Open your eyes: openly about lid operations

Eyes are the mirror of the soul, the most distinctive and expressive feature of the face. It’s not in vain that people want their eyes to sparkle and be nicely “framed”, emphasized by added lashes, colourful cosmetics, and a nicely drawn arch of the brows. However, all these means are often not enough. Especially when the eyelids droop with age and the look becomes sad and tired. 

It would be hard to find a single person who would not want to see the world through youthful eyes. Perhaps that’s why nowadays blepharoplasty or, simply speaking, eyelid plastic surgery, is so popular. Despite the fact that eyelid plastic operations are not considered complex, they should be treated more seriously.

It’s not worthwhile following hearsay or doubtful advertising. Eyelid plastic surgery is not just a simple beautification procedure, and it is not performed on anyone who wants it. The doctor decides whether this operation is advisable and possible after thoroughly examining the patient and assessing the required tests.

Giedrė Stundžaitė-Baršauskienė, a doctor of plastic and reconstructive surgery at the Medical Diagnostic and Treatment Centre answers some questions about one of the three most popular plastic operations globally and refutes the prevailing myths.

It won’t hide the wrinkles, but appearance and self-esteem will improve

The most common reason why people go for blepharoplasty is aesthetic. The typical recipients of this operation are people aged 40 and above. Over the years, drooping upper eyelids turn not just into an aesthetic problem but also start impeding the vision.

According to statistics, up to 70% of people inherit droopy lids. Due to heredity or certain anatomical features, operations are sometimes performed at a younger age too.

For doctors, it is very important that the individual who wants an eyelid operation is in good health and has realistic expectations. After resolving to have a blepharoplasty, it has to be understood that plastic surgery of the eyelids – the removal of excess skin – will not remove any dark circles under your eyes, crow’s feet or other facial wrinkles giving away your age. Before going for an operation, you should think about its specific purpose and discuss this with the surgeon.

Regardless of the eyelid operation not smoothing down the facial wrinkles, the appearance does indeed improve, hence the greater self-esteem.

In order to reach the maximum results, eyelid operations can be combined with other procedures, e.g. lifting the eyebrows, filler injections, or laser procedures.

When might the blepharoplasty be contraindicated?

As with any other procedure, blepharoplasty has several contraindications. It cannot be performed when the patient suffers from certain difficult diseases as they may become exacerbated. The family practitioner will decide if the health allows for this operation to be performed. An acute phase of an infectious disease is also a contraindication.  

An operation may not be carried out if the patient has increased ocular pressure if the infection has damaged the cornea, if the patient has myopia (short-sightedness), or recently had another eye operation.

How is the eyelid operation performed?

The eyelid operation takes 1.5 to 2 hours, provided that the upper and lower eyelids are operated on simultaneously. When only the upper eyelids are operated on, the operation lasts about 40 minutes. The duration of the procedure also depends on the condition of the eyelids before the operation.

When all four eyelids are operated on simultaneously, the plastic surgeon generally starts with the upper eyelids. The incision is usually made along the natural line of the eyelids. During the operation, the surgeon removes the excess skin, muscles and, if appropriate, lipid bodies, through the incisions made.

The operating surgeon integrates the incision of the upper lid into the natural skin fold seeking to hide it and make it practically invisible. When performing plastic surgery of the lower eyelids, the skin incision may be made several millimetres below the lash growth line of the lower lid. Provided that there is no excess skin and just the hypertrophy of the lipid bodies of the lower eyelids, a transconjunctival incision is made (through the inner side of the lower lid from the side of the conjunctiva).

After the operation, the surgeon closes the incisions using hair-thin sutures. The sutures remain in the upper and lower eyelids for approximately a week after the operation. When performing a transconjunctival incision, no sutures are required.

What anaesthetic is used for blepharoplasty operations?

Plastic surgery of the upper eyelids is performed under local anaesthetic, administered by injecting the drugs into the site of the future incision. When the upper and lower lids are to be operated on simultaneously, a general anaesthetic is recommended.

One month of restrictions following the operation

It is necessary to prepare for the operation and post-operative period in advance. Three to four hours after the operation, the patient may go home (when local anaesthetic has been provided). It is best to have next of kin accompany the patient, take them home and even stay the night close by. It is not advisable to drive on the same day, after the operation.

While the eyelids are healing, the patient has to stay at home for some time due to swelling and bruising and to reduce physical activity. After the operation, it is recommended to avoid bending the head downwards and household chores. For about a month, the patient should limit physical exercise, abstain from saunas and swimming pools, and not lift heavy objects. After the operation, the patient will have to forgo physical strain as well as alcohol and cosmetics, until the sutures have been removed.

Those wearing contact lenses will have to go without them for a week after the operation, but after seven days they can continue wearing them.  

After a month, patients can return to their usual pace of life.

It often happens that eyes become dry after the operation; however, generally, this does not last for more than two weeks. If the discomfort from dry eyes persists for more than two weeks, it is advisable to seek medical attention.

After the operation, the following should be available at home: ice cubes, sterile gauze, eye drops or artificial tears (the physician will recommend the best ones), clean towels and analgesics (also to be recommended by the doctor).

The first week is the most difficult

Following an eyelid operation, the sutures remain for no longer than one week. Generally, swelling and bruising occur. After approximately two weeks, the appearance of the eyelids becomes normal. However, it is advisable to plan at least one month for recovery.

Blepharoplasty is an operation that little traumatises, and afterwards, the human body recovers fast. This notwithstanding, the result of the operation depends on the patient as well as the doctor. The first week after the operation is the hardest. The patient has to reconcile with swollen eyelids, desensitised skin around the eyes and very likely bruises. Cold applications and ointments prescribed by the doctor help shorten the rehabilitation period.

Peace is required during the post-operative period. The patient may watch TV, use the internet or read books. Some rest at a resort is allowed and even some moderate sunbathing. The key is not to forget your sunglasses.

The edges of the wound will be taped by special plaster, Steri Strip, which must be kept on until the removal of the sutures.

Complications are rare and surmountable

As with any other surgical operation, complications are possible after an eyelid operation such as bleeding, infections or dry eyes. In rare cases, the colour of the eyelid changes, a keloid scar forms, the eyelid skin turns abnormally inwards or outwards (characteristic to lower lids only), or the eyelids may not close entirely. In such cases, corrective operations are required.

The effect can be seen after two weeks

The result of the operation can be evaluated only after the tissues damaged while operating have recovered entirely and the post-operative scar has formed, i.e. paled. It takes three to six months after an eyelid operation for the scar to pale.

It doesn’t harm the vision and may even improve it

In the course of the surgical intervention, the eyeball is not affected and generally, the operation has no effect on the vision. Quite the opposite – blepharoplasty may even improve the vision in the cases where prior to it the upper eyelids were drooping so much that they prevented normal vision and covered part of the pupil.

The length of time we enjoy the results depends on efforts to maintain them

The results of an upper eyelid operation remain for five to seven years, sometimes even longer. A lower eyelid operation rarely needs to be repeated. It is essential to understand that the eye ageing process does not stop after the operation. There are cases when after some time the eyelids start drooping on the eyelashes again. In this case, it is better to choose a forehead lift operation rather than repeat the blepharoplasty.

Eyelid plastic surgery can be repeated several times. The length of the effects of the operation depends on the patient’s lifestyle, care of the eyelid skin, age-related changes and heredity. The key is to take care of yourself, avoid sudden weight gain or weight loss, and use suitable and good-quality cosmetics.