Blepharoplasty (eyelid surgery)
«Eyes are the window to the soul.» Despite the well—established cliché, this proverb has an important meaning for a cosmetic surgeon. Eyes play an important role in both verbal and non-verbal communication; they convey the full range of human emotions. In light of this, many patients wish to improve the appearance of their eyes or, more specifically, the eyelids. There are a number of motivations that lead patients to seek rejuvenation of their eyelids. One of the most common reasons for correction is a tired, “age—related,” or sad look. This explains the growing popularity of blepharoplasty in Yerevan, Armenia.
By measuring the length of the eyelid in people from 20 to 90 years old, Fezza and colleagues have shown that with age there is a steady linear increase in eyelid laxity when measured from the edge of the eyelid to the orbit. The most significant changes were observed in patients around the age of forty.
Bone loss contributes to a general loss of volume in the periorbital regions and loss of recession of the orbital margin.
The septum weakens, the circular muscle of the eye atrophies, and the skin loses elasticity and allows orbital fat to prolapse anteriorly beneath the eyelid skin.
There is also evidence that the eyeball shifts downward due to loss of support and puts pressure on the orbital fat and septum. It is shown that the lower intraorbital fat is actually a continuous fat mass, which is visualized as three distinct compartments.
Lower blepharoplasty in Yerevan, Armenia, involves a complex set of rejuvenation maneuvers. As a result of age-related changes, the forehead droops, and the distance from the eyebrows to the edge of the eyelid decreases, which causes the eyes narrow and present a tired and angry appearance.
Blepharoplasty is one of the most frequently performed aesthetic procedures. There are more than 145,000 procedures performed in the United States in a single year.
As a rule, lower blepharoplasty in Yerevan, Armenia, is performed through an external incision. To prevent postoperative malposition, preventive concomitant operations are performed on the medial canthus — canthopexy or canthoplasty.
To prevent drooping of the lower eyelid, transconjunctival incisions are often utilized.
In addition, additional surgical procedures such as lipofilling and fat transposition have become widely adopted in plastic surgery.
Numerous methods have been developed and described to maximize the aesthetic result and reduce complications. To this end, surgeons continue to discuss access incisions, orbital fat manipulation, lateral canthus, and other related procedures.
The durability of the effect of lower blepharoplasty in Yerevan, Armenia, is related to the complexity of the primary problem, the quality of the tissues, the skill of the surgeon, and the patient’s healing response.
The most common complication is retraction or drooping of the lower eyelid- ectropion with exposure of the sclera.
Causes:
The risk reported in the literature includes chemosis, defined as swelling and/or inflammation of the conjunctiva. Chemosis is a consequence of surgical trauma.
In addition to malposition and chemosis, there is also a small risk of dry eyes — xerosis (0.24%), corneal abrasions (0.1%), infections (0.07%), and hematomas (0.06%).
Although rare, other complications may include malar festoons, hypertrophic scars, and vision changes.
Lagophthalmos is the inability to close the eyelids.
Ptosis is the drooping of the upper eyelid.
Many of these complications can be avoided with careful planning and appropriate surgical techniques.
Dry eyes should be assessed in the preoperative period and appropriate recommendations and treatment protocols provided.
To prevent the appearance of iatrogenic ptosis, delicate work with the levator muscle and tarsus is necessary. Lagophthalmos often occurs due to excessive excision of the skin of the upper eyelid, especially when combined with browlifting.
To date, there is no consensus on the optimal technique, and based on literature data, there is not enough material to assess long-term results, to assess the true timing and timing of recurrence and the need for revision procedures.
Camouflage methods are often used to improve the aesthetics of the lower eyelid: transposition of orbital fat into the area of the upper orbital rim or tear trough, lipofilling, midface lifting, etc..
At this stage, traditional lipofilling is complemented by more modern techniques, such as microlipofilling, i-PRF injections, SVF gel, or various combinations thereof.
Despite the popularity of this procedure, some surgeons have completely abandoned classical lower blepharoplasty due to its complication profile.
With proper knowledge of eyelid anatomy and the pathophysiology of aging, as well as a logical approach to surgical planning, it is possible to predictably perform transconjunctival lower blepharoplasty. This technique is preferred in cases of mild pseudoherniation of orbital fat with good tissue tone. With this method, fat can also be transferred into the tear trough.
Recommendations:
- Apply ice-soaked gauze or cold compresses to the area during the first 72 hours to minimize swelling.
- Severe pain after blepharoplasty is unusual. If it occurs, patients should be examined immediately to rule out retrobulbar hematoma.
- Keep the head elevated at or above heart level to reduce swelling.
- Apply erythromycin ophthalmic ointment twice daily during the first week.
- Use antibiotic eye drops, with or without steroids, four times a day if transconjunctival blepharoplasty was performed.
- Avoid strenuous activity for 10–14 days.
- Stitches are usually removed on days 5–7.
- Swelling can persist for up to two weeks, occasionally longer (3–6 months), and may be asymmetrical in rare cases.
