The eyes are perhaps our most important facial feature. They are our source of vision, but not only that - ‘the eyes are the mirror of the soul' and have the ability to show our feelings, and emotions, and to greatly influence overall facial expressions. One's eyes and surrounding tissues can also be regarded by the lay person as a barometer of the health of the individual. This is one operation that results in one's friends and relatives remarking ‘Don't you look well - have you had a holiday?'.
Unfortunately, the eye area often shows the earliest signs of ageing. The upper and lower eyelids may develop ‘bags', folds or wrinkles that can add years to one's appearance. There may be swelling and puffiness especially in the morning that gradually becomes more permanent, and there is often a lowering of the brow line. However, these problems are not just age-related, they can be hereditary in origin, when they usually appear in the twenty to thirty age group, or can be due to allergy or some systemic disorder that can then lead to earlier ageing. Aesthetically, these conditions might be visually unattractive and create an unnecessary or premature impression of ageing. The upper lid can also sag sufficiently to actually impair vision.
The treatment is usually for the middle-aged and over but in general the earlier the condition is treated, the better as this slows further deterioration with successful results. Other ageing signs will occur in time, but the ‘bags' are unlikely to return.
Blepharoplasty is a surgical operation designed to remove the excess fatty tissue, muscle and loose skin, and to create a more youthful, wide-eyed look. The upper eyelid lift is performed in cases where the patient requires to lose the excess tissue above the eye that has developed over the years, or merely to lift the eyelid to give the eye a more attractive shape. This problem can also be treated sometimes by elevation of the eyebrows. The eyebrow may be lifted on its own, or it may be done as part of an overall facelift operation. The lower eye operation is obviously used in cases of eyebag removal. All types of wrinkles around the eyes will be lessened by blepharoplasty, but not totally eradicated - a chemical peel may help further with wrinkles. In summary, blepharoplasty is primarily a treatment to remove excess skin and fatty tissue. The operation is usually performed under twilight anaesthesia. General anaesthesia can be used if preferred and/or if necessary. The procedure itself takes an hour or more for either upper or lower eyes depending on the individual case. If a general anaesthetic is used, a one night stay in hospital will be required. If it is undertaken with local anaesthesia, a day stay in the clinic will be sufficient. Between four to seven days post-operatively the stitches will be removed. There may be some discomfort, and some swelling, tenderness and bruising of the eye area must be expected, but this is only temporary. Patients usually return to work after one week, as make-up is allowed after the stitches have been removed and most of the swelling has subsided. Dark glasses are allowed immediately so one can proceed with one's normal routine as soon as possible. Post-operative care instructions are given by the surgeon and these must be carefully followed to ensure best results. The position of the incisions for this procedure vary, and this point should be discussed with the surgeon, but they are inconspicuous in location, usually in a natural crease line of the upper eyelid, or just below the lash line for the lower lid, and sometimes in mild cases from inside the eyelid (transconjunctival). Extremely fine sutures are used, so usually post-operative incision marks become virtually undetectable after a short period of time. Occasionally prolonged post-operative pigmentation might occur. Vision is not affected by this operation, as it is only the tissues that surround the eyes that are involved. There is a slight risk, although rare, of downward displacement of the lower eyelid (ectropian) as a result of skin tension, but this can usually be corrected by ‘squeeze' exercises, involving repeated tight closure of the eyelids. Occasionally, this displacement may be significant enough to require a second operation despite the best possible surgical techniques, particularly in advanced cases with poor muscle tone. Other problems that may arise are those associated with any surgical procedure - infection, scarring, prolonged swelling, etc., which you should always enquire about during a consultation with your surgeon, together with other questions or concerns you might have. These, however, are unlikely to occur, are not hazardous, and are easily treated by routine methods. The ultimate result would unlikely be effected. Finally, both the upper and lower lids can be corrected at the same time or treated separately, and if required combined with a full face lift. This treatment is suitable for both men and women. Women are particularly prone to the problem. In either case, results can be extremely effective and dramatically reduce the impression of ageing.