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Cosmetic Eye Surgery
Your eyes are
often the first thing people notice about your face and are an important aspect
of facial attractiveness. The eyelids protect one's eyes in addition to
adding to their cosmetic appearance.
Unfortunately, over time your upper and/or lower
eyelids may become "droopy" or "baggy" because the eyelid
skin stretches, muscles weaken, and fat pockets bulge and become more prominent
around the eyes. This most commonly occurs because of the aging process
but also may be a hereditary condition that runs in your family. Your
eyebrows also may sag or droop as part of this same process.
Aesthetically, such
conditions may detract from the overall attractiveness of one's eyes and cause a
"tired" or older appearance. When severe, these conditions also
may cause functional problems, such as impaired field of vision (baggy upper
eyelids) or difficulty wearing glasses (baggy lower eyelids).
Eyelid surgery to improve the appearance of the eyelids is termed "blepharoplasty."
Blepharoplasty surgery is usually an out-patient procedure performed under local
anesthesia, with sedation if desired.
The goal of this eyelid
surgery is to reduce the "baggy" or sagging tissues, which may include
skin, muscle, and fat pockets. In upper eyelid surgery, typically all
three types of tissue are removed. In lower eyelid surgery, sometimes only the
fat pockets need to be removed, or the skin and muscle also may need to be
included.
During surgery, incisions are made in the natural folds of the eyelid (in the
crease of your upper eyelid and just below the lashes in your lower eyelid) so
that they are virtually unnoticeable after the tissues have healed. After
the excess tissue is removed, the incisions are closed with fine sutures.
If only fatty tissue needs to the removed from the
lower eyelids and not any skin, the surgery can be performed behind the eyelid.
This is known as "transconjunctival blepharoplasty."
In cases where the eyebrows are also droopy, a
procedure to elevate the eyebrows may be appropriate. This procedure,
known as a brown or forehead lift, may be done directly above the eyebrows,
within the forehead creases, or by approaching the bows from the hairline or
just behind the hairline as a "coronal brow lift."
Following surgery, cold
compresses are applied to the eyelids to reduce swelling and bruising.
These are later followed by warm compresses to improve blood flow to the area
and aid in the healing. The eyes do not need to be patched shut.
During the first week, antibiotic ointment is applied to the eyelids, and
strenuous activity should be minimized.
Discomfort is usually minimal after surgery. Aspirin
products and "blood thinners" should be avoided before and after
surgery because of their tendency to increase bruising.
After surgery, one may temporarily experience minor
discomfort, tightness of the eyelids, swelling, bruising, and dryness of the
eyes. These will usually resolve as the wounds heal. Excessive pain,
bleeding, infection, or loss of vision in the period following surgery are very
rare. In the unlikely event that such a problem should occur, you should
notify your physician promptly.
Complications that may occur include slight asymmetry
in eyelid appearance or eyelid position.These problems occur infrequently
and may require additional surgery to correct.
Blepharoplasty
surgery can provide both cosmetic and functional improvement with minimal risk
of serious problems. Most patients are quite please with the results of
their eyelid surgery.
Cosmetic eyelid surgery is commonly performed by ophthalmic plastic and
reconstructive surgeons who specialize in diseases and conditions affecting the
eyelids, the lacrimal (tear) system, the orbit (bone cavity around the eye), and
adjacent facial structures.
Fellowship in the American Society of Ophthalmic
Plastic and Reconstructive Surgery (ASOPRS) indicates that the surgeon has
special training and expertise in this subspecialty and that he or she is board
certified by the American Board of Ophthalmology or its equivalent.
See page for Dr. Gil Epstein
CO2 Laser is an exciting development
in eyelid plastic and reconstructive surgery. The CO2 Laser is being utilized
for incisional purposes as well as for resurfacing to reduce wrinkles. When
using the CO2 Laser for incisional work, precise cutting can be done with the
added benefit of eliminating bleeding. This reduces surgical time and patients
heal quicker with less swelling and discoloration (black and blue).
The CO2 Laser is also utilized to reduce wrinkles with the aid of computers. The
Laser is programed to precisely vaporize the outermost skin layers and limit the
heat damage to the deeper skin layers. Fresh skin then regenerates. The Laser
does this by emitting short bursts of light energy.
The Erbium/YAG Laser is also utilized for skin resurfacing. This laser has a
shallower depth of penetration and there is less thermal damage because of
better water absorption. The Erbium Laser is better suited for those who have
fine wrinkles, neck resurfacing and patients with darker skintones.
Good candidates for Laser Resurfacing have light to medium colored skin. The
Erbium Laser can be used for patients with darker complexions. Other factors
include history of keloid formation, use of Accutane and those who tend to
develop pigmented scars.
The main indication for Laser Resurfacing is to treat eyelid and facial Rhytids
(wrinkles). Deep rhytids particularly arising from muscle activity are less
effectively eliminated. Other indications for Laser resurfacing include scars
from acne, trauma or for removal of certain lesions (syringoma, actinic
keratosis). It should be noted that the CO2 or Erbium Laser does not effect age
spots, tattoos or hair removal.
Laser resurfacing can be done in conjunction with Blepharoplasty as well as
Ptosis (drooped eyelid) surgery. Usually the procedure is done with local
anesthesia, although IV sedation can be supplemented by the anesthesiologist.
The procedure is performed in a fully accredited ambulatory surgical center with
the utmost concern and safety for our patients.
A comprehensive evaluation in our
office must be done initially to fully evaluate the patient. Evaluation of the
person for Laser Resurfacing determines what type of Laser and which areas can
be treated. A comprehensive history and a customized evaluation will be done on
the initial consultation. Once a candidate for Laser Resurfacing is established,
then preoperative skin preparation (Retin-A, Renova) may be utilized. An
antiviral such as Acyclovir (Zovirax, Famvir) is orally taken a few days prior
to surgery.
Following Laser Resurfacing, it is
important to keep the treated areas clean to prevent infection. Lots of skin
lubrication with Vaseline, CU3, and topical antibiotics are employed. Oral
antibiotics may also be included as well as a short course continuation of oral
antiviral agents. Analgesics and sedatives may be needed the first 48-72 hours.
The skin will initially go through a swollen, exudative phase with crusting
occurring. Vinegar soaks may be utilized to keep the crusts soft. This usually
lasts 7-10 days with CO2 laser and less with Erbium Laser treated skin (4-6
days). After the initial exudative phase, the skin is red but gradually returns
to normal color. This is dependent on the area of skin treated, the amount and
depth of treatment and the type of Laser. It is important to avoid prolonged sun
exposure and to use sunscreens post-laser resurfacing. CO2 Laser redness lasts
1-4 months compared to 2 weeks to 2 months with Erbium Laser.
The patient can shower and bathe at any point in time postoperatively. It is
advisable to use a lot of ice compresses for the first 48-72 hours. Makeup is
allowed when the exudative phase passes. Usually a green concealer is good for
covering the post laser redness.
Hyperpigmentation occurs
occasionally and can be managed with creams containing Hydroquinone or fruit
extracts. Hypopigmentation rarely occurs. Scarring is rarely seen and is related
to the depth of treatment. Skin infection is treated prophylactically with
topical and oral steroids. Herpes Simplex (cold sores, fever blisters) is
mitigated with the antivirals previously described.
If you wish a free consultation, please contact our office at 954-741-5555
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