Tambov branch of IRTC “Eye Microsurgery”: cosmetic blepharoplasty

Ophthalmic surgeon, doctor of the highest category, spoke about the possibilities of blepharoplasty Tambov branch of IRTC “Eye Microsurgery” them. Academician S. N. Fedorov Vera Gavrilovna Kutimova.

Cosmetic blepharoplasty (eyelid surgery) is a complex of surgical procedures to eliminate age-related changes in the eyelids and the adjacent (periorbital) area, including skin, adipose tissue and circular muscle plastic surgery. The operation is purely individual, the scope of the intervention is determined with a thorough preoperative examination of the patient personally and from photographs, identifying existing facial asymmetries and taking into account the wishes and expectations of the patient so that the appearance after surgical treatment remains as harmonious as possible.

A standard incision of the skin of the upper eyelid is made along the fold of the skin at a distance of 7–9 mm from the ciliary edge of the eyelid; lower eyelid – 2–3 mm back from the ciliary edge. Often the incision is extended by 1–2 cm on the skin of the temple. In the absence of keloid scarring over time, postoperative scars become subtle or completely invisible, because located along the natural folds of the skin. On average, at least 10-12 weeks should pass before they are completely smoothed and “evened out” with the shade of the surrounding skin. Scars heal in several stages. In the first 4 weeks, postoperative scars go through the granulation phase, when new connective tissue, rich in small vessels, forms at the incision site. As a result, by the end of the first month, the incision site turns into a pink scar. In the next 1–1,5 months, the scar is organized with its transformation into a white thin line that almost does not protrude above the surface of the skin.

There are the following types of blepharoplasty, depending on the topography: plastic surgery of the upper eyelids (with blepharochalasis), plastic surgery of the lower eyelids, circular blepharoplasty (used extremely rarely), transconjunctival (the incision goes through the lower fornix, the operation is performed in young patients in the absence of excess skin).

The indication for blepharoplasty is the patient’s desire to get rid of cosmetic and aesthetic defects in the upper third of the face: bags and puffiness under the eyes, some types of wrinkles, as well as to cope with such an unpleasant disease as ptosis (drooping of the upper eyelids). With the help of blepharoplasty, it is possible to slightly raise the outer corners of the eyes, eliminate asymmetry, remove excess skin on the lower and upper eyelids.

Preoperative preparation requires a responsible approach from the patient. Initially, you will need to undergo a medical examination in order to identify possible contraindications. Also, 2 weeks before blepharoplasty, it is necessary to exclude the use of alcohol and a number of drugs that affect blood clotting, to quit smoking and sunburn. A week before the operation, hemostatic drugs are prescribed.

The choice of pain relief is determined by the anesthesiologist. Local infiltration (anesthetic injection) anesthesia is often used in combination with intravenous sedation (allowing the patient to relax physically and emotionally during the operation). In rare cases, general anesthesia is used (according to individual indications).

Contraindications to blepharoplasty are: diabetes mellitus (decompensated), thyroid diseases, cardiovascular diseases (including hypertension), kidney, liver, respiratory tract diseases, post-traumatic skin defects in the paraorbital region, diseases of the central nervous system, infectious diseases in the stage of exacerbation. Local contraindications include chronic diseases of the eyelids and conjunctiva, dry eye syndrome, increased intraocular pressure (glaucoma), and high myopia.

The duration of the operation depends on the volume of the intervention, the condition of the skin, subcutaneous fat, muscle tissue, and the patient’s blood coagulation system. The average duration of the operation is 40-60 minutes per eyelid.

As a rule, the operation is well tolerated. However, any surgical operations cause disturbance of microcirculation and lymph drainage in the area of ​​intervention. In the early postoperative period, the main consequences are swelling of the soft tissues of the eyelids, hemorrhages, and decreased skin sensitivity. The use of cold compresses and pressure bandages within 1–2 days after the operation will help prevent the formation of hematomas and speed up the time of their resorption, if any.

The duration of the effect is on average 5–7 years, but largely depends on the general state of health, individual characteristics, lifestyle, hygienic care of the eyelid skin.

Despite the seeming simplicity and safety, blepharoplasty is a serious surgical procedure with all its risks and possible consequences. According to literature data, even a successfully performed “plastic surgery” (in terms of postoperative complications) does not always guarantee a satisfactory aesthetic effect. Blepharoplasty can have consequences specific only for this type of intervention, namely: a change in the shape of the eyes (drooping or raising the outer corners, rounding of the eyes, asymmetry); eversion of the lower eyelid; “Bust” with the removal of the skin of the eyelids makes it difficult to close the eyes; change in facial expressions. In our practice, the percentage of the above complications is extremely low due to the careful individual approach and preoperative examination of each patient, the use of high-tech microsurgical surgery techniques.

The rehabilitation period after blepharoplasty is 10-12 days. It is recommended not to wear contact lenses for the first 2 weeks after surgery. Makeup can be applied no earlier than ten days later. To shorten the rehabilitation period, special physiotherapy procedures are prescribed after blepharoplasty.

In the postoperative period, you should refrain from prolonged exposure to direct sunlight and use sunglasses for the first 8-10 weeks after eyelid surgery. You should also refuse to visit the solarium during this period. It is recommended to avoid staying in the bath and sauna. Excessive exposure to solar ultraviolet radiation and high temperatures can affect the color of the scar and cause overgrowth of connective tissue, which leads to an increase in scar size and an increase in its compaction. These changes can result in a scar or keloid scar.

Blepharoplasty is an intervention on the accessory apparatus of the eye without affecting the eyeball itself. There were no cases of decreased vision in the postoperative period in our practice.