Plastic and Reconstructive Surgeon

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Aesthetic eyelid surgery is performed on adults of all ages. Some people have eyelid surgery to correct problems that are a result of aging, while others have inherited traits that require eyelid surgery.

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. It is important for both you and your surgeon to understand what you expect from the operation so that a decision can be made whether this is realistic and can be achieved. You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems or diabetes are among the medical conditions that may increase the risks associated with eyelid surgery. Other important information required includes:

Previous ophthalmologic abnormalities and previous consults Eye irritants and allergies Recurrent bouts of conjunctivitis (possible eye exposure during the night, or exposure to irritants in the environment) Dry eyes (important) Use of contact lenses or if you have cataracts Facial nerve disorders Hypertension History of other diseases such as Graves disease, diabetes mellitus, glaucoma, thyroid 
disease, renal disease, cardiovascular disease and liver disease Bleeding tendencies Psychiatric disorders Previous eyelid trauma or surgery Medications taken including topical eye-drops and ointments

In some cases, it is important to have an ophthalmological consultation prior to surgery. 
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs and herbal supplements can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery.

Procedure

There are many individual factors involved and therefore not everyone will get the same results. There are also different techniques that may be selected to achieve the best result for you.The surgery is usually performed under general anaesthesia but it can be done under sedation and local anaesthetic.For the upper eyelid, an incision is made within the upper eyelid crease which extends beyond the outside corner of the eye into the laugh lines (crow’s feet). Through this incision, excess skin and fat are removed. This will rejuvenate the look of the upper eyelid. The incision is then sutured and the sutures will need to be removed after several days.
For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. There are other techniques which may be better for you and these will be discussed if they are applicable.
After the surgery you will be monitored for a few hours and possibly go home the same day. It may also be possible that you stay overnight for additional monitoring if required. Your vision will be blurry as a result of the ointments that are placed into your eyes for comfort. There may be some oozing of blood through the incisions which is expected and normal after this procedure. Cold compresses will be placed on your eyes.
Swelling and bruising of the eyes will occur a few hours after surgery and will worsen over the next 48 hours. The swelling will start improving on the third day after surgery in most cases. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first evening after surgery, you should rest quietly with your head elevated. You should apply cold compresses to your eyelids with cotton wool soaked in ice water. Do not place ice directly onto your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications.
Initially, you may feel a "tight" sensation around the eyes and some mild discomfort that can be controlled with oral medication. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. Some patients find that mild swelling persists for several weeks, while others may see swelling resolve in as little as one week. Bruising typically disappears within seven to ten days. After the first week you will be permitted to use makeup, if desired, to conceal any discoloration.
Your vision may continue to be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. Your surgeon may recommend eye drops to help relieve any burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation.
Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Exercise should be avoided for two to three weeks. Although you might feel like going back to work just a few days after surgery, your vision may still be slightly blurry which could make reading or other paperwork more difficult. You should not wear contact lenses for 10 days. You should avoid driving for a week.
Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months until they become barely visible.

Indications

Excess skin obscuring the natural fold of the upper eyelid
Loose skin hanging down from the upper eyelids, perhaps impairing vision
Puffy appearance to the upper eyelids, making the eyes look tired
Excess skin and fine wrinkles of the lower eyelids
Bags and dark circles under the eyes, often with a depression along the bony border of the lower eyelids
Droopiness of the lower eyelids, showing white below the iris (colored portion of the eye)

Aesthetic eyelid surgery can correct these problems, though other treatments may also need to be considered. For example, if the upper eyelid condition is accompanied by sagging of the eyebrows, then a brow or forehead lift may be recommended. Smoothing of crow's feet may require chemical peeling or Botox injections.

Disadvantages / Complications

Fortunately, significant complications from aesthetic eyelid surgery are infrequent. Every year, many thousands of people undergo successful eyelid surgery, experience no major problems and are pleased with the results. It is however important to realize that every surgical procedure has risks.
Some of the potential complications that may be discussed with you include:

Reactions to anaesthesia
Haematoma (accumulation of blood under the skin that may require removal)
Infection
Feeling of dryness or irritation in the eyes which may progress to dry eye syndrome that requires treatment
Possibility of a temporary decrease in sensation of the eyelid skin or impaired eyelid function that sometimes may need to be corrected by additional surgery
Loss of vision and blindness is the most dreaded complication (occurs in 0.04% of cases)
Retrobulbar haematoma (accumulation of blood behind the globe that requires removal)
Corneal injury (scratch on the eye membrane which could become opaque and obscure vision)
Diplopia (double vision can occur secondary to oedema and haematoma and is usually temporary)
Permanent strabismus can result from injury to the extraocular muscles or nerves (inferior oblique muscle is most frequently injured. It is treated conservatively until no further improvement occurs. Refractory cases can be referred for appropriate strabismus surgery)
Wound dehiscence
Epiphora (excessive tearing which usually goes away in a few weeks)
Lower lid hyperpigmentation
Hollow lower eyelids
Eyelid ptosis (inability to open upper eyelids properly and may require further surgery)
Prolonged swelling 

Ectropion (eversion of the eyelid margin)
You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your eyelid surgery.
The results of aesthetic eyelid surgery are long-lasting, but they may be affected by your hereditary and lifestyle factors.
Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure.
Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time.

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