Blepharoplasty

Plastic surgery of the upper and lower eyelids, also known as blepharoplasty, are operations to remove excess skin and fat around the eyes and, if there is a need, - some parts of the orbicularis oculi muscle. The effects of treatment are long lasting and provide facial rejuvenation as well as highlighting of the eyes.

It should be noted that blepharoplasty will not eliminate wrinkles, dark coloration under the eyes, or drooping eyebrows.

Indications - situations which can lead to surgery:

1. Ptosis (a drooping eyelid).
2. Fat herniation.
3. Dermatochalasis of the eyelids (excess skin).
4. A heavily developed part of the orbicularis oculi muscle.

Before surgery.

At the consultation, or beforehand, please inform your surgeon about all medical conditions.

It is also very important to carry out the blood tests (which can be arranged by Medimel if necessary), such as:

• blood morphology and blood group,
• serum glucose,
• serum Na, K,
• blood clotting.
• Hepatitis B and C, HIV (these modify anaesthesia and surgical preparations).

After a thorough examination and surgical consultation the doctor will present possible solutions to the problem. Each patient should be examined by an ophthalmologist to exclude diseases limiting operational indications.

Surgical process.

The operation is performed under sedation and local anesthesia or under general anesthesia.The correction is based on an upper eyelid skin incision in natural skin creases above the tarsal plate, slightly towards the outer part of the eyebrow. Then excess skin is cut with the orbicularis oculi muscle and, if necessary, fatty hernia (from the central, lateral and/or medial compartments). Subsequently all visible blood vessels are closed, and the wound is sewn with a thin thread so that the scar is almost invisible.

The method used to correct lower eyelids can be chosen from several different techniques. The type of surgical technique to be used depends on the severity of the case. In the case of "bags" under the eyes without skin laxity, part of the correction can be made transconjuctivally - without skin incision.

If classic correction is made, the surgeon makes the incision below the edge of the lower lashes, undermining the skin-muscle flap to the orbital septum.

Depending on the size and shape of the bags, or the fatty hernia, fat can be transferred to another location as a filler (e.g. to redress a tear trough). Alternatively, the orbicular septum can be strengthened and shortened without cutting fat, to reduce the so-called "hollow eyes" appearance.

After this the previously measured skin-muscle flap excess is excised and, at this point we can simultaneously perform a small lift of the middle part of the face, and the wounds are closed with thin stitches.

Blepharoplasty can be further supplemented by a treatment to improve the width of the palpebral fissure of the eye, the height of the corners of the eyes, or their symmetry. This is possible thanks to the following treatments:

1. Cantopexy is a treatment for the outer corner of an eye, which aims to tension it. The ligament is reinforced in the outer eye fissure using a special stitch to the inside of the periosteum of the orbits;
2. Cantoplasty involves cutting the ligament in the outer corner of the eye, shortening it, and displaced it and stitching it to the periosteum. As a result of this operation the shape of the eye fissure is changed. With this method we can treat complications such as ectropion (eyelid eversion).

After surgery.

After surgery, you can expect a small amount of swelling and bruising. It is recommended to use cold compresses to reduce bruising and swelling to a minimum, and special droplets onto the conjunctiva to reduce the feeling of itching and/or burning eyes, as well as giving a bactericidal effect.

It is also important to massage the eyelids several times a day in order to accelerate the healing of scars. Sutures are typically removed after 5 to 7 days.

Sun exposure should be limited - without direct exposure of the face to direct sunlight for 6 months, because this could give permanent discoloration of the skin. Do not use cosmetics until after the stitches have been removed, and the wound has healed. After about 7 to 10 days, most patients can return to work.

Possible complications.

The risk of complication is very low if the procedure is performed by an experienced surgeon, as is the case at Medimel, but even so sometimes complications can occur. The most common are:

• haematoma,
• dry eye syndrome,
• keloid,
• excessive tears,
• sensitivity to light,
• blurred vision for a few days after the operation,
• infection of the tissues of the eye and eyelids,
• inability to close the eyes during sleep,
• ectropion and entropion of the eyelids,
• eversion of the lower eyelids.

If you have questions concerning complications, please contact us, and the Consultant Surgeon will be able to answer your questions.

Cantopexy is a lower eyelid correction procedure which changes the position of the outer corner of the eye, and leads to a change in the shape of the eye fissures. This treatment consists of loosening collateral ligaments in the corner of the eye, moving it upwards and stitching to the periosteum of the orbit. This operation is often a complement to the Blepharoplasty.

Cantoplasty

The aim of this treatment is to tension the outer corner of the eye and to prevent eyelid retraction from the eyeball. It consists of cutting the skin along the orbicularis muscle, releasing the lower lateral tendon from the front part of the tarsal plate. The tendon is reinforced with special stitches.

Fat transfer to the tear trough

This treatment of the tear trough with your own fat consists of two stages.

1. The first stage involves harvesting the fat. Fat is most commonly harvested from the inner thighs, inner knees or lower abdomen, as at these locations it has a non-fibrous nature and relatively small vascularity. The harvested fat tissue is subjected to fractionation.
2. Secondly, the fat is injected, and after this surgeon carefully massages it to make it evenly distributed. This procedure is performed under general anesthesia.

Immediately after surgery there is swelling around the eyes, which disappears after about 36 hours. Mild swelling may persist for several weeks, which is caused by a temporary disorder in lymph drainage. After this time, the transplanted fat tissue gradually begins to be absorbed, and this process lasts for around 6 months. Approximately 20 to 40% of the transplanted fat is absorbed. The remainder of the fat remains permanently in place giving the long-lasting effect of transplantation.The effect of this operation is a shallowing or removal of a depression between the lower eyelid and the cheek, but also lightening of the colour of the skin under the eyes.

This therapy gives a natural and long-lasting effect. Fat transfer to the tear trough is a minimally invasive procedure that does not require a long recovery time. If necessary, fat transfer can be done repeatedly, but it should be remembered that adding fat is easier than removing fat.

Warts

Warts are skin lesions that are caused by the human papilloma virus. You can very easily get these because they are widely distributed in the population and are transfered from skin to skin. In people who have warts these can appear at various locations in the body at different times (autoinnoculation).

The warts that appear on the eyelids are most often filamentous. Most warts disappear spontaneously, but if within two years of their appearance they have not faded they can be removed with cryotherapy, a scalpel or exfoliating agents. Warts do not involve any oncological risk but give an infectious outbreak.

There are several ways to remove warts. The mildest method is by use of exfoliating agent, which can be bought from a local chemist. However, this method does not always work.

Another way is to use cryotherapy. This treatment consists of freezing the skin lesions with liquid nitrogen. As a result of this treatment, the wart is destroyed by the action of extremely low temperatures. Several visits can be necessary to bring about complete removal of warts.

Curettage is another way of getting rid of warts. It is characterized by cutting the skin lesion with a curetta and then thoroughly cleansing the location. If the wart is large, sometimes it may be necessary to use a suture, which is removed after a week.

Warts can also be removed with a laser or radioscalpel. Such treatment is fast and does not require sutures. No bleeding results from these methods. They result in small scabs, which fall off after some time giving an almost invisible scar.

Xanthomata are raised lesions with a pale yellow color which occur most often on the upper and lower eyelids, in particular around the inner corner of the eye. They can reach a size of up to 7 cm, but are usually much less. They can be flat or raised, soft or semi-hard. A characteristic of xanthomata is slow growth and that they merge together. The presence of many xanthomata is defined as xanthomatosis.

In some cases, the presence of Xanthomata is a result or a symptom of congenital or acquired disorders of fat metabolism. Xanthomata can be caused by a condition of elevated cholesterol and triglycerides in the blood (hyperlipidemia). This often occur in diabetes, kidney disease, liver disease or gastrointestinal obstruction. However, most xanthomata occur in people who do not have any lipid disorders, and the cause of the appearance of them remains unknown.

Xanthomata appear most often in women between the ages of 40 and 50 years. They do not disturb the function of the eyelids and constitute a cosmetic issue. The most common way of dealing with xanthomata consists of surgical removal. For this procedure very delicate surgical threads are used and these are almost invisible to the naked eye. Small scars can be hidden in the natural folds of the eyelids. The sutures are removed relatively quickly - usually 4 to 5 days after the operation.