Lifting of the upper and lower eyelids: the technique of the operation

Age does not spare anyone: the skin on the face, and especially near the eyes, gradually becomes thinner, loses elasticity, becomes 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 an eyelid lift. Next, we will talk about what it is, and what you need to know about it.

What is an eyelid lift called?

With the appearance of wrinkles, there is often no need for a surgical eyelid lift. It is enough to use hardware techniques, as well as all kinds of peelings, masks, massage procedures. Some experts advise doing contouring with the help of 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 to prevent the formation of skin creases near the eyes and in the forehead. The effect of injections is present 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 can be radio wave lifting, non-surgical vaporization (laser lifting).

As for surgical methods, the eyelid lift in this case is called blepharoplasty. This is a more radical, but 100% effective way to preserve and prolong the youthfulness of the skin around the eyes.[1]

Is blepharoplasty of the upper eyelids dangerous?

When talking about an eyelid lift, they usually mean a reconstructive 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 is different, without removing excess tissue, but only with its redistribution.

As a rule, an eyelid lift involves achieving a positive aesthetic result with the least possible tissue damage. Properly carried out intervention helps to restore youth to the area near the eyes, and even improve the shape and incision of the eye.

Blepharoplasty is considered one of the most sought after plastic surgeries on the planet. It is especially popular with patients over thirty years of age.

An eyelid lift can be called a relatively simple procedure, with a minimal likelihood of injury. The operation is practically devoid of risks: according to statistics, the risk of complications is estimated by experts at only 3%.

However, despite the favorable statistics, surgeons are advised to seek surgical eyelid lift only if there is an indication for surgery. If there are no such indications, it is better to postpone the intervention and try to solve the problem in non-surgical ways.[2]

Indications for the procedure

Corrective anti-aging operations in the vast majority of cases are performed based on the patient's own desire - for example, if a person does not like something in his appearance. However, there are medical indications for an eyelid lift:

• strongly sagging upper eyelid, or lowered lower eyelid;
• a sufficiently large excess of skin in the periorbital region, causing discomfort to a person;
• fatty hernia;
• deformed changes in the eyelids, lowered corners of the eyes;
• eyes of different shape, skin asymmetry;
• pronounced age-related changes in the skin around the eyes;
• early but deep wrinkles.

Possible repeated blepharoplasty of the lower eyelids may be indicated in such cases:

• in case of postoperative violation of the shape of the eyes - for example, due to a surgeon's mistake;
• if there are problems with deformation of the skin near the eyes during the rehabilitation period;
• to maintain the tightening effect in the previously operated area.

It is believed that the effect that was obtained with a surgical eyelid lift persists for a long time. But even in this case, doctors do not rule out a second blepharoplasty in about seven or ten years. In order to delay the need for a second procedure as much as possible, experts recommend eating right, getting enough sleep, and getting rid of bad habits. Some patients may benefit from certain cosmetic treatments to support tissue tone.

The most common indication for a surgical lift is the correction of an overhanging eyelid. The upper eyelid can sag due to natural anatomical features or age-related changes. This operation is performed on the area of eyelash growth.

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

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

Preparation

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

Approximately 7-10 days before surgery, the patient will be advised to exclude any non-steroidal anti-inflammatory drugs, drugs with hormonal or anti-coagulant activity. Alcoholic beverages should be stopped 3-4 days before the procedure.

The saturation of the preparatory stage largely depends on the method of anesthesia during the operation. For example, if local anesthesia is supposed to be used, then a special dietary change is not required. In preparation for general anesthesia, any food and water intake should be completed 8 hours before the intervention.[4]

What tests are needed for eyelid blepharoplasty?

Prior to the surgical eyelid lift, the patient will be asked to undergo an initial diagnosis, which includes the delivery of laboratory tests. Most often, a person needs to conduct such types of research:

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

Additionally, the doctor can refer the patient to fluorography, rhinomanometry, etc.

Technique of the eyelid lift

• Correction of the upper eyelids is considered the most common: the procedure is carried out without placing the patient in a hospital, since within a few hours he can go to home rehabilitation. As a rule, an upper eyelid lift is performed under local anesthesia, and general anesthesia is used only on the basis of the client's desire (if there are no contraindications). The operation is performed by making an incision in the area of the natural crease of the upper eyelid. The doctor removes excess adipose 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 about 45-50 days after the operation.
• An upper eyelid lift is often done for people who have persistent swelling and circles under the eyes: with this method, you can get rid of these problems. The lower lift is performed through a subciliary incision in the lower eyelid area. It is possible to use both local and general anesthesia (in some cases - at the request of the patient). The intervention lasts about 45-55 minutes, it can be carried out according to the classical or fat-saving technology. A classic lift involves the removal of "excess" adipose tissue and the excision of "excess" skin. The incision is closed with a cosmetic suture. Fat-saving lifting 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 admitted to the hospital, since he is allowed to go 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.
• A circular eyelid lift involves the simultaneous correction of the upper and lower eyelids. Anesthesia is used local or general, at the discretion of the doctor. The duration of the intervention is always different (1-3 hours), depending on the scope of the operation and the individual characteristics of the patient. The surgeon makes an incision in the natural crease of the upper eyelid, as well as slightly below the line of ciliary growth near the lower eyelid. Fat accumulation and “extra” skin are removed, and the incisions are sutured with microsutures.
• A transconjunctival eyelid lift is an intervention involving small incisions in the conjunctiva of the lower eyelids (namely, on the inside of the eyelid). Through the incisions, the doctor removes the "excess" adipose tissue. No sutures are required. The procedure lasts about 35 minutes, and the patient is already at home for several hours. The recovery period averages two weeks. 

Types of blepharoplasty

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

• A surgical eyelid lift is fundamentally different from a non-surgical lift: most non-surgical methods are purely cosmetic procedures and do not involve changes in the integrity (resection) of tissues. The only exception is an eyelid lift with threads - this is an alternative method of correction, which is used in cases where gentle anti-aging methods are already ineffective, and blepharoplasty is not indicated for some reason, or even contraindicated. With a thread lift of the eyelids, special cosmetic threads are injected into the skin layers, tightening sagging tissues. By the way, the term "blepharoplasty" most often refers to the surgical method of lifting the eyelids.
• A lift of the upper eyelid is indicated if there is an overhang - the so-called blepharochalasis. This pathology develops with age, but sometimes occurs even in young people. Experts explain the appearance of the problem by endocrine and cardiovascular disorders, failure of neurotrophic processes, genetic characteristics, and a consequence of inflammatory reactions in the eye area. With a slight overhang, a surgical lift is usually not performed, but with a pronounced defect, the procedure is really indicated: the doctor performs an incision in the area of the natural crease of the upper eyelid, excising excess tissue.
• Lower eyelid lift is mainly indicated for female patients belonging to the middle age group. The procedure is carried out if there are excessive fat deposits in the deepening of the tear trough, or fatty hernias, which many take for ordinary "bags" under the eyes. Over the years, the muscles of the lower eyelid weaken, as a result, it falls, and the skin stretches. During the lift, the doctor makes an incision along the contour of the lower eyelid, removes the "extra" tissue, and the seam remains hidden.[5]
• Circular blepharoplasty is a comprehensive 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 seams after the intervention remain invisible, since the incisions lie directly under the line of the lower ciliary growth and in the natural crease of the upper eyelid. It is often possible to combine the procedure with laser resurfacing: this enhances the effectiveness of the treatment.
• Endoscopic eyelid lift is one of the most modern and comprehensive methods of rejuvenation that allows you to eliminate excess skin in the area of the upper eyelids, smooth out wrinkles in the frontal zone, at the outer corners of the eyes and on the bridge of the nose, as well as correct aesthetic defects of the eyebrows (for example, those that are human genetics). Endoscopic lifting is performed as follows: minimal incisions are made in the hairline area on the head, an endoscope is inserted, pulling up the soft tissues of the forehead and eyebrows, reducing the strength of the interbrow muscles. In addition, an absorbent device is used - for fixation and natural effectiveness of the eyelid lift. The procedure is minimally invasive, with a minimum period of rehabilitation and a fairly stable result.
• Transconjunctival eyelid surgery is one of the most gentle ways to get rid of fatty hernias of the lower eyelid: the incision is made conjunctivally, through which excess periorbital adipose tissue is removed. The procedure is carried out using local anesthesia, further scarring 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 redistribution of adipose tissue. If this tissue is not enough, then the surgeon also performs eyelid lipolifting at the same time. Thanks to the procedure, it is possible to more naturally correct and rejuvenate the periorbital zone. The fat-preserving eyelid lift is characterized by a stable result: the effect can last for five to seven years.[7], [8]
• Injection blepharoplasty of the lower eyelids refers to non-surgical (non-surgical) methods of lifting. This method allows you to get rid of hernias of the lower eyelid, fine wrinkles and dark circles under the eyes. To achieve the desired effect, four to ten injections of a special drug may be required: they are repeated with an interval of one week. Directly one procedure lasts no more than 30 minutes. The resulting edema 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 a true resection, since it is performed using a laser. The laser beam plays the role of a scalpel, which makes the operation less traumatic. An erbium or carbon dioxide laser is usually used: the light flux is able to penetrate 1 micron deep into the tissue 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, lowering of the 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 lift have contraindications, and it is imperative to take them into account. Some of them are temporary, and the possibility of the procedure is determined by the surgeon during an individual consultation. Contraindications may be:

• skin diseases, acne, skin lesions in the area of the intended intervention;
• endocrine pathologies;
• inflammatory processes in the area of the proposed intervention;
• acute period of chronic diseases;
• benign or malignant tumors;
• blood diseases, blood clotting disorders;
• eye diseases, 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 with the eyelid lift, the surgeon will definitely inform the patient about the likely occurrence of such undesirable effects after the operation:

• Excessive dryness of the mucous membrane of the eye, or vice versa, permanent tearing, which may be caused by a change in the functionality of the sebaceous glands. Restoration of the excretory function occurs within 2-3 weeks: this process is accelerated by the use of special ophthalmic agents prescribed by the doctor.
• Pain after the intervention can have different intensity - from mild soreness to severe discomfort, requiring the use of analgesics (as prescribed by a doctor).
• Edema of the eyelids after blepharoplasty almost always occurs, but they do not last long and disappear on their own within two to ten days (depending on the type of intervention and on the characteristics of the body). Such edema is usually associated with a violation of the integrity of the venous and lymphatic network, and also appear 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 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 resolve on their own within 1-1.5 weeks.
• Asymmetry of the eyelids after blepharoplasty may be due to the anatomical features of the patient, but sometimes it becomes an indicator of insufficient literacy and qualifications 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 a one-stage upper lower eyelid lift: in this case, the incision lines practically connect, only a small “bridge” remains, which cannot provide full blood flow and lymph outflow. If lymphostasis is detected after blepharoplasty of the lower eyelids, 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 be conjunctival chymosis and swelling 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 an eyelid lift, or a few days after the procedure. In most cases, numbness is temporary, as it is associated with nerve damage or a lack of tissue trophism. In this situation, it is necessary to contact the operating doctor: he will prescribe the appropriate restorative medication or physiotherapy. With complete irreversible numbness, which is quite rare, it is necessary to perform surgery again - but not earlier than 6-8 months after the last eyelid lift.
• Small wrinkles after blepharoplasty of the lower eyelids may not be eliminated: this issue is discussed with the surgeon even 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 blepharoplasty of the lower eyelids can be formed scar tissue, edema, accumulations of adipose tissue, as well as cysts and granulomas. Most often, we are talking about a violation of scarring processes, but when 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 for getting rid of seals should be determined by the doctor individually.

Complications after the procedure

If inaccuracies and mistakes were made during the surgical intervention for eyelid lift, or the rehabilitation period proceeded with violations, then the desired result after the operation may be overshadowed by unpleasant complications, such as:

• cicatricial tissue changes, with further formation of eversion of the eyelid;
• change in the shape of the palpebral fissure, deformation, "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 tear secretion due to improper closing of the eyelids;
• formation of residual hernias of periorbital tissue.

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

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 area;
• if there were violations of the rehabilitation period (the skin was exposed to ultraviolet radiation, the patient went to the bathhouse or performed heavy physical exercises, did not follow the diet prescribed by the specialist).

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

Care after the procedure

How soon the patient can return to normal daily activities - for example, go to work, engage in vigorous activity - 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, the degree of eyelid lift, and the characteristics of the body. What exactly should be clarified with a doctor:

• which postoperative symptoms are normal and which should alert;
• which indicates the potential development of complications;
• what actions can be taken to facilitate well-being and accelerate tissue repair.
• As a rule, the doctor recommends:
• prepare ice cubes, ice packs in the freezer in advance;
• have at home rounded gauze discs, or pads;
• buy eye drops and analgesics recommended by the doctor.

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

Doctor's prescriptions and recommendations cannot be ignored. It is necessary to carefully follow all instructions regarding dressings, drainage, antibiotic therapy, or taking other recommended drugs. If the recovery is delayed, you need to once again consult with the doctor: perhaps we are talking only about the individual characteristics of the organism.

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

• apply cold compresses to the eye area (on the day after blepharoplasty and the next day);
• treat stitches with drugs prescribed by a doctor, drip prescribed eye drops (to prevent dryness of the conjunctiva);
• sleep only with the head end of the bed raised (the head should be above the sternum);
• for the first time (within three or four weeks), avoid playing sports, sudden movements of the neck and head, tilting, carrying heavy objects, visiting the bath and sauna, as well as any other activities that can affect the increase in blood pressure;
• often and for a long time to rest, avoiding reading, wearing contact lenses, watching TV or a computer monitor;
• protect eyes from solar radiation and wind;

If you experience pain behind the sternum, arrhythmias, blurred vision, bleeding, as well as increased pain in the operated area, you should consult a doctor for advice.

• What cosmetic procedures after blepharoplasty of the eyelids are allowed and which are prohibited?

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

Light stroking and tapping of the face to accelerate the resolution of edema is welcome, but eyelid massage after blepharoplasty is allowed no earlier than after 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 unnecessarily, as this can provoke the development of an infection, or stretch the delicate skin.

Do not use any preparations for the treatment of the postoperative zone, unless they are recommended by a doctor.

Face masks are allowed to be applied after 10 days, however, the areas of the seams and eyes must be avoided.

To avoid increased swelling, as well as irritation and redness of the skin, cosmetic products are allowed to 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, it is allowed to carry out lifting procedures, Botox or Dysport.

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

Exercises after an eyelid lift help the skin recover faster, get rid of hematomas, remove excess fluid, prevent the development of 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 up, looking up at the ceiling. They blink intensively for half a minute, after which they lower their head.
• They close their eyes, count to three and open them sharply, looking into the distance (for example, out the window). Then they close their eyes again. Repeat five times.
• They cover their eyes, apply clean index fingers to the eyelids (without excessive pressure). Slowly open your eyes without removing your fingers. Repeat 5-6 times.
• Reject the neck backwards, without removing the gaze from the tip of the nose. After 5 seconds, the neck is returned to its previous position, looking straight ahead.
• They cover their eyes, 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 why is it needed?

Grinding after an eyelid lift improves the condition of the skin on the face, smoothes scar tissue. The procedure is prescribed approximately 30-60 days after the operation, when the sutures have already tightened and the tissues have recovered. Resurfacing itself is the effect of laser radiation on the skin previously treated with an anesthetic for a couple of minutes. Laser heating of the deep layers of the skin activates the proliferation of collagen and elastin cells, due to which rejuvenation is stimulated. The scars become smooth and almost invisible.

• How to smear eyelids after blepharoplasty?

To speed up regeneration, the doctor may advise the treatment of damaged tissues with any preparations - for example, 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 area of \u200b\u200bthe seams:

• Contractubex is a gel drug that inhibits connective tissue growth in the incision area. What does it give? Under the influence of the drug, the scar becomes almost invisible. Contractubex is used only after the removal of sutures.
• 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 the treatment must be coordinated with the 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 drugs, including external action, can be used only on the recommendation of a specialist.

• When can eyelid tattoo be done after blepharoplasty?

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

Reviews

Eyelid lift - with or without tissue removal - is a fairly popular plastic surgery practiced in many clinics and medical surgical centers. However, you should not make a decision on the need for blepharoplasty on your own: a doctor, a specialist in the field of plastic surgery, should assess the situation. It is also undesirable to apply for this service to any clinic that has come across. First you need to make sure of the "seriousness" of the medical institution and the proper qualifications of doctors.

In order for the 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 a specialist and positive feedback about him. Do not hesitate to ask other patients about the experience and reputation of this or that doctor, as well as the clinic as a whole.