surgical eyelid lift, the patient will be asked to undergo primary diagnostics, which includes laboratory tests. Most often, a person needs to undergo the following types of research:

• general blood test;
• blood biochemistry (ALT, AST, glucose, bilirubin, potassium, creatinine levels);
• blood for coagulation quality, coagulogram;
• blood for syphilis, HbsAg + HCV;
• general clinical urine test;
• electrocardiogram;
• consultation with an anesthesiologist (provided only after receiving the results of all tests and performing an electrocardiogram).

Additionally, the doctor may refer the patient for fluorography, rhinomanometry, etc.

Technique eyelid lifts

• Upper eyelid correction is considered the most common: the procedure is performed without hospitalization of the patient, since within a few hours he can go to home rehabilitation. As a rule, upper eyelid lift is performed under local anesthesia, and general anesthesia is used only based on the client's wishes (if there are no contraindications). The operation is performed by an incision in the area of the natural fold of the upper eyelid. The doctor removes excess fatty tissue through the incision, cuts off the skin, and then applies microsurgical sutures. The total duration of the procedure is about 40-45 minutes. The sutures are removed after 4-5 days, and the end of the rehabilitation period corresponds to approximately 45-50 days after the operation.
• Upper eyelid lift is often performed on people with persistent puffiness and dark circles under the eyes: this method can help get rid of these problems. Lower eyelid lift is performed through a subciliary incision in the lower eyelid area. Both local and general anesthesia can be used (in some cases, at the patient’s request). The procedure lasts about 45-55 minutes and can be performed using classic or fat-sparing technology. Classic eyelid lift involves removing “excess” fat tissue and excising “excess” skin. The incision is sutured with a cosmetic suture. Fat-sparing eyelid lift does not involve removing fat deposits, but only redistributing them to avoid the effect of “sunken” eyes. All of these types of eyelid lifts do not require hospitalization, as the patient is sent home after a couple of hours (depending on the type of anesthesia used). The full effect of the procedure can be assessed in about 4-8 weeks.
• Circular eyelid lift involves simultaneous correction of the upper and lower eyelids. Local or general anesthesia is used, at the discretion of the doctor. The duration of the intervention is always different (1-3 hours), which depends on the scope of the operation and the individual characteristics of the patient. The surgeon makes an incision in the natural fold of the upper eyelid, as well as slightly below the border of eyelash growth in the lower eyelid. Fat accumulation and "excess" skin are removed, and the incisions are sutured with microsutures.
• Transconjunctival eyelid lift is an intervention with small incisions in the area of the lower eyelid conjunctiva (namely, on the inner side of the eyelid). Through the incisions, the doctor removes the "excess" fatty tissue. No stitches are required. The procedure lasts about 35 minutes, and the patient is home within a few hours. The recovery period is on average two weeks.

Types of blepharoplasty

Eyelid lift is divided by surgeons into several varieties. Let's look at each of them in a little more detail.

• Surgical eyelid lift is fundamentally different from non-surgical lifting: most non-surgical methods are purely cosmetic procedures and do not involve changing the integrity (resection) of tissues. The only exception is perhaps eyelid lift with threads - this is an alternative correction method that is used in cases where gentle rejuvenating methods are no longer effective, and blepharoplasty is not indicated or even contraindicated for some reason. With thread eyelid lift, special cosmetic threads are inserted into the skin layers, tightening sagging tissues. By the way, the term "blepharoplasty" most often refers to a surgical method of eyelid lift.
• Upper eyelid lift is indicated if there is an overhanging eyelid – the so-called blepharochalasis. This pathology develops with age, but sometimes it occurs even in young people. Experts explain the occurrence of the problem by endocrine and cardiovascular disorders, failure of neurotrophic processes, genetic features, and the consequence of inflammatory reactions in the eye area. With minor overhang, surgical lifting is usually not performed, but with a pronounced defect, the procedure is really indicated: the doctor makes an incision in the area of the natural fold of the upper eyelid, excises excess tissue.
• Lower eyelid lift is mainly indicated for female patients belonging to the middle age group. The procedure is performed if there are excess fat deposits in the tear trough, or fatty hernias, which many people mistake for ordinary "bags" under the eyes. Over the years, the muscles of the lower eyelid weaken, as a result of which it droops, and the skin stretches. During the lift, the doctor makes an incision along the contour of the lower eyelid, removes the "excess" tissue, and the suture remains hidden. [ 5 ]
• Circular blepharoplasty of the eyelids is a complex corrective procedure that is performed on both the upper and lower eyelids. Thanks to the operation, it is possible to simultaneously get rid of both the upper overhang and fatty hernias, or "bags" under the eyes. The stitches after the intervention remain invisible, since the incisions are located directly under the line of the lower eyelash growth and in the natural fold of the upper eyelid. It is often possible to combine the procedure with laser resurfacing: this increases the effectiveness of the treatment.
• Endoscopic eyelid lift is one of the most modern and comprehensive methods of rejuvenation, which allows you to remove excess skin in the upper eyelid area, smooth out wrinkles in the forehead area, at the outer corners of the eyes and on the bridge of the nose, and also correct aesthetic defects of the eyebrows (for example, those that are a genetic feature of a person). Endoscopic lifting is performed as follows: minimal incisions are made in the hairline area on the head, an endoscope is inserted, tightening the soft tissues of the forehead and eyebrows, reducing the strength of the interbrow muscles. An absorbent device is additionally used for fixation and natural effectiveness of the eyelid lift. The procedure is minimally invasive, with a minimal rehabilitation period and a fairly stable result.
• Transconjunctival eyelid surgery is one of the most gentle ways to get rid of lower eyelid fat hernias: the incision is made conjunctivally, through which excess periorbital fat tissue is removed. The procedure is performed using local anesthesia, further scar formation is excluded. The most popular and preferred is laser transconjunctival eyelid lift: the rehabilitation period is shorter here, and the risk of complications is reduced to zero. [ 6 ]
• Fat-preserving blepharoplasty of the lower eyelids does not involve resection, but rather redistribution of fatty tissue. If there is not enough of this tissue, the surgeon also performs lipolifting of the eyelids. Thanks to the procedure, it is possible to more naturally correct and rejuvenate the periorbital zone. Fat-preserving eyelid lift is distinguished by a sustainable result: the effect can last for five to seven years. [ 7 ], [ 8 ]
• Injection blepharoplasty of the lower eyelids is a non-surgical (non-surgical) lifting method. This method allows you to get rid of lower eyelid hernias, fine wrinkles and dark circles under the eyes. To achieve the desired effect, four to ten injections of a special preparation may be required: they are repeated at intervals of one week. One procedure itself lasts no more than 30 minutes. The resulting swelling disappears within 24-48 hours. The expected effect of injection blepharoplasty can last up to 1-2 years.
• Laser eyelid lift is a surgical procedure, which, however, has many advantages over true resection, since it is performed using a laser. The laser beam acts as a scalpel, which makes the operation less traumatic. Usually, an erbium or carbon dioxide laser is used: the light flux is able to penetrate deep into the tissue by 1 μm without causing a burn. After laser lifting, swelling is less pronounced, and recovery is quick and painless. The main indications for the procedure are drooping or drooping eyelids, excess skin on the eyelids, fatty hernias, drooping corners of the eyes or a violation of their shape, wrinkles and other pronounced age-related changes. [ 9 ]

Contraindications to the procedure

Even the safest methods of eyelid lifting have contraindications, and they must be taken into account. Some of them are temporary, and the possibility of performing the procedure is determined by the surgeon during an individual consultation. Contraindications may include:

• skin diseases, acne, skin damage in the area of the proposed intervention;
• endocrine pathologies;
• inflammatory processes in the area of the proposed intervention;
• acute period of chronic diseases;
• tumors of a benign or malignant nature;
• blood diseases, blood clotting disorders;
• eye diseases, high intraocular pressure;
• viral infections;
• hypersensitivity to drugs and procedures used during surgery.

Consequences after the procedure

Any surgical operation can be accompanied not only by unpleasant sensations, but also by some painful consequences. Before starting the eyelid lift, the surgeon will definitely inform the patient about the possible occurrence of such undesirable effects after the operation:

• Excessive dryness of the mucous membrane of the eye, or, on the contrary, permanent lacrimation, which can be caused by a change in the functionality of the sebaceous glands. Recovery of the excretory function occurs within 2-3 weeks: this process is accelerated by the use of special ophthalmological agents prescribed by the doctor.
• Pain after the intervention can vary in intensity – from mild soreness to severe discomfort requiring the use of analgesics (as prescribed by a doctor).
• Eyelid edema after blepharoplasty occurs almost always, but does not last long and goes away on its own within two to ten days (depending on the type of intervention and the characteristics of the body). Such edema is usually associated with a violation of the integrity of the venous and lymphatic network, and also appears as a result of direct tissue damage and increased permeability. Permeability increases due to the release of local mediators of the inflammatory process.
• Bruises after lower eyelid blepharoplasty, contrary to the opinion of many, do not occur often. Their appearance may be due to damage to small vessels during the operation. As a rule, hematomas resolve on their own within 1-1.5 weeks.
• Asymmetry of the eyelids after blepharoplasty may be a consequence of the patient's anatomical features, but sometimes it becomes an indicator of the operating doctor's insufficient literacy and qualifications. The possibility of further correction of asymmetry is determined on an individual basis.
• Postoperative lymphostasis develops mainly against the background of a one-stage upper lower eyelid lift: in this case, the incision lines are practically connected, leaving only a small "bridge" that cannot provide full blood flow and lymph drainage. If lymphostasis is detected after lower eyelid blepharoplasty, treatment is prescribed individually, since the course of such a complication is difficult to predict. Often, the problem drags on for up to six months or even a year after the intervention. Manifestations of postoperative lymphostasis can include conjunctival chymosis and swelling of the lower eyelid.
• Numbness of the eyelids after blepharoplasty may be expressed in a decrease or loss of sensitivity of the skin in the incision area. Such sensations are unpleasant, they can appear immediately after the eyelid lift, or several days after the procedure. In most cases, numbness is temporary, since it is associated with nerve damage or lack of tissue trophism. In this situation, it is necessary to contact the operating doctor: he will prescribe the appropriate restorative medication or physiotherapy. In case of complete irreversible numbness, which happens quite rarely, it is necessary to perform surgery again - but not earlier than 6-8 months after the last eyelid lift.
• Fine wrinkles may not be eliminated after lower eyelid blepharoplasty: this issue is discussed with the surgeon before the lift. To correct the problem after blepharoplasty, you can resort to laser resurfacing, peeling, Botox/Vistabel or Dysport injections.
• Thickened areas or bumps after lower eyelid blepharoplasty may be developing scar tissue, edema foci, fatty tissue accumulations, as well as cysts and granulomas. Most often, we are talking about a violation of the scarring process, but if such a problem occurs, it is better to undergo an examination by a doctor. Correction is possible in each of these cases, but the most suitable option for getting rid of compactions should be determined by a doctor individually.

Complications after the procedure

If inaccuracies and mistakes were made during the surgical intervention for eyelid lifting, or the rehabilitation period was not completed smoothly, then the desired result after the operation may be marred by unpleasant complications, such as:

• cicatricial changes in tissues, with subsequent formation of eversion of the eyelid;
• changes in the shape of the eye slit, deformations, “round eyes”;
• gross cicatricial changes with subsequent shortening of the lower eyelids;
• the appearance of asymmetry;
• pronounced drooping of the outer corners of the eyes;
• significant tension of the skin;
• increased lacrimation due to improper eyelid closure;
• formation of residual hernias of periorbital tissue.

Scars from eyelid lifts are not considered a complication: they form at the site of the incisions, gradually smoothing out and turning into a thin, barely noticeable white line. Normally, this process takes about ten or twelve weeks. If smoothing out occurs more slowly, you should visit the surgeon who performed the eyelid lift. He will be able to assess the dynamics of healing, recommend certain physical procedures that can prevent excessive connective tissue growth.

The formation of a rough colloid scar usually occurs when the doctor’s recommendations are not followed:

• if the patient rubs and stretches the skin in the eyelid lift area;
• if there were any violations in the rehabilitation period (the skin was exposed to ultraviolet radiation, the patient visited a sauna or performed heavy physical exercises, did not follow the diet prescribed by a specialist).

Such troubles as eversion of the eyelid, ectropion after blepharoplasty are also a consequence of strong cicatricial changes: connective tissue strands are formed that have much less elasticity than the surrounding tissues, which leads to tension of the skin. Scars can provoke the appearance of both eversion and eversion of the eyelid. Such complications are detected relatively infrequently and are eliminated by temporary fixation of the eyelid with adhesive tape, or by means of surgical correction (if the eyelid lift was performed a long time ago).

Care after the procedure

How soon the patient will be able to return to normal daily activities - for example, go to work, engage in active activities - this information should be voiced by the doctor individually. Recommendations after upper eyelid blepharoplasty are given to each patient individually, depending on the scale of the operation, the degree of eyelid tightening, and the characteristics of the body. What exactly should be clarified with the doctor:

• which postoperative symptoms are normal and which should be a cause for concern;
• which indicates the potential development of complications;
• what actions can be taken to improve your well-being and speed up tissue recovery.
• Typically, the doctor recommends:
• prepare ice cubes and ice packs in the freezer in advance;
• have round gauze pads or cushions at home;
• Buy eye drops and pain relievers recommended by your doctor.

It is important to rest as much as possible and not to overload the body physically, not to bend, not to run and not to jump. In conditions of rest, the tissues will recover faster after the facelift.

The doctor's orders and recommendations should not be ignored. It is necessary to carefully follow all instructions regarding dressings, drainage, antibiotic therapy, or taking other recommended medications. If recovery is delayed, you should consult with your doctor again: perhaps this is just an individual feature of the body.

Most often, doctors give patients the following advice on how to conduct primary rehabilitation after an eyelid lift:

• apply cold compresses to the eye area (on the day after blepharoplasty and the following day);
• treat the stitches with medications prescribed by the doctor, use prescribed eye drops (to prevent dry conjunctiva);
• sleep only with the head end of the bed elevated (the head should be higher than the chest);
• at first (for three or four weeks), avoid playing sports, making sudden movements with the neck and head, bending over, carrying heavy objects, visiting a bathhouse or sauna, as well as any other actions that could affect an increase in blood pressure;
• rest often and for long periods of time, avoiding reading, wearing contact lenses, watching TV or a computer monitor;
• protect eyes from solar radiation and wind;

If you experience chest pain, arrhythmia, deterioration of vision, bleeding, or if pain in the operated area increases, you should consult a doctor.

• What cosmetic procedures are allowed and what are prohibited after eyelid blepharoplasty?

You can wash your face starting from the third day after the eyelid lift, provided there are no complications: when washing, you need to close your eyes so that water does not get into them.

Light stroking and tapping of the face to speed up the absorption of edema is welcome, but eyelid massage after blepharoplasty is allowed no earlier than 7-10 days (it is better if the procedure is performed by a specialist). It is not recommended to touch the eyes and the suture area without necessity, since this can provoke the development of infection or stretch the delicate skin.

You cannot use any medications to treat the post-operative area unless they are recommended by your doctor.

Face masks can be applied after 10 days, but the suture and eye areas should be avoided.

To avoid increased swelling, as well as irritation and redness of the skin, cosmetics may be used no earlier than 14 days after the eyelid lift. The use of scrubs and alcohol lotions should not be started earlier than 20-22 days after the procedure.

In the absence of complications, approximately two months after the eyelid lift, lifting procedures, Botox or Dysport are allowed.

• Why are special exercises used after eyelid blepharoplasty?

Exercises after eyelid lifting help the skin recover faster, get rid of hematomas, remove excess fluid, prevent complications, and improve blood circulation. What are these exercises:

• Warm-up: look forward, then left, right, up and down. Repeat the warm-up slowly, 5-6 times.
• Raise your face upward, looking at the ceiling. Blink intensely for half a minute, then lower your head.
• Close your eyes, count to three, and open them abruptly, looking into the distance (for example, out the window). Then close your eyes again. Repeat five times.
• Close your eyes, put clean index fingers on your eyelids (without excessive pressure). Slowly open your eyes without removing your fingers. Repeat 5-6 times.
• Tilt your neck back, without taking your gaze away from the tip of your nose. After 5 seconds, return your neck to its previous position, looking straight ahead.
• Close your eyes, holding your index fingers at your temples and pulling the skin to the sides (the so-called "Chinese cut" of the eyes). Repeat 5-6 times.

• What is eyelid resurfacing after blepharoplasty and why is it needed?

Resurfacing after eyelid lift improves the condition of the skin on the face, smoothes out scar tissue. The procedure is prescribed approximately 30-60 days after the operation, when the sutures have already healed and the tissues have recovered. Resurfacing itself is the effect of laser radiation on the skin pre-treated with anesthetic, for a couple of minutes. Heating the deep layers of the skin with a laser activates the proliferation of collagen and elastin cells, thereby stimulating rejuvenation. Scars become smooth and almost invisible.

• What to apply to eyelids after blepharoplasty?

To speed up regeneration, the doctor may recommend treating damaged tissues with some medications, such as ointments. You should not do this on your own: a doctor's consultation is necessary. The following external agents are most often applied to the suture area:

• Contractubex is a gel preparation that inhibits connective tissue growth in the incision area. What does it give? Under the action of the preparation, the scar becomes almost invisible. Contractubex is used only after the stitches have been removed.
• Hydrocortisone ointment is a hormonal agent that stimulates healing processes and prevents the development of infectious and inflammatory reactions. The use of the ointment is characterized by a large number of warnings and contraindications, so treatment must be agreed upon with a doctor.
• Levomekol is a well-known anti-inflammatory and regenerating ointment that can be used almost immediately after the eyelid lift procedure.
• Traumeel C is a homeopathic preparation in the form of an ointment that accelerates tissue regeneration and promotes the resorption of bruises.

Any medications, including those for external use, can only be used on the recommendation of a specialist.

• When can you get eyelid tattooing after blepharoplasty?

Eyebrow tattooing is allowed to be performed 2 months after eyelid lift surgery (provided there are no complications), and eye tattooing – approximately three months later.

Reviews

Eyelid lift – with or without tissue removal – is a fairly popular plastic surgery performed in many clinics and medical surgical centers. However, you should not decide on the need for blepharoplasty on your own: a doctor, a specialist in plastic surgery, should assess the situation. It is also undesirable to seek this service at any clinic you come across. First, you should make sure of the “seriousness” of the medical institution and the proper qualifications of the doctors.

In order for the eyelid lift to be successful, without complications, it is necessary to make sure that the clinic's specialists carry out medical activities legally: every plastic surgeon must have a license to carry out this type of activity. The next nuance is the specialist's qualifications and positive reviews about him. Do not be shy about asking other patients about the experience and reputation of a particular doctor, as well as the clinic as a whole.