Eyelid Aesthetic (Blepharoplasty)

What are the signs of aging in the upper eyelid?

When talking about the signs of aging on the face, it is necessary to consider the face as a whole. At the age of 30, displacement begins from the forehead and down the eyebrows. This situation is manifested by the enlargement of the upper eyelid skin. At the age of 50s, with the thinning of the muscles in the upper eyelid, both the abundance in the skin increases and the fat pads in the eye socket become prominent. This natural process begins to be apparent in some people at an earlier age depending on some characteristics taken from the family. For example, patients whose eyebrows have been in a lower position since their youth.

What are the signs of aging in the lower eyelid?

Just as signs of aging in the upper eyelid are related to aging in the forehead, signs of aging in the lower eyelid are also related to the cheeks. In the 40s, the fatty tissue in the cheek begins to shift downwards with the effect of gravity. This situation manifests itself with a rounded image under the lower eyelid and a prominent laugh line on the rim. With the thinning of the lower eyelid skin, the lines we call crow’s feet around the lower eyelid begin to form. In the 50s, with the weakening of the lower eyelid muscles, the fat pads in the eyeball become more prominent as they lose the front support.  

What should be considered before the operation?

Do not use aspirin or similar drugs for a week before the operation. Likewise, since herbal teas such as green tea and vitamin E are believed to have bloodthinning effects, it is beneficial not to take them for a week before surgery. Conditions such as high eye pressure, hypertension, thyroid diseases, and dry eye are conditions that increase the risk in eyelid aesthetic surgeries. If you have any of these chronic conditions, inform your doctor about it.

How is the upper eyelid aesthetic surgery decided?

The eyebrows are checked by physical examination of the forehead and eyebrows. After determining whether there is any asymmetry by evaluating the eyelid movements, the upper eyelids are re-evaluated after the preoperative botox is applied to the patients with minimal eyebrow level and fine lines on the forehead. If the plethora of eyelids continues, upper eyelid aesthetics is decided. If there is an obvious drop in the eyebrows, deep lines on the forehead, and significant fullness in the upper eyelid, it is decided to perform endoscopic eyebrow and temple lift procedures. During the operation, it is decided to re-evaluate the upper eyelids and perform upper eyelid aesthetics. 

How is upper eyelid aesthetic surgery performed?

The surgeon removes excess fat through an incision in the natural crease of the upper eyelid or inside the lower lid. If only upper eyelid aesthetics will be performed, the procedure can be performed under local anesthesia. The duration of upper eyelid surgery does not exceed an hour. The amount of skin and muscle to be removed is decided by drawing while the patient is sitting. Often, removal of the skin and muscle, which is done in a suitable size to cause a line to be hidden in the fold line of the lid, provides sufficient tension in the eyelid. However, in some cases, fat pads present in the inner and middle parts may be very prominent. Therefore, they are also surgically reduced, even if they are very small.

How is the lower eyelid surgery decided?

It is necessary to evaluate the aging of the lower eyelid together with the aging of the cheek. Since the cheek tissue shifts downward mostly after the age of 40, endoscopic surgery should also be used to remove the cheek tissue. After this procedure, if there is still slack in the lower eyelid skin and prominence in the lower eyelid fat pads, it is decided to perform the lower eyelid aesthetics during the surgery.

What is done in lower eyelid surgery?

The lower eyelid is removed together with the muscle of the lower eyelid skin with the incision made just below the eyelashes. The reduction of fat pads is rarely necessary. Generally, the spreading of the oil packs to the edge of the eye socket helps in correcting the collapse under the eye. If the cheek lifting and spreading of the fat pads are insufficient in removing this debris, the oil injection process is also added. After removing the skin and muscle abundance, the muscle tissue is hung on the outer wall of the orbit. This provides support to the fat pads. Since lower eyelid aesthetics is usually performed together with mid-facelift surgery, it is performed under general anesthesia. The duration of the operation varies between 2 and 4 hours depending on the additional interventions to be performed.

What should we pay attention to after the surgery?

When the process is over, the eyelids will be covered with tapes. These do not prevent you from seeing. Cold compress is applied around the eyes to control the post-procedure edema. Despite these precautions, swelling and bruising may occur around the eyes. These swelling and bruises increase in the first 2 days. It starts to decrease gradually from the 3rd day. Appling arnica cream in the early period helps the bruises to pass more quickly. Especially in the first hours after the procedure, leakage and slight bleeding may be seen on the tapes covering the eyelids. Effort, coughing, sneezing increase these complaints. While resting after the procedure, keeping the head high with a few pillows helps to reduce edema. In the first days after the procedure, there may be complaints such as tension, stinging, burning around the eyes. These complaints can be resolved with simple painkillers. Edema around the eyes begins to decrease from the third day after the procedure. On the fifth day after the procedure, tapes and stitches around the eyes are removed. A small band can be placed around the corner of the eye for another 5 days. On the same day, it is allowed to wash the eye contour and to apply moisturizer to the eyelids. While performing these procedures, care should be taken and drastic movements should be avoided. When the tapes and stitches around the eyes are removed, it is natural to have a yellowing purple area and a limited swelling. These decrease day by day and can be hidden with light makeup. After the procedure, heavy sports, applications that increase edema such as solarium, sauna, sun bath and steam bath should be avoided for 6 weeks. In the first weeks after the procedure, it is extremely common to have swollen eyes when waking up in the morning. This swelling gradually decreases during the day. In the first weeks, due to wind and sun exposure, eye strain, stinging and watering may occur. Sunglasses can be used to prevent this situation.

Will there be any scars after eyelid surgery?

In the upper eyelid fold, lower eyelid, under the eyelashes, a thin pink line may be noticeable in the first weeks. In the corner of the eye, this situation may continue for a longer time in some cases. Since the eyelid skin is very thin, it is very difficult to distinguish the scar that will occur on the skin after 1 year. In cases where the outer edge of the eye needs to be hung with a muscle sling, the eyes may be slanted, especially in the first week. This situation decreases with each passing day. 

What are the risks of eyelid surgery?

• Although rare, bleeding problems may be encountered during or after eyelid surgery. If bleeding occurs after the operation, emergency drainage treatment may be required. Aspirin or anti-inflammatory drugs should be stopped ten days before the operation because they increase the risk of bleeding. Hypertension that is not under medical control can also cause bleeding during or after the operation. Bleeding under the eyelids may delay healing and cause scarring.
• Infection is usually not expected after this surgery. In rare cases, if the infection develops, the problem can be solved with appropriate antibiotic treatment.
• Blindness is extremely unlikely after blepharoplasty. However, intraocular bleeding during or after surgery may cause this. With early diagnosis and drainage, this problem can be overcome.
• The most feared and relatively common complication is Ectropion - a condition in which your eyelid turns outward. This possibility increases in patients who have had a second surgery since previous eyelid surgery (blepharoplasty) can cause ectropion, particularly if a considerable amount of skin was removed from the eyelid at the time of surgery. In order to treat it, it may be necessary to take the skin from the upper eyelid.
• There may be changes in the appearance of the eyelid as a result of aging, sun exposure and some other conditions. Blepharoplasty surgery does not stop aging, nor does it continuously provide tension in the eyelid area. New surgeries and treatments may be required in the future to preserve the results of blepharoplasty surgery.