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Candidates: Adults
of all ages can benefit from blepharoplasty. Patients in their 20s or 30s might
improve their inherited traits that can make them look older or tired. Patients
with excess skin or puffy appearance on the upper eyelids, excess skin, bags and
dark circles on the lower eyelids.
Objectives: The eyelid procedure can be designed according to the problem.
If only the upper eyelids are affected there is no need to operate on the lower
eyelids, and vice versa. If the problem is only caused by excess fat, with no skin
excess, there is no need to remove skin. If excess skin is the problem, there might
not be necessary to remove fat. Usually, however, with a patient in their forties
of fifties, there is usually the need to correct the drooping upper eyelids and
puffy bags below the eyes by removing excess fat, skin, and muscle. Sometimes a
forehead lift is recommended if the upper eyelid condition is accompanied by sagging
of the eyebrows. A chemical peel can be necessary if there is dark pigmentation
forming circles around the eyes. Crow's feet can be treated simultaneously through
laser resurfacing.
Incisions and technique: I prefer to do blepharoplasty using a CO2 laser.
The technique will depend on the problem, the excess fat and skin in the eyelid
areas, and the position of the eyebrows. In the upper eyelid the incision is hidden
within the natural fold and extends to the outside corner of the eye. Excess skin
and fat are removed. The incision is performed with the laser and there is no bleeding.
The lower eyelid fat pockets are removed through an incision placed inside the lower
eyelid. There is no need for stitches. If there is a need to remove excess skin
and muscle another incision is hidden just below the lower lashes, easily camouflaged
by natural creases. The laser may be used to tighten the lower eyelid skin.
Length: 1 to 3 hours. Anesthesia: Usually locally with sedation or general.
In/Outpatient: Usually outpatient.
Recovery period: There is usually no pain, just temporary discomfort, swelling,
bruising, itching of eyes, tearing and sensitivity to light for a few days.
Risks: Hematoma (accumulation of blood under the skin that may require removal),
infection and reactions to anesthesia. Temporary blurred or double vision. Bleeding,
dry eyes, slight asymmetry in healing or scarring. There might be a temporary difficulty
in closing eyes completely (rarely permanent). If there is a pulling down of the
lower lids it may require further surgery. Blindness is extremely rare.
Recovery: Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses:
two weeks. Exercising about 3 weeks. Bruising and swelling may take several weeks
to disappear, but usually with makeup or dark glasses the aspect is almost normal.
Duration of Results: Several years. Sometimes permanent.
Details: Besides the normal pre-operative exams you will be asked to do an
eye test. The first evening after surgery, you should rest quietly with your head
elevated. You should apply cold compresses to your eyelids to increase comfort.
Stitches are usually removed after five to seven days.
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