DR. FILIPPOS PAPATHEODORAKIS
AESTHETIC PLASTIC SURGERY
If the eyes are the windows to the soul, then the eyelids are the curtains, and when they’re sagging, puffy or unduly wrinkled, it can have a significant effect on how others perceive you. Eyelid surgery is ideal for rejuvenating the smile and refreshing the entire upper face. The procedure can also help improve vision for those whose eyelids are drooping below the pupil.
Eyes are a very important facial feature. They reflect our mood, they express our feelings. As we age though, quite often their look doesn't correlate with what we actually feel. Patients that come in office seeking for improvement on how their eyes look often describe themselves as looking tired even when they are not. A lot of them also feel the upper eyelids heavy, as if they negative effect their vision. Eyelid bags on the other hand are common even at a younger age.
Patients can not be fitted in just one category and individual characteristics play an important role on choosing what to do, how to make things better. That's why pictures and discussion are crucial.
Transconjuctival Approach Classic Approach
suitable for younger patients treats skin laxity
no external incision hidden skin incisions
shorter recovery needs 7-10 days
On younger patients the main problem is the lower eyelid bags. Patients usually mention that someone relative also has the problem too. The operation of choice is trans conjunctival approach. The approach for these eyelid bags is an incision through the conjunctiva without any external visible mark. The recovery is quick, it usually followed by some bruising. The skin on these patients is of good quality so in the next few weeks it shrinks and there is no need for further intervention. Occasionally a minor laser resurfacing may be necessary a couple of months later. The anesthesia of choice is general and the procedure lasts about 30 min.
On older patients we need to make an external incision that will remove the extra skin. A manipulation of the lateral canthus is also a part of the surgery to make the eyelid tighter. The recovery is a bit more prolonged as bruising and swelling are more of an issue.
As far as the upper eyelid is concerned we focus on excising a minimal amount of skin and muscle. This along with the removal of the fat located close to the nose are enough to reshape the eyelid. Patients sometimes ask for an upper eyelid vlepharoplasty in order to fix the lowering of their brow as they age. Unfortunately vlepharoplasty will only modestly improve this problem. Use of botulinum toxin or proper brow surgery can give a better result on these patients.
Although the worse complication of vlepharoplasty is considered to be blindness this is sporadically reported. When patients are well informed and have good communication with their surgeon this will never happen. Excessive swelling combined with pain in the first 6 hours post operative is a cause of alert. Minor ectropion or chymosis can present after the operation but rarely they need anything else than medication and some physiotherapy.
As in every operation realistic expectations and a good surgical plan are necessary in order to get the best result. Careful planning for adequate recovery is fundamental.