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The eyes account for a large part of the expression of the human face;
they project an array of emotions including happiness, sorrow and
fear. Yet the eyes themselves are virtually expressionless structures.
It is the contour of the skin - the tissue, muscle, fat, hair and
lashes around the eyes - that conveys expression. Wrinkles and deep
lines as well as puffiness of the lids begin to develop with the passage
of time. Exposure to the sun and genetic predisposition can also be
contributing factors. The result can be marked changes in expression
causing a tired and/or older appearance. These physical changes can
produce anxiety and actual visual impairment. Today, several remarkable
surgical techniques, including blepharoplasty, forehead and browlift,
have been developed to eliminate many of these problems. Blepharoplasty
can correct sagging eyelids, pouches beneath the eyes and excess folds
around the eyes. This surgical procedure involves the removal of excess
skin and fat on upper and lower eyelids and is often done in conjunction
with other surgical procedures including facelift, eyebrow and fore
head lift. Brow and forehead lifts are designed to raise eyebrows
and reduce ridges and furrows on the forehead, thus creating a smoother,
more youthful appearance. As with blepharoplasty, this procedure is
frequently done in conjunction with other surgeries.
Prior to surgery, a complete medical history is taken in order to
evaluate the general health of the patient. A thorough examination
of the eyes and face is made to determine the most effective surgical
approach. The amount, distribution and type of excess skin to be removed
is carefully noted. The physician describes the anesthesia to be used,
the procedure, what results might realistically be expected, and possible
risks and complications. An examination by an ophthalmologist may
be recommended. Preoperative directions may include the elimination
of certain drugs that contain aspirin in order to minimize the possibility
of increased bleeding. Antibiotics may be prescribed for a few days
prior to surgery to prevent infection. The areas to be excised are
marked and photographs are usually taken before and after surgery
in order to evaluate the final results.
Blepharoplasty can be performed in a physician's office, an outpatient
surgical facility or a hospital, depending upon the surgeon's and
patient's preference. It can be done under general anesthesia with
the patient asleep, or under local anesthesia in which the area is
numbed and the patient remains awake. Prior to surgery, premedication
to relax the patient is administered.
The surgeon, following natural lines and creases, makes very fine
incisions from the inner to the outer edge of the eyelid. In selected
cases, incisions can be made inside the eyelid. The upper eyelid is
worked on first with the incision made in the fold of the lid. On
the lower eyelid, the incision is made directly below the eyelash
(Figure A) or in the conjunctive (the pink lining of the inner eyelid).
Excess fat and skin are then removed from the underling compartments.
The amount of fat excised is determined by the degree of protrusion
of fat when pressure is gently applied to the area. Small sutures
are used to close the incision and special ointments and dressings
may be applied. The procedure can take from one to two hours, depending
upon the extent of the surgery.
Antibiotics may be continued for several days following these eye
surgeries. Sutures are removed within a week. Some swelling and bruising
occur but subside in a few days. The physician may prescribe ice compresses
and/or eye exercises to reduce swelling and regain mobility. Women
may be allowed to use eye makeup ten days to two weeks after surgery
but are cautioned to cleanse the area thoroughly after each use. The
physician determines when normal activities can be resumed. However,
strenuous exercise must be avoided for several weeks following surgery.
After blepharoplasty, excessive drying of eyes can occur, but this
condition can be alleviated with medication. There may be sensitivity
to bright light and wind in which case the use of dark glasses is
indicated. Sensory changes such as numbness and itching may occur
during the healing process. Final evaluation may not be possible for
several months following surgery. Complications connected with brow
and forehead lift are relatively few and minor. However, there are
certain inherent risks connected with every surgical procedure which
should be thoroughly discussed with the physician. Patients can minimize
complications by carefully following directions given by the physician.
Some insurance companies will pay part or all of the costs of surgery
if it is performed as a result of visual impairment. Each insurance
carrier is different, and it is recommended that individuals check
with their own agents to determine if there is coverage.
If you would like more information about Cosmetic Surgery, please
contact our office for an appointment.
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