One of the most popular operations in aesthetic surgery is rejuvenation of upper and lower eyelids. Majority of patients have similar complaints such as: skin folds formation, wrinkles, “eyelid bags”. However patient’s age, degree of ageing changes severity, race specific eyes shape, patient’s wish, all that eventually determines the individual approach to be used for existing problems correction.
For patients over 40 years old rejuvenation of upper and lower eyelids is usually performed in combination with other facial rejuvenation treatments (facelift, forehead lift, eyebrow lift, laser resurfacing).
Upper and lower eyelids rejuvenation
Diagnisis: Skin ageing changes of upper and lower eyelids
Surgical correction: upper and lower eyelids plastic surgery.
Recording initial conditions
Before and after patient’s image stored in computer memory.
The surgery is performed under local or general anesthesia
Pre-operative eyelids marking. Upper eyelids are marked when the patient is in supine position with eyes open. Marking of the lower margin of the drooping fold, located 9-11 mm above ciliary margin. In the course of the surgery the marked skin stripe is removed. As may be required a strip of orbicularis oculi muscle can be removed as well. Bleeding control and placement of intradermal suture is also necessary. Correction of upper eyelid skin excess can be performed in the process of endoscopic forehead and eyebrow lifting surgery. Small incisions are made in the hairy part of the head (see endoscopic forehead and eyebrow lift).
Lower eyelids subciliary incisions are performed at 2-3 cm away from the margin and extend for 5-9 mm outside the external eye corner along the middle “crow foot” (pic. 3)/
Excessive skin fat needs to be removed and relocated into the lacrimal fold. An important state of the surgery is the identification of the lower eyelid skin excess excision boundaries. Every flap is stretched with patient’s eyes opened while looking upwards. The flap excess can be excised with the muscle or without it. The wound is closed using absorbable suture while the skin is closed by intradermal suture.
In some cases when the lower eyelid external margin is weak and the external corners of the eyes declined, it is necessary to perform the external eyelid lift with its subperiosteal fixation. This manipulation is meant to prevent such postoperative complication as lower eyelid ectropion (contraction).
Different types of lower eyelid correction
There are more than 8 types of correction
Sometimes the lower eyelids fat tissue fat hernias) are removed by means of puncturing the internal eyelid surfaces (transconjunctivaly) or not removed at all. In other case the fat protrusion somewhat pressed down via superiorly transferred muscular tissue which is fixed afterwards.
This operation is meant for young patients who do not have skin excess. It is also indicated to those who plan to have laser resurfacing.
In this case the incision extends along the internal eyelid surface (pic. 3). The incision is made on the lower eyelid conjunctiva at 3 mm from the bottom of the conjunctival sac extending for 1-1,5 cm wit the following fat tissue excess removal from all lower eyelid pockets.
Sutures may not be placed.
One of the anatomical specific features that negatively affect appearance is the deepening of the lacrimal duct area. In such cases, the existing defect is filled up using the graft material harvested from patient’s temporal or periauricular fascias. This method is used in the world practice of plastic surgery for many years in order to complete individual objectives and provide excellent aesthetic results
During the first postoperative hours we monitor your health state along with the state of the postoperative wound. On the next day after the surgery, wearing glasses, you can leave home. You will return to the clinic just to change the dressing. The surtures are removed on the 4th and 5th day after the treatment. Postoperative bruising and swelling usually disappear in the course of 2 weeks. You can resume active lifestyle and go back to work 3-5 days after the surgery wearing dark glasses.
In spite of seemingly easy nature of the eyelid rejuvenation operation, it is also
important to remember about complications that may happen if the work is done by inexperienced surgeon.
Most frequent complication is ptosis of lower eyelid margin (contraction).
Operations that lead to poor aesthetic effect demonstrate hollow eyes, undisguised postoperative scarring, short-term effect, sings of wrinkles, upwards and downwards eye-ball misplacement, lower eye-lid margin contouring, not fully closed eyelids during the sleep. That is why we should not turn to the clinics with doubtful reputation.
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