Eyelid surgery (blepharoplasty) is a surgical procedure that can dramatically improve the signs of the aging in the upper and lower eyelids. Superfluous skin and bulging fat pockets that create a tired and sad look can be changed to gain a youthful and fresher appearance. Mot most commonly performed as separate procedures, upper and lower eyelid blepharoplasty can be combined with each other or be added to a rhinoplasty or facelift.
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important facts about blepharoplasty
Advantages of upper blepharoplasty
Eyelid surgery does so much more than just ameliorating the signs of aging in the eye area. If performed correctly, eyelid surgery has the potential to change your overall facial expression in a very positive way, bring back a fresh look, and make your appearance years younger. Further advantages of this procedure are:
- Removal of excess fat and skin from the eye area
- Tightening of sagging and inelastic skin
- Removal of droopy skin that affects your field of vision
- Restoring a natural contour of the upper eyelids
- Supplement to other rejuvenation measures, such as a forehead lift or facelift
- Reduction of signs of aging, stress and fatigue
- Reduction of swelling of the lower eyelids
Your consultation before eyelid surgery
Before eyelid surgery can be performed, you first need to visit Dr. Kremer for a personal consultation in Dubai. As part of the consultation, Dr. Kremer will in detail explain to you how eyelid surgery is performed and he will ask you about your complaints, expectations and previous operations, medical history and medications. Furthermore Dr. Kremer will carefully examine your eyelids as well as the periorbital area and inquire about you health status and any risk factors, as these factors can affect surgery itself as well as surgical outcome. A demonstration of before-after photos of patients undergoing surgery will complete the consultation and will help you to get an idea of the expected improvements.
Following this, Dr. Kremer will develop a personal treatment plan and send you this plan together with a cost quotation.
Upper eyelid tightening – removal of excess skin and fat
Surgery of the upper eyelids is mainly performed in order to remove excess or drooping skin that has formed throughout the aging process. Family history, high levels of sunlight exposure as well as smoking accelerate these aging changes. In younger patients, the problem is not so much superfluous skin but more likely swelling of fatty deposits in the eye sockets or a mismatch between the size of eye sockets and the amount of orbital fat which in such a situation is being pushed forward and forming bags.
Upper blepharoplasty in Dubai can dramatically improve the appearance of your upper eyelids. It can also greatly improve puffiness next to the nasal bones and in the middle of the upper eyelids which, as I stated before, is caused by a fat being pushed forward in these areas.
What exactly is done during upper eyelid surgery?
Before anesthesia is initiated, the planned skin incisions are being marked with a skin marking pen with the patient in a sitting position in order to determine the exact amount of excess skin that is to be removed during surgery. Also, fatty deposits that need to be removed are being marked. It is essential to avoid over excess skin removal in order to gain a natural appearance as well as a normal function of the upper eyelids moisturizing and protecting the cornea. Surgical wounds are closed with fine nylon sutures thatcan be removed after about 1 week.
BEFORE AND AFTER BLEPHAROPLASTY
How does the treatment of a “sad look” work?
There is a certain percentage of patients in whom not excess skin of the upper eyelids is responsible for a diminished eye opening and thus for a “sad look”, but a congenitally overdeveloped, upper lateral edge of the orbital bone. Because this has nothing to do with ageing, this phenomenon of “sad eyes” is already evident in young adults even though many doctors are not aware of this phenomenon and thus do not diagnose it or even misdiagnose it as too much upper eyelid skin. Removal of upper eyelid skin will lead to absolutely no improvement and causes great disappointment as these wrongfully operated patients basically look the same like before. Dr. Kremer, a US-trained craniofacial surgeon, is very familiar with this issue and has since 2002 developed his so-called “Sad Eyes Procedure”.
Under general anesthesia, a skin incision is made like in a regular upper eyelid correction, then the excess bony orbital edge narrowing the eye opening is being burred down with a high-speed surgical burr and, if necessary, asymmetry to the opposite side is corrected as in most cases both sides need to be treated. Skin is very rarely and conservatively being removed as this especially in younger patients is not necessary. In the middle-age patient who suffers from this phenomenon but has abundant skin, too, skin and sometimes bulging eye socket fat is being removed as well.
The healing time is hardly longer than in a normal upper eyelid correction without bone reduction. This highly specialized procedure is to our knowledge exclusively carried out in Dubai by plastic surgeon Dr. Michael A. Kremer which is also contributed to the fact that a high-speed surgical drilling machine including saw, burr and drill is typically not included into the typical surgical instrument armamentarium of plastic surgeons, as they are mainly are engaged with operating on soft tissues, not the bony skull. Dr. Kremer as a US-trained craniofacial surgeon, however, is trained and experienced in exactly this subspecialty!
Lower eyelid lift – removal of lower eyelid bags and puffiness
While the main problem in upper eyelids usually is excess skin, the main problem with eye bags of the lower lids is excess fat. As we age, fat surrounding the eyelids tends to decrease in volume while the fat that causes eyelid bags bulges forward / outward. In addition, the connective tissue layer (“orbital septum”) that has retained this orbital fat during adolescence becomes weaker over time, allowing the fat to push forward. As we grow older, the appearance of the lower eyelids becomes increasingly uneven, so that many patients are getting interested in non-surgical (e.g., injections) and surgical enhancement options.
Removal of excess fatty tissue in the lower lid area alone is quite unspectacular and can, as explained below, be done either from the inside through the conjunctiva (“transconjunctival”) without visible scars or from the outside by a fine skin incision right below the eyelashes.
Exception: in some usually very young patients congenitally deficient midface bones are responsible for the development of bulging fat pockets. In these patients cheek augmentation with implants can be the treatment of choice. Such a special situation will be recognized by Dr. Kremer in Dubai during your initial consultation and he will then explain more about surgical treatment.
The situation is quite different in case of necessary treatment of excess skin in the lower eyelids. It is often not possible to remove enough skin so that wrinkles can be completely smoothed out as the lower lid margin due to aging changes lacks the mechanical stability to allow such a removal.
In case an unexperienced surgeon removes excess lower eyelid skin too generously, the lower eyelids will be pulled down unnaturally. This creates a very unpleasant appearance called “sclera show” phenomenon because the white conjunctiva is exposed below the iris and is no longer covered by the lower lid margin. In extreme cases, such a failed procedure can lead to a formation of a so-called “ectropion” where the lower edge of the eyelid turns outward. This complication, which inevitably leads to severe irritation of the anterior segment of the eye, pain and dehydration of the cornea, must be prevented at all costs by careful removal of lower lid skin and temporary surgical fixation of the lower eyelid with anchored sutures (“canthopexy”). It can be stated that formation of a permanent ectropion is very likely to be medical malpractice and must be surgically corrected as soon as possible. Different from this severe problem a temporary ectropion is caused by surgical swelling and temporary muscle denervation. This, however, will last only for a few days and, if eye ointments and tape is thoroughly being used, does not lead to permanent problems.
For these reasons, Dr. Kremer will assess exactly and on an individual basis if and how much skin of the lower eyelids can or should be removed.
Surgical steps of lower eyelid blepharoplasty
In the case of sole lower eyelid swelling, which is mainly caused by bulging fat, Dr. Kremer often removes the excess fat from inside the lower eyelid. Sometimes, the fat is even being surgically shifted down into the so-called “tear trough deformity” in order to achieve an improved contour of the lower lid and the transition to the cheeks.
Since the incision is performed within the lower eyelid, no sutures are required and no visible scar is left behind. In case of excess skin in the lower eyelid, Dr. Kremer will place the skin incision in an inconspicuous area just 1 or 2 mm below the eyelash line running laterally into the existing fine crow’s feet lines. Excess fat and skin are removed and the incision is closed with fine single sutures.
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What kind of anesthesia can be obtained with eyelid surgery?
Upper eyelid surgery is almost always performed under local anesthesia, except in very anxious patients. Because the patient can close his/her eyes during the surgery, general anesthesia is not necessary.
Lower lid correction must always be performed under general anesthesia because it is impossible to undergo plastic surgical corrections or even surgery from the inside of the lower eyelids with open and seeing eyes.
How is the healing process going?
Bruising and swelling are normal during the first few days after eyelid surgery. Most patients can return to work after 7 – 10 days. In order to promote proper healing, you should avoid strenuous activities during the first few weeks. If you perform additional procedures like elevation of the corner of the eyes (“canthoplasty”), your recovery time may take a little longer. Dr. Kremer will provide you with more details about your individual recovery process before surgery, after having developed your individual treatment plan.