Blepharoplasty, which is sometimes also referred to as eyelid tightening, is one of the more frequent procedures in cosmetic surgery. Aging around the eyes begins relatively early and – like other manifestations of facial aging – is unlikely to be missed as we all look into mirrors on a daily basis.The early signs of aging around the eyes manifest themselves at roughly the same age in dark skinned people in the Caribbean as in light skinned Caucasians in our experience. Eyelid skin is the thinnest of all regions of the body. This is no different in East Indians and Afro-Caribbeans, whose skin in the remainder of the face tends to be thicker and more elastic thus providing a certain protective effect against early aging of the facial skin. Also, aging in the eyelids is more than skin deep. In the course of facial aging the muscles around the eyelid, the membrane holding the fat around the eyeballs back inside the eye sockets and the suspension of the eyelids and eyebrows to the bones of the eye socket all become lax. The characteristic aged appearance of the eyelids ensues – fat protrusion and under eye bags, lengthening of the eyelids, excess skin, wrinkling, visible troughs at the junction between eyelid and cheek.
In most occidental societies it is customary to keep eye contact during conversations. Thus, the eyes tend to be in the focus of perception of ourselves and others. During consultations clients often give as a chief complaint that they appear tired even when they feel fresh and rested. This perceived discrepancy between inner emotional state and outer appearance may be one of the best motivators for cosmetic surgery and usually results in very satisfied clients.
Were it not for this discrepancy there would be no reason to pay for consultations and operations by plastic surgeons. A different issue is a discrepancy between an individual’s desire and the degree his or her environment is willing to respond to it. Such external motivators should not be used to make a decision to undergo cosmetic surgery. Marriages are not saved by insertion of breast implants, choices in life cannot be undone by liposuction and professional advancement is usually not obtained by rejuvenating the eyelids with blepharoplasty. Exceptions may prove he rule.
But let us return to those clients who fall into the first category and are not driven by external motivators. For those clients blepharoplasty is the procedure with the most favorable effort to reward ratio. In relation to the financial resources, recovery time and operative risk invested (all relatively low), blepharoplasty offers the maximum subjective and objective improvements (all relatively high) and thus the greatest measurable value of all facial rejuvenation procedures. A relatively small (measured in millimeters) removal of skin and redistribution of fat results in a relatively large improvement of appearance, perceived subjectively as well as by the environment.
For the surgeon lower blepharoplasty is one of the more difficult procedures in cosmetic surgery due to the risk of an unfavorable lid position, while upper blepharoplasty probably comes as close to the notion of a picnic as there is in cosmetic surgery. However, for the patient neither of the procedure is particularly straining, provided the aforementioned complication of lid malposition is avoided. Postoperative pain is almost always very minor, but there will be a moderate degree of swelling and bruising in the lower eyelids. Thus clients usually feel quite well after the procedure, but don’t yet look that way. Bruising and swelling around the eyes tend to last longer than in other areas of the face as edema fluid and blood only slowly leave the relatively loose and soft tissue.
Thus recovery after any blepharoplasty is more social recovery than medical recovery. Clients feel well, but do not want others to notice they had cosmetic surgery. Thus the majority of patients wait anywhere between seven to ten days before resuming their professional and social obligations, which is about the time it takes for swelling and bruising to resolve noticeably. Also, by that time make up can be applied again, which then is very helpful to camouflage small remaining bruises. We made it a habit to offer clients (male as well as female) at this point the services of a professional make up artist or aesthetician to assist with the camouflage if needed.
All cosmetic procedures are to some degree influenced by what is done before and after the surgery. This is particularly true for blepharoplasty. All medications, herbal supplements and over the counter drugs with any influence on the blood’s capability to coagulate have to be discontinued at least two weeks prior to the procedure and must not be resumed until anywhere of five days after the procedure. Head elevation (also during sleep) and cooling the periorbital area are the biggest favors the client can do to him or herself after the procedure to hasten the resolution of swelling. Administration of steroids for this purpose at the conclusion of the blepharoplasty procedure has a scientifically doubtful risk to benefit ratio and has largely been abandoned with the exception of the once in a year case of intractable vomiting after general anesthesia. Nicotine, coffee and activities resulting in increased blood pressure are to be avoided for a week after the procedure at least.
In blepharoplasty the surgical incisions are almost always closed with so called non resorbable sutures. These have to be taken out after five days at the latest, which is no fun, neither for the client nor surgeon. This is the tradeoff for decreasing the risk of milia and suture tracts associated with resorbable sutures. The removal process can be aided by applying a thin layer of any opthalmic ointment, e. g. bacitracin, to the suture lines two to three times per day, which prevents crusting of the sutures.
After ten to fourteen days the clients regain an unoperated look and three to four weeks after the procedure they begin to enjoy the full benefits of the procedure in terms of a youthful, refreshed appearance around the eyes. By this time the fine scars from the incision have faded and blend into the surrounding skin in all ethnicities. It can only be guessed that the youthful look was obtained with some help.
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