EYELIDS REJUVENATION SURGERY .

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BLEPHAROPLASTY THE EYELIDS REJUVENATION SURGERY


DEFINITION, AIMS AND PRINCIPLES

‘Blepharoplasties’ means aesthetic surgical procedures of the eyelids aiming to correct unsightly aspects, whether due to heredity or age. They can be performed on the upper or lower eyelids alone, or all four at the same time.

This technique may be carried out alone or in association with other cosmetic facial surgery (brow-lift, forehead-lift, face- and neck-lift) or with techniques such as laser resurfacing, dermabrasion or chemical peels. These procedures can be carried out during the same operation or in two stages. The unsightly aspects most commonly found are the following:

• Drooping heavy upper eyelids, with a more or less marked skin-fold.
• Lower eyelids which have drooped and shrunk, leading to horizontal wrinkles due to distended skin.
• Bulging fat, responsible for ‘bags under the eyes’ at the lower eyelid level, or sagging upper eyelids.
The procedure aims to correct these problems durably by surgical removal of excess skin, fat and muscle, and/or correcting the “fat hernia’s that can be responsible for bags under the eyes, without of course a ecting the normal functions of the eyelids.and minor scars. This procedure, for both men and women, is often carried out around the age of forty. It can however be done much earlier where the problem is congenital rather than age-related, for example in the case of bags under the eyes.

BEFORE THE OPERATION

Prior to the operation a thorough examination of the eyes and eyelids will have been carried out in order to detect any anomalies which could complicate the procedure or indeed show that it is not recommended in this special c case. A specialised ophthalmologic examination will often be prescribed to rule out any ocular pathology.
A preoperative check up will be carried out as prescribed.
An anesthesiologist will see you in consultation at the latest 48 hours before the operation.
No aspirin-based medication should be taken during the 10 days preceding the operation.
For certain types of anesthesia you may be required to fast (neither eat nor drink) for six hours before the operation.

HOSPITAL STAY AND TYPE OF ANESTHESIA

Type of anaesthesia :

Three possibilities exist :
• Local anesthesia alone, in this case the eyelids are numbed by an injection given locally.
• Local anesthesia with sedation given by intravenous drip (‘twilight’ anesthesia)
• Standard general anesthesia, you sleep throughout the procedure.

The type of anaesthesia will be chosen after discussion between yourself, the surgeon and the anaesthesiologist.

Hospital stay : The procedure may be carried out on an out- patient basis, in an ambulatory facility, the patient leaves on the same day after a few hours under observation. However, in some cases a short hospital stay can be preferable. The patient arrives in the morning (or sometimes the previous evening) and is discharged the following morning.

THE PROCEDURE

Each surgeon has adopted his or her own speci c technique which he or she adapts in order to obtain the best results in each case. We can however give some basic points.

Incisions :

• Upper eyelids : They are concealed in the fold situated at the mid-point of the eyelid, between the mobile and xed parts. • Lower eyelids : They are 1 to 2mm below the eyelashes, and can go slightly beyond them. PICTURES

The line of these incisions corresponds of course to the position of the scars, which will therefore be hidden in folds of skin. Note : For the lower eyelids, in the case of isolated “bags” (without excess skin to be removed), a blepharoplasty can be carried out by the transconjunctival approach, that is by using incisions placed inside the eyelids, thus leaving no visible scar.

Resection :

Once the incision made, unsightly excess fat is removed, as are redundant muscle and sagging skin. At this stage, numerous appropriate adjustments can be made in order to tailor the procedure to the speci c needs of the patient.

Sutures :
< Stitches are made using very ne nonabsorbable thread (they are removed a few days after the procedure).
The operation can take between 30 minutes and 2 hours depending on the speci c requirements and complexity of the case.


AFTER THE OPERATION
There is no actual pain, but possibly some discomfort with a sensation of tension in the eyelids, slight irritation of the eyes and perhaps some blurring of vision. During the rst few days rest is advised, with no physical strain, no lifting heavy weights for example.
During the recovery period there will be edema (swelling), and bruising, to a variable degree for each individual patient.
For the rst few days it may be impossible to close the eyes completely, a slight detachment of the external angle of the eye may also be observed, but in both cases these signs are rapidly reversible.
The sutures will be removed between the 3rd and 6th day after surgery.
Visible signs of the operation will diminish little by little, a return to normal social and professional activities will be possible after 6 to 20 days.
The scars may remain as pinkish lines for the rst few weeks, but can be hidden by makeup from the 7th day onward.
Slight hardening of the detached zones may persist for a few months, but is not perceptible to others.


THE RESULT
The nal aspect will not be visible before 3 to 6 months. This is the time lapse necessary for the tissues to regain their softness and for the scars to heal and practically disappear. The results of this procedure are usually among the most durable found in aesthetic surgery. Once the fatty pads removed or repositioned they do not in general return, so this is a perma- nent e ect. On the other hand skin does continue to age and the excess folds of the eyelids can, over time, recur. However a second operation is rarely envisaged within twelve years.
DISAPPOINTING RESULTS
These can result from a misunderstanding concerning what can reasonably be achieved. For example lowering of the forehead and eyebrows can only be corrected by a forehead- and brow-lift. They can also be due to unexpected tissue reaction or unusual scarring phenomena.
Very ne lines may persist, the eyes may appear slightly too ‘hollow’ (the bony outline of the eye-socket being visible). Other imperfect results could be a slight downward retrac- tion of the lower eyelids, slight asymmetry, or ‘whitish’ scars.
These imperfections can be remedied by corrective surgery if necessary, usually under local anesthesia from the 6th month following surgery. In general the procedure will have corrected redundant skin folds and removed fatty pads thus rectifying the old, tired look.
POSSIBLE COMPLICATIONS
A blepharoplasty, although essentially an aesthetic procedure, is nevertheless an operation, and this implies that the risks inherent to any surgery apply here. We must distinguish here between risks related to the anes- thesia and those related to the surgery. For the anesthesia, the risks will be explained by the anes- thesiologist during the preoperative consultation. You must be aware that anesthesia can cause unpredictable reactions, which can be di cult to control : the presence of an expe- rienced anesthesiologist, in a surgical context, means that the risks are statistically practically negligible. In fact techniques, products and monitoring methods have progressed considerably over the last twenty years, giving optimal safety, especially when the operation is not an emer- gency and the patient is in good general health. Concerning surgery : by choosing a competent, quali ed Plastic Surgeon, used to performing this procedure, you limit the risks, without however eliminating them completely. Fortunately, real complications are rare following a blepharo- plasty which has been carried out correctly. In fact practically all the operations go well and patients are completely satis ed with the result. In spite of the fact that complications are so rare you must be aware of the following possible problems : • Hematomas : not usually serious, they can be drained if necessary. • Infections : extremely rare for this procedure, micro-abscesses can develop on stitches but are easily treated. Conjunctivitis will be prevented by routine prescription of eye-drops for the rst few days after the procedure. • Abnormal scarring : this is very rare for the eyelids where the skin usually heals leaving almost no trace of surgery, the scars can however sometimes be more pronounced than hoped. • Epidermal cysts : they can appear along the scars, but often clear spontaneously, if not they can easily be removed and do not a ect the nal result. • Lacrymal problems : excessive tear production is a rarer problem than ‘dry eye syndrome’ which can decompensate a pre-existing lack of tear production. • Ptosis : (Drooping of the upper eyelid) : this is very rare except in the over 70’s where a pre-existing problem can be made worse by the operation. • Lagophthalmos : (inability to close the upper eyelid com- pletely) : this can occur for the rst few days after surgery but should not persist after a few weeks. • Ectropion : (lower eyelid retraction) : the severe form is extremely rare following this procedure when it is carried out correctly. The minor form can occur when lax tissue is a ected by excessive scar retraction; it usually recedes after several weeks of regular massage which improves the tonus of the eyelids. • Finally, extremely rare cases of diplopia (double vision), glaucoma, and even blindness following blepharoplasty have been described in International Medical Journals. All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors. You can be assured that if you are operated on by a quali ed Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary. • Finally, extremely rare cases of diplopia (double vision), glaucoma, and even blindness following blepharoplasty have been described in International Medical Journals. All things considered, the risks must not be overestimated, but you must be conscious that an operation, even a minor one, always has some degree of unforeseeable unknown factors. You can be assured that if you are operated on by a quali ed Plastic Surgeon, he will have the experience and skill required to avoid these complications, or to treat them successfully if necessary. These are the facts which we wish to bring to your at- tention, to complement what you were told during the consultation. Our advice is for you to keep this document and to read it and think it over carefully after your consultation. Once you have done this you will perhaps have further queries, or require additional information. We are at your disposal should you wish to ask questions during your next consultation, or by telephone, or even on the day of the operation, when we will meet in any case, before the anaesthesia. It should be noted that other age-related problems may be present but their treatment necessitates techniques more complex than standard blepharoplasty, or requires supplementary surgery. These problems include sagging of the eyebrows, forehead wrinkles, frown lines, crow’s feet at the corners of the eyes, dark rings under the eyes, ‘hollow’ eyes, ‘sad’ eyes with down-turned corners, and also skin blemishes Cosmetic eyelid surgery, or blepharoplasty, is an operation to remove excess skin, fat and muscle from around the eyes to produce a more alert and youthful appearance.


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Gaze rejuvenation surgery : blepharoplasty by doctor Philippe Chout cosmetic surgeon
 gaze rejuvenation cosmetic surgery by dr philippe chout  eyelids rejuvenation surgery by dr philippe Chout plastic surgeon


Blepharoplasty, Eyelids rejuvenation cosmetic surgery


The procedure can be performed on the upper and lower lids, at the same time or separately. As we age, the skin around our eyes loses its elasticity. You may develop loose folds of skin on the upper eyelids and deep creases on the lower lids. At the same time, your muscles in this area may also slacken so that any fat bulges forward and looks baggy. Cosmetic eye surgery can remove the excess skin, fat, or both, from around your eyes. Sometimes you can develop baggy eyes in your 20s before your skin changes. You can inherit this trait from your family. Cosmetic eye surgery may also improve your sight if saggy skin in the upper lids hangs over the eyelashes to obstruct vision. The surgery can also remove wrinkles, but only those in the skin that is cut away in the operation. It will not remove "crow's feet" and cannot change the colour of dark shadows under the eyes. It is important to discuss with your surgeon what you are hoping to gain from the operation, and the result you can realistically expect.

Cosmetic eyelids rejuvenation surgery,is performed in order to remove fat and skin excess to the eyelids is called upper and /or lower blepharoplasty. This procdure dan be done under a twilight anaesthesia as a day case , or under general anaesthetic. The cost and price of a blepharoplasty is between 2500 euro and 6000 euro, according to Dr. Philippe Chout.

 Eyelids cosmetic surgery, eye-bags removal, eyelids lift, or double lid surgery for asian eyes westernization are blephraoplasty operations as well. the external canthopexy ( canthoplasty ) is something different : the purpose is to lift the external corner of the eyes in order to give the doe eyes. It is a Beutification operation, not a rejuvenation. For information abuout canthopexy pleae, visit Doctor Chout's Temporal Lift andt the Beauty Design surgery pages.

What are the alternatives to bleapharoplasty?
No other treatment can properly reduce a skin excess and fat bulges or hollows. In some cases, wrinkles around the eyes may be reduced using botox injections, or by a forehead, or brow, lift. For more information ask your doctor for advice or see the separate fact sheets on facial resurfacing and Facelifts. Many creams, gels and beauty treatments claim to be able to tighten the skin around the eyes. However, there is no scientific proof that they work.

What happens before cosmetic eye surgery?

You will have a consultation with your surgeon before your operation, and with your Ophtalmologist as well. He or she will ask about your general health and discuss how to prepare for your operation. Your Ophtalmologist will examine: • Your eyelids • Your vision • Your tear film (a layer of tears covering the surface of your eye) • The front of the eye • Your retina - an area on the rear wall of your eyeball • Your whole face to see the condition of your skin • The position of your eyebrows and eyelids, which will be measured and pictured • A report will be written by the Ophtalmologist for the cosmetic surgeon

The Blepharoplasty Operation

The operation lasts one to two hours, under general anaesthetic or sedation plus local less if just the upper or lower lids are being done. It can be performed as a day case, which means that you can have the operation and go home the same day. However, you may need to stay one or two nights in hospital for observation. The surgery can be carried out under general anaesthetic or a local anaesthetic, in which case the area around your eyes will be numb but you will be awake although sedated. It can also be done under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain. Your surgeon may use either conventional or laser techniques.

For surgery on the upper eyelids, cuts are made: - Into the natural lines and creases in your eyelid, ending into the laughter lines at the corner of your eye For surgery on the lower eyelids, cuts are made: - just below your eyelashes, which means the scars will run along your eye's natural folds, hiding them naturaly - and sometime inside the corner of the eyes sometimes cutting the external ligament for a canthopexy or canthoplasty which purpose is to change the eyes slant and the whole gaze, in a doe eye shape.This would be charge a higher price than a plain blepharoplasty. Excess fat, muscle and loose skin are then removed, and the cut is closed using fine stitches. These are generally removed two days to a week after surgery. If only fat is being removed, the cut can be made on the inside of the lower eyelid, leaving no visible scar. This is called a transconjunctival blepharoplasty. You should remember the difference between: - Cosmetic blepharoplasty, i.e. eyelid rejuvenating surgery, which consists in the removal of excess skin or fat from the upper or lower eyelid; - Eye expression improvement surgery (canthoplasty or canthopexy ) which consists in changing the position of the eyebrow external part, the shape of the external part of the orbital rim, the location of the eye’s external canthus, and, if necessary, in removing excess skin or fat from the upper or lower eyelid. The scope of blepharoplasty is not to change the eye expression but to make it look younger.


Lower eyelid blepharoplasty/Upper and lower blepharoplasty

This is performed under general anaesthesia or neuroleptanalgesia, and requires overnight hospitalisation, as well as all tests as described above. The resection of fat deposits and wrinkles in the lower eyelid is made either internally, with no visible scar when there is no loose ski or externally when loose skin and lines are present. In that case, there is a small nearly invisible scar along the lower eyelashes; this also permits resection of excess skin, or correction of a bulging orbicularis muscle. There are no postoperative pains but rather discomfort. Suture threads are removed on the 5th operative day. The after-effects are the same to upper blepharoplasty. On the 10th day, both postoperative oedema and ecchymoses have significantly regressed, and one can show socially after two weeks, but final results are visible only after three months. Normally, work can be resumed after a week. For a few months, there may be a slight oedema, which can be sometimes asymmetrical, and can be attenuated by massage.

After the Operation
Immediately after the operation, your eyes may be covered with gauze pads. The surgeon will apply some sterile paper tape (steristrips) to support the eyelids after surgery, which is normally removed after three to five days. An ointment or eye drops will be applied to your eye area to prevent it from drying out. You will be given painkillers to help with any discomfort as the anaesthetic wears off. If the operation has been planned as a day case, most people go home once they have made a full recovery from the anaesthetic. If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours (unless you stay at the hospital). Before you leave hospital, a nurse will give you some advice about how to care for the eye area and you will usually be given an eye ointment to use at home.

Recovering from cosmetic eye surgery
You will initially be bruised and swollen. Once you are home, you may take further painkillers if you need to. You will put the prescribed teardrops four times a day in both eyes during eight days. Follow the hospital's advice. Applying a cold compress, such as an ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an "ice burn". There are some important things to remember while recovering from cosmetic eyelid surgery.

1. Keep your head higher than your body by lying propped up on pillows, and avoid bending over for a few days. This will help to reduce swelling and bruising.
2. Clean around your eyes and use any ointment that the hospital staff gave you as they instructed.1
3. Avoid wearing eye make-up until a couple of days after the stitches have been removed, or for as long as your surgeon tells you to.1
4. Avoid wearing contact lenses for three weeks (they may still feel uncomfortable for a while after that).
5. Avoid driving until your vision has returned to normal and your eyes have stopped watering.
6. Most people are able to read or watch television within a few days. People usually feel like returning to work after a week to 10 days.
7. No alcohol at all and no smoking or smoke for t four weeks.


Deciding on having a blepharoplasty

It's important not to rush into the decision to have a cosmetic operation. And, it's sensible to discuss the issue with your GP. Cosmetic eye surgery is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side effects and the risk of complications. Side effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having cosmetic eye surgery can also expect sometimes:
• Soreness around the eyes, which can be helped by taking painkillers
• Bruising and swelling for up to a month after the operation, which might make your eyes feel tight and difficult to close when going to sleep
• Sticky, dry and itchy eyes for the first week
• Watery eyes for a few weeks
• rarely double or blurred vision for a few days usually related to the oily ointment Vaseline)like – otherwise you should contact your hospital or a GP if this lasts longer than three to four days
• Sensitivity to light for a few weeks
• Tiny white heads along the line where the stitches were - your surgeon can remove these with a very fine needle
• Pink scars for three months, but eventually they become skin colour thus almost invisible

Complications are unexpected problems that can occur during or after the procedure.
Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection, or an unexpected reaction to the anaesthetic. Specific complications of cosmetic eye surgery are uncommon but can include:
A haematoma where a pool of blood collects under the skin around the eye, which may need to be drained in a second operation if it doesn't disappear on its own or if it is large
Swelling that pulls the lower lid away from the eye, which usually settles on its own after a couple of days, but occasionally another operation will be needed. Damage to the surface of the eyeball or the surrounding muscles.are extremely rare: Keratitis, conjunctivitis, acute glaucoma, an eye condition requiring treatment by an eye specialist.
Unusually red or raised scars (called keloid scars) which some people have an inherited tendency to form sunken appearance if too much fatty tissue is removed.
A difference in appearance of the two eyes - they may not be identical due to your natural and intrinsic asymetry.
Partial or complete blindness, as reported in books, is absolutely exceptional (0.02%) .
Haemorrhage, infection, diplopia, ectropion, subcutaneous cysts.
For information mainly of people with a disease, cardiovascular, neurological, respiratory or immunoallergic complications of anaesthesia sometimes lethal or invalidating which may evolve independently.
As for all cosmetic surgery, extra costs, which may become necessary due to complications, as well as days away from work, are to be incurred by the patient. The chance of complications is low though and depends on the exact type of procedure that is being performed and other factors such as your general health. Your surgeon will be able to explain how these risks apply to you.

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(©) copyright- All Rights Reserved - Dr Philippe Chout- tous les droits sont réservés- Article L335-2 et 335-3 modifié par loi française n°2016-731 du 03/06/ 2016 - art. 44 , et Article L215-1 - LPD