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Lifting the lid on
upper eyelid surgery.
When people start telling you that you look tired - even when you
aren't - there's a fair chance it's your eyes. Droopy upper lids,
or bags under the eyes, are often the first signs of ageing.
Blepharoplasty (cosmetic eyelid surgery) is one of the most commonly
performed cosmetic surgery procedures and can make a striking difference
to a person's appearance when performed on the right patient.
If you ask for improvement in heavy, drooping or sagging upper eyelids,
it is crucial for your surgeon to establish if upper blepharoplasty
really is the correct procedure to fix the problem. In some patients
'heavy lids' are, in fact, due to sagging of the eyebrows. Lowered
eyebrows push the skin immediately below them into the upper eyelid
giving a heavy look. As eyelid surgery does not raise the eyebrows,
it will not correct this problem - a brow lift is needed. Of course
many patients with sagging eyebrows also have excess eyelid skin
and these patients need both a brow lift and an upper blepharoplasty
to get the best results. You can check this yourself. Look in the
mirror. If you feel your eyebrows are a little low, use your fingers
to push them up to a height you think looks desirable. This will
probably be only I - I .5cm. Look what happens to the upper eyelid.
If it appears as you wish, then you probably only need a brow lift.
If there is still sagging in the eyelid, you need a brow lift and
an upper blepharoplasty. If you think the level of your eyebrows
is just fine - and raising them makes you look surprised or unnatural
- the upper blepharoplasty alone is probably for you.
Make sure you get the risks and the benefits of the operation explained
to you. There will be a scar in the upper eyelid crease but this
tends to heal very well and is rarely a problem.
Upper blepharoplasty is normally carried out under local anesthetic
with sedation. Your cosmetic surgeon will mark out the area to be
excised and then inject local anesthetic with adrenalin. The
Adrenalin dramatically reduces the amount of bleeding by temporarily
clamping down the blood vessels. The excision can be made with a
scalpel or carbon dioxide laser. The final result will probably
be the same, but recovery times have been shown to be a day or two
quicker when laser is used. This is because it seals blood vessels
as it cuts, further reducing bleeding and bruising. From the outside
in the layers removed are: skin, muscle and fat. Because only excess
tissue is removed, the eyelids should function normally after surgery.
The skin is then sewn together, usually with quick dissolving stitches.
If non-dissolving stitches are used, they are usually removed at
about 5 days.
Immediately after the operation, you will probably have ice packs
applied to reduce swelling. You should be fit to leave about one
hour later. You will need someone with you to drive and generally
look after you for the first 24 hours. Antibiotics, painkillers
and sometimes eye drops are prescribed. Typically, there is very
little pain afterwards and it is unusual to need painkillers for
more than 24 hours. Some patients don't need painkillers at all.
You should expect some bruising and swelling in the days after surgery.
You should avoid strenuous activity and bending down for the first
week after surgery. Expect to be fit for social circulation and
back to work in a week. There will be some swelling at this stage
but it will not be too dramatic. In most patients the swelling is
gone, and the final result apparent, about six weeks after surgery.
Who should perform it?
The answer is simple: someone experienced in upper blepharoplasty.
Choose a doctor who has performed this procedure many times before
and with high quality results. Ask how many times he or she has
done this procedure and ask to see photographs of the doctor's results.
If possible, speak to previous patients.
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