Upper and lower eyelid lift: surgical technique

Age spares no one: the skin on the face, and especially near the eyes, gradually becomes thinner, loses elasticity, covered first with 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 eyelid lift. Next we will talk about what it can be, and what you need to know about it.

What is the name of the eyelid lift?

In the appearance of wrinkles, most often there is no need for surgical eyelid lift. It is enough to use hardware techniques, as well as all sorts of peels, masks, massage procedures. Some experts advise to do contour plasty with the help of fillers - means based on hyaluronic acid. Injections are repeated annually, thanks to which moisturizing and filling of the skin near the eyes is ensured.

The use of botulinum toxin A prevents the formation of skin creases near the eyes and in the forehead area. The effect of injections is present for about six months. Plasmolifting is no less popular: a person takes his own blood and injects platelet-rich plasma subcutaneously. This procedure accelerates the production of collagen and elastin fibers. Other non-surgical lifting procedures may include radio wave lifting, non-surgical vaporization (laser lifting).

As for surgical methods, eyelid lift in this case is called blepharoplasty. It is a more radical, but 100% effective way of preserving and prolonging the youthfulness of the skin near the eyes. [1]

Is upper eyelid blepharoplasty dangerous?

When talking about eyelid lift, they usually mean a reconstructive surgery, 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 involves achieving a positive aesthetic result with the least possible tissue damage. Competently performed intervention helps to restore youthfulness to the area near 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 with patients over thirty years of age.

Eyelid lift can be called a relatively uncomplicated procedure, with minimal probability of traumatization. The surgery is practically risk-free: according to statistics, the risk of complications is estimated by specialists to be only 3%.

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

Indications for the procedure

In the vast majority of cases, corrective rejuvenation surgeries are performed based on the patient's own wishes - for example, if a person does not like something about his or her appearance. However, there are also medical indications for eyelid lift surgery:

• a sagging upper eyelid or a drooping lower eyelid;
• A rather large excess of skin in the periorbital area, causing discomfort to the person;
• fat hernias;
• deformed eyelid changes, drooping corners of the eyes;
• differently shaped eyes, skin asymmetry;
• pronounced age-related changes in the skin near the eyes;
• early but deep wrinkles.

Possible repeat lower eyelid blepharoplasty may be indicated in these cases:

• If the eye shape is abnormal after surgery - for example, due to a surgeon's error;
• if there are problems with skin deformation near the eyes during the rehabilitation period;
• to maintain the lifting effect in the previously operated area.

It is believed that the effect, which was obtained during eyelid lift surgery, lasts for a long time. But even in this case, doctors do not exclude the re-performance of blepharoplasty in about seven or ten years. To delay the need for a second procedure, experts recommend eating right, enough sleep, get rid of bad habits. Some patients may benefit from certain cosmetic interventions to support tissue tone.

The most common indication for a surgical lift is the correction of a drooping eyelid. The upper eyelid can sag due to natural anatomical features or age-related changes. Such surgery is performed on the growth zone of the eyelashes.

Correction of eyelid ptosis - gravitational drooping on one or both sides - may be indicated for both elderly and young patients. For example, ptosis can be the result of age-related changes, congenital or acquired hyperelasticity of tissues, 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 there are no additional scars, and the operation itself does not require special equipment. It is possible to perform correction after upper blepharoplasty.

Blepharoplasty of heavy eyelids allows you to eliminate the upper overhanging skin, strengthen and restore elasticity of the area near the eyes. Often such "heaviness" is asymmetrical, more strongly manifested on the side of the face with a decrease in muscle tone. The causes of such a decrease may be multifunctional disorders typical of age-related atrophic changes or cerebral vascular diseases. [3]

Preparation

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

Approximately 7-10 days before surgery, the patient will be advised to exclude the intake of any non-steroidal anti-inflammatory drugs, medications with hormonal or anti-clotting activity. 3-4 days before the procedure, alcoholic beverages should be discontinued.

The intensity of the preparatory stage depends largely on the method of anesthesia during surgery. For example, if local anesthesia is supposed to be used, no special dietary changes are required. In preparation for general anesthesia, any intake of food and water should be completed 8 hours before the intervention. [4]

What tests are needed for eyelid blepharoplasty?

Prior to eyelid lift surgery, the patient will be asked to undergo initial diagnostics, which includes taking laboratory tests. The most common types of tests required are:

• general blood work;
• blood chemistry (ALT, AST, glucose, bilirubin, potassium, creatinine);
• blood clotting tests, coagulogram;
• blood for syphilis, HbsAg + HCV;
• general clinical urinalysis;
• EKG;
• Consultation with an anesthesiologist (provided only after receiving the results of all tests and electrocardiography).

In addition, the doctor may refer the patient for fluorography, rhinomanometry, etc.

Technique of the eyelid lifts

• Correction of the upper eyelids is considered the most common: the procedure is performed without placing the patient in hospital, as within a few hours he can go to home rehabilitation. As a rule, the upper eyelid lift is performed under local anesthesia, and general anesthesia is applied only based on the client's desire (if there are no contraindications). The operation is performed through an incision in the area of the natural crease of the upper eyelid. The doctor removes excess fatty tissue through the incision, cuts away the skin, and then applies microsurgical sutures. The total duration of the procedure - about 40-45 minutes. Sutures are removed after 4-5 days, and the end of the rehabilitation period corresponds to about 45-50 days after surgery.
• The upper eyelid lift is often performed on people who have permanent swelling and circles under the eyes: with this method, you can get rid of these problems. The lower eyelid lift is performed through a subcostal incision in the lower eyelid area. It is possible to use both local and general anesthesia (in some cases - at the patient's request). The intervention lasts about 45-55 minutes, it can be carried out by classical or fat-saving technology. Classic lift involves removal of "excess" fatty tissue and excision of "excess" skin. The incision is sutured with cosmetic sutures. Fat-saving lift does not involve the removal of fat accumulations, but only their redistribution, in order to avoid the effect of "sunken" eyes. All of these types of eyelid lift do not require the patient to be hospitalized, as he is released home after a couple of hours (depending on the type of anesthesia used). The full effect of the procedure can be assessed after about 4-8 weeks.
• Circumferential eyelid lift involves simultaneous correction of the upper and lower eyelid. Anesthesia is used local or general, 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 performs an incision in the natural fold of the upper eyelid, as well as slightly below the border of the ciliary growth at 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 conjunctiva of the lower eyelids (namely, on the inner side of the eyelid). Through the incisions, the doctor removes "excess" fatty tissue. Sutures are not required. The procedure lasts about 35 minutes, and the patient is already at home within a few hours. The average recovery period is two weeks.

Types of blepharoplasty

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

• Surgical eyelid lift is fundamentally different from non-surgical eyelid lift: most non-surgical methods are purely cosmetic procedures and do not involve changes in the integrity (resection) of tissues. The only exception is only eyelid lift threads - we are talking about an alternative method of correction, which is used in cases where gentle rejuvenating methods are already ineffective, and blepharoplasty for some reason is not indicated, or even contraindicated. In thread eyelid lift in the skin layers are injected with special cosmetic threads that tighten sagging tissues. By the way, the term "blepharoplasty" is most often understood as a surgical method of eyelid lift.
• An upper eyelid lift is indicated if the upper eyelid is overhanging - the so-called blepharochalasis. This pathology develops with age, but sometimes occurs even in young people. Specialists explain the appearance of the problem by endocrine and cardiovascular disorders, failure of neurotrophic processes, genetic features, the consequence of inflammatory reactions in the eye area. With a slight overhang, surgical lifting is usually not performed, but in case of a pronounced defect, the procedure is really indicated: the doctor makes an incision in the area of the natural crease of the upper eyelid, excises excess tissue.
• Lower eyelid lift is mainly indicated for middle-aged female patients. The procedure is performed if there are excessive fat deposits in the recess of the lacrimal sulcus, or fat hernias, which many people mistake for the usual "bags" under the eyes. Over the years, the muscles of the lower eyelid weaken, as a result, it falls down 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]
• Circumferential blepharoplasty of the eyelids is a complex corrective procedure that is performed on both upper and lower eyelids. Thanks to the operation, it is possible to get rid of both the upper overhang and fatty hernias, or "bags" under the eyes. Sutures after the intervention remain invisible, because the incisions are directly under the line of the lower lash growth and in the natural fold of the upper eyelid. It is often possible to combine the procedure with laser resurfacing: this enhances the effectiveness of treatment.
• Endoscopic eyelid lift is one of the most modern and comprehensive methods of rejuvenation, which allows you to eliminate excess skin in the upper eyelid area, smooth wrinkles in the frontal area, at the outer corners of the eyes and on the bridge of the nose, as well as correct aesthetic defects of the eyebrows (such as those that are a genetic feature of a person). Endoscopic lifting is performed as follows: make minimal incisions in the hairline area of the head, introduce an endoscope, tightening the soft tissues of the forehead and eyebrows, reducing the strength of the interbrow muscles. Additionally, an absorbent device is applied - for fixation and the natural effectiveness of the eyelid lift. The procedure is minimally invasive, with minimal rehabilitation period and a fairly permanent result.
• Transconjunctival eyelid plasty is one of the most gentle ways to get rid of fat hernias of the lower eyelid: the incision is made conjunctivally, through which the excess periorbital fatty tissue is removed. The procedure is carried out using local anesthesia, further scar formation is excluded. Laser transconjunctival eyelid lift is considered the most popular and preferable: the rehabilitation period is shorter, and the risk of complications is reduced to zero. [6]
• Fat-preserving blepharoplasty of the lower eyelids involves not resection, but redistribution of adipose tissue. If such tissue is not enough, the surgeon also performs lipolifting of the eyelids at the same time. Thanks to the procedure, it is possible to more naturally correct and rejuvenate the periorbital zone. Fat-preserving eyelid lift is characterized by a stable result: the effect can be maintained for five to seven years. [7], [8]
• Injectable blepharoplasty of the lower eyelids refers to non-surgical (non-surgical) methods of lifting. This method allows you to get rid of lower eyelid hernias, fine wrinkles and dark circles under the eyes. To achieve the desired effect may require from four to ten injections of a special drug: they are repeated at intervals of one week. Directly one procedure lasts no more than 30 minutes. Formed at this swelling disappears within 24-48 hours. The expected effect of injectable blepharoplasty can last up to 1-2 years.
• A laser eyelid lift is a surgical procedure that, however, has many advantages over a true resection because it is performed using a laser. The laser beam acts as a scalpel, which makes the surgery less traumatic. Usually used erbium or carbon dioxide laser: the light stream is able to penetrate deep into the tissue by 1 micrometer, without causing a burn. After laser lift swelling is less pronounced, and recovery is quick and painless. The main indications for the procedure are considered overhanging or drooping eyelids, excess skin on the eyelids, fat hernias, drooping corners of the eyes or violation of their shape, wrinkles and other pronounced age-related changes. [9]

Contraindications to the procedure

Even the safest methods of eyelid lift have contraindications to the procedure, and it is mandatory to take them into account. Some of them are temporary, and the possibility of carrying out the procedure is determined by the surgeon during an individual consultation. Contraindications can be:

• skin diseases, acne, skin lesions 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, clotting disorders;
• eye disease, high intraocular pressure;
• viral infections;
• hypersensitivity to drugs and procedures that are involved in the process of surgical intervention.

Consequences after the procedure

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

• Excessive dryness of the eye mucosa, or vice versa, permanent tear production, which can be caused by changes in the functionality of sebaceous glands. Recovery of excretory function occurs within 2-3 weeks: this process is accelerated by the use of special ophthalmologic remedies prescribed by the doctor.
• Pain after the intervention may vary in intensity from mild soreness to severe discomfort requiring analgesics (as prescribed by a doctor).
• Swelling of the eyelids after blepharoplasty occurs almost always, but it does not last long and goes away on its own within two to ten days (depending on the type of intervention and the peculiarities of the body). Such swelling 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. The permeability is increased due to the release of local inflammatory mediators.
• Bruises after blepharoplasty of the lower eyelids, contrary to the opinion of many, do not occur often. Their appearance may be due to damage during the operation of small vessels. As a rule, hematomas resorb on their own within 1-1.5 weeks.
• Eyelid asymmetry after blepharoplasty can be a consequence of the anatomical features of the patient, but sometimes becomes an indicator of insufficient literacy and qualification of the operating doctor. The possibility of further correction of asymmetry is determined on an individual basis.
• Postoperative lymphostasis develops mainly against the background of one-stage execution of the upper lower eyelid lift: in this case, the incision lines are practically joined, there is only a small "bridge", which can not provide a full blood flow and lymph flow. If lymphostasis is detected after blepharoplasty of the lower eyelids, treatment is prescribed individually, as the course of such a complication is difficult to predict. Often the problem is delayed up to six months and even a year after the intervention. Manifestations of postoperative lymphostasis can be conjunctival chemosis and edema of the lower eyelid.
• Numbness of the eyelids after blepharoplasty can 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 eyelid lift, or a few days after the procedure. In most cases, numbness is temporary, because it is associated with nerve damage or lack of trophic tissue. In this situation, it is necessary to contact the operating doctor: he will prescribe the appropriate restorative medication or physical therapy. In case of complete irrecoverable numbness, which is quite rare, it is necessary to perform surgery again - but not earlier than 6-8 months after the last eyelid lift.
• Fine wrinkles after blepharoplasty of the lower eyelids may not be eliminated: this issue is discussed with the surgeon before the lift. Laser resurfacing, peeling, Botox/Vistabel or Dysport injections may be used to correct the problem after blepharoplasty.
• Compacted areas or bumps after blepharoplasty of the lower eyelids may represent forming scar tissue, foci of edema, accumulations of fatty tissue, as well as cysts and granulomas. Most often it is a violation of scarring processes, but if such a problem appears, it is better to be examined by a doctor. Correction is possible in each of these cases, but the most appropriate option to get rid of the seals should be determined by a doctor individually.

Complications after the procedure

If in the process of eyelid lift surgery were made inaccuracies and errors, or the rehabilitation period proceeded with irregularities, the desired result after surgery can be overshadowed by unpleasant complications, such as:

• scar tissue changes, with further formation of eyelid eversion;
• changes in the shape of the eye slit, deformities, "rounded eyes";
• gross scarring changes with subsequent shortening of the lower eyelids;
• the appearance of asymmetry;
• pronounced drooping of the outer corners of the eyes;
• significant skin tension;
• increased tear production due to improper eyelid closure;
• formation of residual periorbital hernias.

Eyelid lift scars are not considered a complication: they form at the site of the incisions, gradually smoothing out and turning into a thin, inconspicuous white line. Normally, this process takes about ten or twelve weeks. If smoothing is slower, then you should visit the surgeon who performed eyelid lift. He will be able to assess the dynamics of healing, recommend certain physical procedures that can prevent excessive connective tissue overgrowth.

The formation of a rough colloidal 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 violations of the rehabilitation period (the skin was exposed to ultraviolet light, the patient visited a bath or heavy exercise, did not follow the diet prescribed by the specialist).

Such troubles as eyelid eversion, ectropion after blepharoplasty are also a consequence of severe scarring changes: connective tissue strands are formed, which have much less elasticity than the surrounding tissues, which leads to tension of the skin. Scars are able to 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 a leukoplasty, or with the help of surgical correction (if eyelid lift was carried out a long time ago).

Care after the procedure

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

• which postoperative symptoms are normal and which should be alarming;
• indicating the potential development of complications;
• What actions can be taken to help you feel better and speed up tissue repair.
• As a general rule, the doctor recommends:
• prepare ice cubes, ice packs in the freezer in advance;
• Have rounded gauze disks, or pads, at home;
• buy eye drops and analgesic medications recommended by your doctor.

It is important to rest as much as possible and do not physically strain the body, do not bend over, run or jump. In resting conditions, the tissues will recover faster after the lift.

The doctor's prescriptions and recommendations should not be ignored. All instructions regarding dressings, drainage, antibiotic therapy or other recommended medications must be carefully followed. If recovery is delayed, it is necessary to consult the doctor again: it may be just an individual peculiarity of the body.

Most often, doctors give patients these tips for managing the initial rehabilitation after eyelid lift:

• Apply cold compresses to the eye area (on the day after blepharoplasty and the next day);
• treat stitches with medications prescribed by the doctor, drip prescribed eye drops (to prevent dryness of the conjunctiva);
• sleep only with the head end of the bed elevated (head should be above the sternum);
• for the first three or four weeks, avoid sports, sudden movements of the neck and head, bending over, carrying heavy objects, visiting baths and saunas, and any other activities that may increase blood pressure;
• rest frequently and for long periods of time, avoiding reading, wearing contact lenses, watching television or computer monitors;
• protect your eyes from sunlight and wind;

If there is pain behind the sternum, arrhythmia, deterioration of vision, bleeding, as well as in case of increased pain in the operated area, it is necessary to consult a doctor for advice.

• Which cosmetic procedures after eyelid blepharoplasty are allowed and which are prohibited?

You can wash your face from the third day after eyelid lift, provided there are no complications: the eyes should be covered when washing to prevent water from entering them.

Light stroking and stroking of the face to accelerate the resorption of swelling is welcome, but eyelid massage after blepharoplasty is allowed no sooner 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 area of the sutures unnecessarily, as this can provoke the development of infection, or stretch the delicate skin.

You should not use any medications to treat the postoperative area unless recommended by your doctor.

Facial masks are allowed after 10 days, but the suture and eye area should be avoided.

To avoid increased swelling, as well as skin irritation and redness, cosmetic products may be used no earlier than 14 days after eyelid lift. Scrubs and alcoholic lotions should not be used earlier than 20-22 days after the procedure.

If there are no complications, about two months after eyelid elevator, Botox or Dysport procedures are allowed.

• What are special exercises after blepharoplasty of the eyelids used for?

Exercises after eyelid lift help the skin to recover faster, get rid of bruises, remove excess fluid, prevent the development of complications, improve blood circulation. What are such exercises:

• Warm-up: look forward, then left, right, up and down. Repeat the warm-up without hurrying, 5-6 times.
• Raise the face upward, staring at the ceiling. Blink intensely for half a minute and then lower the head.
• Close their eyes, count to three and open them sharply, looking away (e.g. Out the window). Then close their eyes again. Repeat five times.
• Cover the eyes, put clean index fingers on the eyelids (without excessive pressure). Slowly open the eyes without removing the fingers. Repeat 5-6 times.
• Tilt the neck to the back without taking your eyes off the tip of the nose. After 5 seconds, return the neck to its previous position, looking strictly in front of you.
• Cover the eyes by holding the index fingers at the 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 what is it for?

Resurfacing after eyelid lift improves the condition of the skin on the face, smoothes scar tissue. The procedure is appointed about 30-60 days after surgery, when the sutures have already tightened, and the tissue - recovered. The resurfacing itself is the impact of laser radiation on the skin pre-treated with anesthetic, for a couple of minutes. The heating of the deep layers of the skin by the laser activates the reproduction of collagen and elastin cells, so that rejuvenation is stimulated. Scars become smooth and virtually invisible.

• What to ointment on eyelids after blepharoplasty?

To speed up regeneration, the doctor may advise treating the damaged tissue with some medication - for example, ointments. This should not be done on your own: a doctor's consultation is necessary. On the area of the sutures most often apply such external remedies:

• Contractubex is a gel preparation that inhibits connective tissue growth in the incision area. What does it do? Under the influence of the drug, the scar becomes almost invisible. Contractubex is used only after the sutures are removed.
• Hydrocortisone ointment is a hormonal remedy that stimulates healing processes, prevents the development of infectious-inflammatory reactions. The use of ointment is characterized by a large number of cautions and contraindications, so the treatment must necessarily be coordinated with the doctor.
• Levomekol is a well-known anti-inflammatory and regenerating ointment that is allowed to be used almost immediately after an eyelid lift procedure.
• Traumel C is a homeopathic preparation in the form of an ointment that accelerates tissue regeneration and promotes the resorption of bruises.

Any drugs, including external action, can be used only on the advice of a specialist.

• When can eyelid tattooing be done after blepharoplasty?

Eyebrow tattooing is allowed 2 months after eyelid lift surgery (provided there are no complications), and eye tattooing - after about three months.

Testimonials

Eyelid lift - with or without tissue removal - is a fairly popular plastic surgery, which is practiced in many clinics and medical surgical centers. However, you should not decide on your own about the need for blepharoplasty: the situation should be assessed by a doctor, a specialist in the field of plastic surgery. It is also undesirable to apply for this service in any clinic. To begin with, it is necessary to make sure that the medical institution is "serious" and that the doctors are properly qualified.

In order for eyelid lift to be successful, without the development of complications, it is necessary to make sure that the specialists of the clinic carry out medical activities on legal grounds: each plastic surgeon must have a license to carry out this type of activity. The next nuance is the qualification of the specialist and positive feedback about him. You should not hesitate to ask other patients about the experience and reputation of this or that doctor, as well as the clinic as a whole.