All about upper eyelid blepharoplasty

The surface of the eyeball tends to be exposed to various adverse environmental factors. To eliminate this kind of contact, the conjunctiva, the mucous membrane of the eye, is included in the work. The most serious pathology that can occur in the conjunctiva, due to the formation of an inflammatory process, is considered to be chemosis - swelling of the fundus conjunctiva. Let's take a closer look at the causes of pathology, diagnostic methods, and how to treat the disease.

Characteristics of the pathology

The conjunctiva, in addition to the eyeball, also covers the eyelids from the inside. Due to this, it ensures the functioning of the eyes and supplies them with the necessary amount of lubrication. The part that covers the fundus of the eye is called bulbar. It consists of a superficial epithelial layer; and submucosal, deeper. When the inflammatory process begins, swelling forms between these two layers and fluid accumulates.

In the area of ​​the iris, the conjunctiva flows into the corneal layer, where the border of the limbus is located, at the junction of it with the underlying tissue. In this regard, when chemosis forms, the conjunctiva practically protrudes above the surface of the bottom, and a person may have problems closing the eyes.

Preparation

After receiving permission for surgery and setting a date for plastic surgery, preoperative preparation is necessary. In particular, two weeks before the appointed date you will need to give up alcohol and cigarettes. If the patient is taking hormonal or blood thinning medications, it is necessary to inform the doctor about this and stop using them at least a week before the intervention.

1-3 days before the correction date, it is recommended not to use decorative cosmetics and other skin products. On the eve of the operation, you should not take food or water for at least 8 hours before the procedure to prevent problems with anesthesia. The success of the operation and subsequently the ease with which the rehabilitation period will pass depends on proper preparation.

Chemosis of the conjunctiva after blepharoplasty, and other causes

The superficial layer of the conjunctiva can be influenced by various factors. These include:

• blepharoplasty;
• vascular pathologies;
• eye injury (foreign body, dry or dusty air, thermal or chemical burn, exposure to ultraviolet rays);
• abscess of the eyelid. It is a purulent inflammation in any part of the eyelid caused by the inflammatory process of the sebaceous glands;
• a tumor of the periorbital zone is swelling in the area of ​​the eye orbit, caused as a result of pathologies of brain diseases and eye lesions;
• allergic reaction caused by animal hair, house dust, plant pollen;
• exophthalmos, which is a forward or sideward displacement of the eyeball, can cause serious systemic or ocular pathologies;
• conjunctivitis, infection in the conjunctiva of the eye, may be fungal, viral or bacterial in nature;
• meibomitis, the appearance of an abscess in the inner or outer part of the eyelids, caused by an inflammatory process of the sebaceous glands;
• blepharitis - inflammation in the area of ​​​​the edges of the eyelids, can be caused by infection with bacteria, viruses, fungi, Demodex mites

In most cases, chemosis is a sign of severe disorders in the functioning of the whole organism, and requires timely diagnosis and correct treatment. According to statistics, the most common cause of pathology is allergies, which can be caused by the uncontrolled use of medications.

Surgeon about blepharoplasty: age, complications, recovery

We continue the series of interviews with our doctors! Today Oksana Alekseevna Makeeva talked with the star of plastic and microsurgery in our city - Andrei Vladimirovich Baitinger.

Oksana Alekseevna: Hello! Andrey Vladimirovich, it’s spring, many women are thinking about their beauty. What procedure (consultation or operation) do you most often get asked for?

Andrey Vladimirovich: One of the most popular reasons for visiting a plastic surgeon at the moment is the issue of correcting age-related changes in the eye area, blepharoplasty. We change the shape, size and get rid of age-related changes in the upper and lower eyelids.

O.A.: Do they mostly come with age-related problems? Or do girls come who want to change the shape and cut?

A.V.: Yes, most often this is surgery for age-related changes. However, blepharoplasty does not necessarily require age-related changes; it is also performed for aesthetic purposes. Often girls want to change the Asian shape of their eyes, make it more familiar, European.

O.A.: Do men come for blepharoplasty?

A.V.: Yes, men also think about this. However, male and female blepharoplasty are extremely different. A thorough consultation is necessary to explain and communicate these differences to the patient.

O.A.: Will you tell us?

A.V.: Of course. Most technologies and techniques are aimed at correcting age-related changes and lead to the effect of “feminization” of the face; it is necessary to obtain a more feminine, more youthful face. If you perform such blepharoplasty on a man, it will turn out to be aesthetically unprofitable. Therefore, in terms of the general perception of a man’s face, blepharoplasty should be economical and conservative. Most often, men come to us about their lower eyelids - dark circles, bags under the eyes, this is the maximum accent. Correction of the upper eyelids does not lead to a rejuvenation effect, only to feminization.

O.A.: What is different about a man’s appearance from a woman’s? What exactly needs to be done to achieve feminization results from a surgical point of view?

A.V.: In fact, if you look at traditionally masculine men (Alain Delon, Sean Connery, etc.), then notice that they have very massive upper eyelids, often even at a young age they lie on the eyelash line edge of the upper eyelid. This is a direct indication for classic blepharoplasty, but in combination with the position of the eyebrows, such eyelids impart masculinity. If we remove these eyelids from the actors, we will get a more feminine look.

O.A.: Does it happen that patients have to be dissuaded from blepharoplasty?

A.V.: We must try to find out what the true reason for the appeal is. Unfortunately, age-related changes are not always the reason for treatment. Some patients believe that by aesthetically changing their appearance they will be able to improve some psychological aspects, well-being, find a better job, husband, wife... If a patient comes with such secondary requests, then you need to understand that changing facial parameters may not give such a result, which the patient wants. It is not a fact that changing the shape and configuration of the eyelids will somehow affect the quality of life.

O.A.: What age do you consider to be the maximum? At what age is it better to have these operations?

A.V.: The beauty of plastic surgery is that it is permitted and indicated from the age of 18. Genetic age-related changes can appear at different times in different people. The youngest patient came to me at 32 years old, with pronounced bags under her eyes. The oldest patient is 70+. Everything, of course, depends not only on genetics, but also on skin care and self-care. With proper care, some patients do not need surgery, but only a trip, for example, to a cosmetologist.

O.A.: What are the most serious consequences?

A.V.: This operation is considered easy, but it can also have its own problems and complications. Again, genetics is such that things can go differently for different people, even blepharoplasty is never performed in the same way. For each patient, a specific strategy is built - for some a more aggressive procedure, for others less, for some it is necessary to correct several problems at once in a complex, for others only one. A good analysis before surgery and a thorough consultation are important. Depending on the strategy, the operation can last from 20 minutes to 2 hours.

O.A.: 20 minutes... That is, blepharoplasty can be done without general anesthesia?

A.V.: Yes, that’s right. The upper eyelids are most often performed under local anesthesia, since all structures are located quite superficially. Lower eyelids - often sedation, general anesthesia, where it is necessary to work with the eye socket, with bone tissue, pull out or redistribute fatty hernias.

O.A.: Your approach: is it better not to finish it or to redo it? Or do you prefer optimal?

A.V.: We must try to do everything as optimally as possible for each patient. The question is that there is nothing superfluous in our body. Excessive removal of fat in any area will not lead to anything good. Removing too much fat from the upper eyelids can lead to deformation, where the eyelids become triangular and the upper eyelid droops. With the lower eyelid, even dislocation of the eyeball can occur, up to a serious deterioration in vision. Neither one nor the other is good and requires additional correction, and this is a reconstructive, not an aesthetic operation.

O.A.: The eyes are symmetrical. How do you achieve perfect symmetry between your eyes?

A.V.: It would seem, yes, a person’s face is completely symmetrical, but to some extent this is a deception of our brain. We strive for symmetry, which is not in human nature. Each of us can go to the mirror and see that this symmetry does not exist. This is the difficulty - there is no symmetry, but we must perform the operation in such a way as not to change or lose the patient’s points of symmetry, so that after the operation there is no feeling that something is wrong.

O.A.: After the operation, how detailed and carefully do you monitor the result? How often does the patient come for appointments? Do you always analyze the ideality of the work done?

A.V.: Yes, of course, always. In my personal opinion, the work of any surgeon should include a thorough analysis of his patients. I always tell my patients that for the first seven days after surgery you need to always be in touch so that no one goes anywhere, contact is mandatory. This is the most unpleasant and dangerous time - stitches, swelling, bruises, bandages... Most often, on the seventh day, in 99% of cases we remove the stitches. Then the rehabilitation period begins, it is easier for surgeons and the most difficult for patients. Any intervention in the facial area cannot pass without leaving a trace; the skin near the eyelids is the thinnest. Even a small prick can cause a lot of swelling. All marks from the surgeon's scalpel disappear within a month. We have to be in touch for seven days, for up to a month we have to follow certain rules, restrictions, not everything can be done. From the fourth week, we perform a follow-up examination, answer questions, and think about how to correct anything.

O.A.: How long should it take after blepharoplasty for the patient to return to work?

A.V.: Interesting question. Much depends on the type of work. There are patients who work remotely - they do not have social contacts, they work the same way they always worked. Patients with mandatory social contacts should wait at least a week and take care. Some take vacations, some plan surgery during vacation, some do it before the holidays. Individual approach. At least a week is the moment when you should limit your work and communication with people.

O.A.: How often do complications occur?

A.V.: There is a common aphorism among surgeons: complications do not occur only in those who do nothing. They happen, they cannot but happen, they are an indispensable attribute of the life of any surgeon. In my practice, they also happened, and, thank God, they can be corrected. Sometimes operations have to be repeated, sometimes conservatively. Complications are difficult to predict; there is no surgeon who would willingly want to harm the patient.

Interested in the blepharoplasty procedure or want more information about another procedure? Sign up for a consultation and Andrey Vladimirovich will tell you everything that may be interesting and important!

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Signs of the disease

At the primary stage, chemosis is quite difficult to identify due to the absence of obvious symptoms. At the beginning of the disease, the fluid, which gradually accumulates between the layers of the conjunctiva, is in a small volume. And only a qualified specialist can identify it. As the disease progresses, the symptoms will become more pronounced and the patient’s condition will worsen. The formation of chemosis can be identified by the following symptoms:

• blurred vision, blurred images;
• feeling of discomfort in the eyes: burning, itching, pain;
• the formation of swelling, which gradually spreads to the entire conjunctiva; with this complication, the person feels pain when closing;
• purulent discharge appears from the eyes because a bacterial infection is associated with inflammation;
• The most unpleasant situation is the spread of swelling to both eyes at once. Due to this, vision is significantly impaired

How dangerous is the disease?

In order to get rid of the reasons that provoked irritation and swelling, it is necessary to carry out comprehensive treatment of the pathology. This includes eliminating the allergen, influencing pathogenic microflora, and using other restorative agents.

If it is not possible to get rid of the causes of chemosis after blepharoplasty, and the treatment does not bring the desired effect, as a result, a malnutrition of the corneal tissue may develop. In this case, non-infectious keratitis (inflammation of the cornea) may develop in the presence of systemic infections, such as syphilis, tuberculosis.

FAQ

How long does swelling last after lower blepharoplasty?

Swelling is a normal tissue reaction to damage. You should not be afraid of them - the surgeon will tell you how to minimize their appearance, but patients must understand that even with all the most effective methods of influencing tissue, it is impossible to get rid of swelling. These processes after tissue removal are natural and accompany regeneration. The severity of swelling and the speed of its disappearance vary from person to person and also depend on the condition of the tissues around the eyes before surgery.

In the first 2-3 days, the swelling increases, and even a bruise may appear, extending to the nose. From the fourth day, the swelling subsides, becomes significantly smaller, and the intercellular fluid resolves. It is during this period that you need to treat your eye as carefully as possible - do not overheat it, do not rub it, and do not touch it again. Try to blink less often, sleep for the prescribed amount of time, but no more. Drink a moderate amount of liquid that is easily excreted by the body - clean water, tea, juices.

Visually, swelling after lower eyelid blepharoplasty disappears within 5–7 days. This is the average period during which facial contours are restored after surgery. There will still be a slight swelling on the face near the eyelids, but visually the condition is much better. By the 10th day of rehabilitation, the consequences of the operation are practically not visible. Only upon careful examination can traces of intervention be seen.

From the beginning of the third week, the appearance is completely restored, but a slight asymmetry in the convergence of edema may be noted. Usually this is difficult to notice, and even in a photo the face looks perfect, and with the help of decorative cosmetics, patients can hide this flaw if they are too worried about it. Over the next 1.5 months, the body will establish all metabolic processes in the operated area, changes for the better will become more obvious. This is not noticeable on the face in the area around the eyes - patients look normal and can return to work.

Are the seams visible?

Eyelid surgery is performed today using new, progressive techniques, thanks to which the seams remain practically invisible. Along the eyelash edge of the lower eyelid, the tissue is stitched so skillfully by the doctor that the seam looks like only a small scratch. By the time the patient can use decorative cosmetics, the swelling from the stitch has already subsided, and it can be very easily hidden. On average, it will take 3 to 6 weeks for the incision and suture to completely disappear.

During the first time after surgery, swelling will persist, and the suture will be most noticeable. After 4-5 days, the patient should come to the doctor, and he will remove the stitches. After this, the condition will noticeably improve - recovery will go faster, and traces will become completely invisible.

To sign up for lower blepharoplasty at the Miracle Doctor clinic, find out the cost of the operation and ask any remaining questions, call the phone number in Moscow or fill out the feedback form.

Diagnostics

In order to prescribe the correct treatment, you need to fully examine the patient, collect anamnesis, and pass the necessary tests. The doctor may prescribe:

• ophthalmoscopy;
• visometry, determination of visual acuity;
• biomicroscopy;
• tonometry, measurement of intraocular pressure;
• tests: blood, to detect bacterial infection, scraping from the conjunctiva;
• Ultrasound, X-ray, CT

A differential study plays an important role, which allows us to exclude the possibility of such serious pathologies as tuberculosis, abscess, and oncological formations. If conjunctivitis is present, it allows you to determine the type of infection.

Drug treatment of chemosis

The use of medications for the disease directly depends on the nature of the identified inflammation: infectious and non-infectious. Main groups of prescribed drugs:

1. Antiviral drugs . They are used when a viral nature of the disease has been identified; they are most effective in the first day after the infection enters the body. These include: Interferon, Indoxuridine, Acyclovir, Poludan;
2. Antibacterial . Used for local therapy during the first few days of the disease, up to 8 times. As symptoms decrease, the amount decreases. The most common drugs: Floxal, Gentamicin, Okamicin, Tobramycin;
3. Antihistamines and vasoconstrictors . The use of this type of medication will be effective after eliminating the allergen that causes allergic damage to the conjunctiva.

You should not self-medicate. All of the above-described medications for the treatment of chemosis after blepharoplasty can only be prescribed by an ophthalmologist, after diagnosing the underlying disease and conducting all the necessary studies and tests.

Rehabilitation

If at the stage of surgery the skill of the surgeon is primarily important, then at the stage of recovery much is entrusted to the patient himself. The final result, aesthetics, and invisibility of marks depend on how responsibly the patient took all the prescriptions and recommendations of his surgeon.

In the first days, natural postoperative symptoms will be observed - swelling and bruising. This is a normal condition for the rehabilitation period. To speed up the decline of swelling and bruising, it is recommended to adjust your diet - give up alcohol and cigarettes, reduce or limit the consumption of salty or spicy foods.

At this time, it is important to observe the prohibitions. During the first 1-2 weeks, you should not put stress on your eyes. You should limit the use of computers and other gadgets, watching TV and reading. You should also not play sports or be exposed to physical activity. It is necessary to avoid thermal procedures (hot bath and shower, bathhouse, sauna) and minimize exposure to ultraviolet radiation (solarium, beach).

Surgical treatment

If there is a mild to moderate degree of the disease that provoked chemosis, it can be treated conservatively, without staying in the hospital. These conditions include:

• blepharitis;
• conjunctivitis;
• allergy

If there are serious complications, treatment is carried out in the clinic. There are a number of conditions where the only solution is surgery. Such pathologies include:

• exophthalmos;
• internal stye;
• tumors in the orbital region;
• abscess of the eyelid

In the presence of such pathologies, surgical intervention is indicated to help permanently eliminate the pathology.

Progress of the operation

The features of the intervention depend on what type of correction was chosen. With conventional eyelid surgery, the doctor makes incisions on the eyelids in predetermined locations, then removes excess tissue and fatty tissue. After this, the surgeon fixes the tissues in the new position, applies sutures and a sterile bandage. The incision is made in the natural crease of the eyelid, so there is no need to worry about noticeable scars. If the transconjunctival approach is used, no sutures are required since the incision is minimal.

The cuts are made according to pre-planned markings.

During Asian eyelid surgery, a “European” fold is formed on the upper eyelid, and epicanthus surgery is performed. After this, stitches and a sterile bandage are also applied. After upper eyelid blepharoplasty, the patient can go home, usually on the same day on which the operation was performed.

How to avoid chemosis

In order to protect yourself from the onset of the disease, you need to follow certain rules that will increase the body's resistance to infectious diseases and improve the functionality of the organ of vision.

1. Sleep should be at least 8 hours a day. You need to sleep in a well-ventilated area, with thick curtains, in a comfortable bed.
2. When prescribed by a doctor, you should take special complexes with vitamins for the eyes;
3. If your eyes are constantly under strain during work (for example, working at a computer), you should take a rest every hour. This break will allow the eyes to relax, and it is advisable to do simple eye exercises, which will improve tissue metabolism;
4. It is recommended to lead a healthy lifestyle. Most eye diseases manifest themselves with age, when a person’s chronic diseases begin to progress;
5. It is worth following your diet. The menu should include products containing vitamins for the eyes. These include: dark chocolate, garlic, onions, spinach, carrots, eggs, broccoli, blueberries, parsley.

Remember that the organ of vision is the most important, without which life will lose its colors. A healthy lifestyle and prevention of ophthalmic diseases will help protect you from most eye diseases. The basis of health is immunity, which also affects vision. It’s not for nothing that they say that the eyes are the mirror of the soul. Let's make sure this mirror is crystal clear!