Chatting a little about blepharoplasty!!

Chatting a little about blepharoplasty!! Hope you enjoy it!
Kisses 😘

Video transcript

Hi, everyone! My name is Carolina, and I’m a plastic surgeon. I’ve come to bring you a video today about blepharoplasty, or eyelid surgery. So, there isn’t a very written-out script of what I’m going to talk about here — it’s more of a conversation about the surgery with you. It’s a surgery that is very often requested in the office. It’s a surgery I really like, and it is intended for the rejuvenation of the upper and lower eyelids. So, around 25 to 30 years of age, we begin rejuvenating the periorbital region — which is the region of the upper and lower eyelids — superficially, usually with botulinum toxin injections to neutralize the crow’s feet, neutralize the periorbital wrinkles as well, and modify the shape of the eyebrow a little bit. And we also start some fillers, often in the under-eye area, here in this region, where we end up with a deeper sulcus, which can also extend to the lateral region of the orbit. The orbit is the bony cavity where our eyes and the adjacent structures are located. So, we can see fillers in this region, as well as the facial harmonization that we work on — the middle third and other regions of the face. But there comes a time when the skin gradually develops a little more laxity and, on top of that, with the laxity of the structures and the atrophy of some structures, we gradually develop protrusion of bags in the upper and lower eyelids. This varies from person to person. So, some people have deeper orbits, and some people have shallower orbits. But here, if we assess it, we start to see some bags forming in these regions here, on the lower eyelid. We gradually see the demarcation of the end of the lower eyelid, the demarcation of the bony region becoming more evident. Excess skin in this region — we see that the skin has its laxity. And here, on the upper eyelid, where the palpebral sulcus would normally be positioned — the region that women call the crease when doing their makeup — we start to get a fold of skin here that keeps folding over and sometimes comes very close to the margin of the upper eyelid. And why did this surgery catch my attention this week? Because the YouTuber and makeup artist Alice Salazar said that she had this surgery, and precisely one of the benefits she was mentioning about this surgery is that she gained more space to do her makeup. And this makeup application is frequent. Sometimes, because this skin fold on the upper eyelid is getting too close to the eyelashes, the person sometimes can’t wear every type of makeup or the makeup they would like. The eyeliner starts to smudge when you apply it, and the skin fold—when you blink or even just from opening your eye—it already touches it and ends up smudging the eyeliner you put on. Even the eyeshadows, too, start to build up in those little skin creases. And on the lower eyelid as well, when you apply concealer to soften the dark circles, it creases, it builds up. It ends up being hard to apply makeup in some situations. And when your skin laxity is still in its early stages, we can do some treatments, such as laser application, or even some peels, which tighten the skin to a certain degree and improve this laxity. However, in more advanced degrees, you end up having to remove some excess skin, end up having to remove some of the excess from these fat pads that protrude—but without removing too much. Sometimes we reposition these fat pads. So, we place fat in areas where we have a lack of tissue, all of this to rejuvenate this region. So, what does this surgery consist of? When we go to the upper eyelid, we—let’s suppose—we have an excess of skin here; we mark out the area of skin we’re going to remove, in such a way that we try to position our final scar in the position of the eyelid crease. So, when the person’s eye is open, the scar doesn’t show much. Of course, we can never remove too much skin, right? The person isn’t going to go back to the eyelid they had when they were 20 years old, but each person will have this skin in such excess that it interferes with makeup, and in the more advanced degrees—and many times that’s men’s complaint—it even ends up impairing vision, it ends up weighing on this region. And on the lower eyelid, we try to position the scar very close to the eyelash area, so it stays very discreet in most people. And here it extends a little bit out to the side so we can remove a little more skin. So, we work with these structures in here, then we close with internal stitches and out here a few little external stitches, which we usually remove in a week, and the area stays swollen for a while, then the swelling gradually goes down and the person starts seeing the benefits of this surgery. Often, some light makeup — the person can even wear it after 15 days from surgery; if everything is fine, it stays on. So this surgery can be performed. If you’re going to work more on just the skin area or just the upper eyelid, often it can be done under local anesthesia, right? The person needs to, well, tolerate the little stings of the anesthesia. It can be done with local anesthesia and sedation, or even with general anesthesia, all depending on the patient. The procedure doesn’t take long; it lasts around one to two hours, but it’s not a procedure with standard steps, where we’d have to do the same thing on everyone. We’ll assess each orbital region and plan exactly what needs to be addressed in this specific patient. It’s more or less, you know, the same logic as in most surgeries — but, for example, rhinoplasty too. You’ll evaluate each case and see exactly what you need to work on. You won’t touch structures you don’t need to. And sometimes there are some complementary procedures to this surgery. So you end up with a scar here, in this area; you end up with a scar along the lash line. In some cases where the person only has the fat pockets but doesn’t have excess skin, we can still do the lower blepharoplasty through the transconjunctival approach. So we go in from the inside — here, we access the fat pockets from the inside, with no scar on the skin. But that’s a small portion of the patients who benefit from this surgery, because usually the person may have some excess skin. There are even doctors who remove the fat pockets via the transconjunctival approach, which is from the inside, right? But even so, you end up having to make a scar here to remove a small amount of skin. Other times — other things we can assess in the patient. Often, besides the excess skin, the patient has ptosis of the eyelid, which is different from sagging skin. So here is the skin, in this region. And eyelid ptosis involves the muscle that opens the eyes. So it’s when the person has the eyelid a bit like this. So, see, it’s different from excess skin. It’s when the eyelid doesn’t open much. And then, sometimes, besides removing the skin and working on the fat, we may need to work on that muscle down there to open the person’s eye a little bit more. That makes a very big difference in the gaze for people who need this surgery. Other times, too, due to tissue atrophy, our eyelid producing this. It keeps drooping down, and the person ends up with the eye kind of like this, with this droop. So, what do we need to do? In surgery, we need to reposition this structure and anchor it a little more to the bone so we can bring back a more attractive almond-shaped eye look and not have this retraction here. And many times, we also need to moderate the amount of skin we remove so there is no retraction and it doesn’t end up like this in the postoperative period. So, these are several evaluations that we do. It’s very important that you see a plastic surgeon, because sometimes you’re looking for a surgery, but you have to look for a diagnosis. And then we can present the surgery that best suits your complaint, according to your physical exam as well. All right? As for the postoperative period of this surgery, the aftercare is very straightforward. The person’s eye stays swollen, so sometimes, in the first few days, it doesn’t close very well. So, you keep applying little compresses with gauze and cold saline solution every two hours. Also every two hours, to lubricate the eye, you apply lubricating eye drops. And at night, you apply a little ointment right inside the eye; it creates a film, so if the eye isn’t closing very well, your cornea won’t dry out and you won’t have problems resulting from that, okay? And as for oral medications, usually an anti-inflammatory and an analgesic — nothing too advanced in terms of medication. Well, the risks of this surgery — every surgery has risks, that’s something I always say. The risks of this surgery are generally related to hematoma, which is something that can happen. This region is highly vascularized, so we cauterize all the little vessels, but often, if the person has a cough, a sneeze, anything that increases the pressure in this region of the face, or bends their head down, or has high blood pressure, some of these vessels may start bleeding again and accumulate in the form of a hematoma. Sometimes, this blood spreads through the tissues, the area stays purple for longer, but it goes away little by little. But sometimes, if it accumulates very intensely right after the person has had the surgery, it may be necessary for us to intervene to drain this hematoma, to remove this blood. Other complications can be scar-related complications, so if a person doesn’t have favorable healing, they may end up with a scar that is more apparent, that has some retraction, that may keep pulling a little, and that you can, if necessary, intervene on later. But we always say to wait a long postoperative period, because everything keeps changing: the swelling of the structures goes away, they regain their mobility, their normal movements, and the final shape of the surgery gradually settles in. Alright? So, I hope you enjoyed this video. If I left any point out, let me know, ask me, and I’ll answer you. And see you next time!

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Originally published on Instagram on 28/01/2020: https://www.instagram.com/p/B74lAkyANKe/