Double eyelid, or blepharoplasty, is the most common cosmetic surgery today, and can be performed on people with single eyelids or those with excessively loose and droopy eyelids or inverted eyelashes. However, the surgery must vary from person to person and cannot be forced to be consistent. The surgery should be decided according to the individual’s face shape, eye shape (length and size of the eye socket, relative position of the eye socket to the eye ball, width of the upper eyelid, height of the eyebrow, direction of the eyelashes, whether the inner canthus is redundant, thickness and texture of the skin, amount of muscle and fat), as well as the individual’s temperament, aesthetic situation, length of recovery time, etc. Therefore, you should discuss and negotiate with your surgeon before having double eyelids to have a proper judgment of your post-operative appearance.
Although blepharoplasty adds a lot of charm to a person, some people with a saddle nose (low nose) and canthus should have a comprehensive correction to achieve the desired effect. Some people, such as those with very narrow eye fissures, excessively protruding eyeballs, and a narrow distance between the upper edge of the eyelid and the eyebrow, should not undergo this surgery. In addition, congenital amblyopia, acute and chronic eye inflammation are contraindicated, and surgery is strictly forbidden for people with blood clotting disorders and scarring.
I. Incisional blepharoplasty
It involves cutting the upper lid skin to create anatomically similar fiber adhesions to the natural blepharoplasty. This method is suitable for any type of single eyelid, especially for older patients with lax and hypertrophic upper eyelids, and for those with high aesthetic requirements who require a longer postoperative eyelid retention.
This method is clearly exposed, easy to operate, facilitates tissue removal and hemostasis, and creates a very stable double eyelid crease with upturned eyelashes; for patients with lax skin, orbicularis oculi hypertrophy or orbital fat bulge (swollen eyes) a small amount of skin, muscle and part of the orbital fat can be removed to reduce the symptoms of laxity and bloating of the upper eyelid. The disadvantages are that the stitches need to be removed after surgery, the swelling is long in some patients, the eyelid is unnatural in the near future, and the scar of the incision line is visible and takes 3-6 weeks to fade.
Common complications include high pain, significant swelling, lid ectropion, infection, localized depression of the upper lid, asymmetry in the length or width of the eyelid on both sides, significant scarring, unnatural curvature of the eyelid line, and a very small percentage of the upper lid crease is not visible or disappears.
B. Buried Blepharoplasty
This method uses a thread to fix the dermis to the lid plate so that the eyelid appears when the eyes are open. It is divided into intermittent and continuous. It is suitable for young people with a large eyelid, thin eyelids, no muscle or fat hypertrophy, and normal eyelid skin tension without laxity.
The procedure is simple, easy to master, and minimally invasive. The ligature persists in the upper eyelid, so the wall of the eyelid is solid; the swelling after surgery is light, there is no obvious incision scar, and the appearance is natural; the surgery can be corrected with an incision if the result is poor; for those who are not satisfied with the shape of the eyelid, the ligature can be cut within a few days after surgery to return the original single-lid face.
The disadvantages are that the upper lid crease becomes shallow or even disappears after the adhesions between the eyelid and the lid plate are loosened; the nodes are buried too shallowly and easily form nodal cysts or inflammatory reactions, resulting in localized bulging of the upper lid when the eyes are closed; and the surgery does not remove loose upper lid skin and excess muscle and fat at the same time.
Common complications include suture relaxation resulting in loss of the upper lid wall and small cysts in the nodes.
Commonly used adjunctive procedures for blepharoplasty.
Because each person is different, sometimes one or more of the following procedures may be required for comprehensive correction during or after blepharoplasty to achieve better results.
1. Adjustment of the upper lid skin, orbicularis muscle and orbital fat: In order to make the blepharoplasty more natural and beautiful, the right amount of skin, muscle or fat needs to be removed during blepharoplasty for those with loose upper lid skin, orbicularis muscle hypertrophy and orbital fat hypertrophy or sagging.
2. Inner and/or outer canthoplasty: Inner canthoplasty not only lengthens the eyes but also improves the shape of the eyelid; if the eyes are too short, the outer canthus can be opened to increase the length of the eyes.
3.Brow cut or temporal lift: For those with sagging eyebrows and/or crow’s feet, brow cut or temporal lift can be performed to lift the eyebrows and eliminate crow’s feet.
4. Tear gland repositioning: In a very small number of patients, the upper lid bloating is due to the prolapse of the tear gland, which can be improved by repositioning the tear gland during blepharoplasty.
5) Shortening of the levator muscle: For mild ptosis, the levator muscle can be shortened at the same time as the blepharoplasty to correct the ptosis.
What kind of preparation must be done before surgery?
Patients should avoid menstruation, preferably between periods; have no localized eye or facial allergies or inflammation; stop taking medications that affect blood clotting, such as aspirin, one week in advance if it does not affect the effectiveness of the original disease; abstain from smoking and alcohol before and after surgery; cleanse the face well before surgery and do not use cosmetics; and schedule a rest period of one to two weeks in advance.
Is the procedure painful?
Blepharoplasty is performed under local anesthesia, and the pain is mainly from the eyelid anesthetic injection, but not from the surgery.
What is the post-operative care?
Oral antibiotics can be taken for 3-5 days to prevent infection. Although the incisions and tissues are closed, small blood vessels that have been closed during surgery may open again, and there may be a small amount of blood leakage. In principle, ice can be applied for 24 hours, and oral painkillers can be given to patients with low pain domain. The dressing can be removed on the second day after surgery to clean the wound and ocular secretions for optimal healing.
How to deal with postoperative swelling and when will it go down?
Some patients may also experience localized bruising due to intraoperative or postoperative blood leakage, which is normal and usually subsides on its own in one to two weeks. The swelling of the eyelid may be noticeable in the first three days after surgery due to the impact on the blood and lymphatic flow to the eyelid, and may cause stinging and tearing when using the eye.
We recommend that patients reduce eye use and sleep with their heads elevated to reduce eyelid swelling, but review the swelling promptly if it becomes severe and worsens. The time for swelling and bruising to subside depends on the individual’s body type and condition, and generally ranges from 2 weeks to 2 months, although it may take longer for patients over 30 years of age to subside.
When will the stitches be removed? Is it painful?
The stitches are removed 5-7 days after surgery. The removal of the stitches is not as scary as some patients may think. There is usually no special sensation when the stitches are removed on the outside and middle of the eyelid, but the pain is only slightly stronger on the inside of the eyelid. As long as the patient is cooperative and relaxed with the doctor, the removal of the stitches will go smoothly. After the stitches are removed, the eyelid swelling will go down more quickly and will basically return to natural in about 2-3 weeks.
What are the possible dissatisfactions after double eyelid surgery? How do I choose the timing for re-repair?
Possible unsatisfactory situations after double eyelid surgery are
1. Asymmetry of the eyelid.
2. Overly wide or narrow eyelid line.
3. Subcutaneous nodules.
4. A short eyelid line, forming a half double eyelid.
5. Triple eyelids.
6, triangular eyes, etc.
If you are dissatisfied with the results of double eyelid surgery and want to have surgery again, you should do it 3 months or 6 months after the surgery. It is best to do it after three months or longer because it is in the tissue repair period, when the tissue is brittle, adhesions are heavy, and anatomical relationships are unclear, when the repair skin is easily torn by the sutures, bleeding is heavy during surgery, and scar growth is heavy.
Why do some people who have undergone blepharoplasty recover quickly and some recover slowly?
Some patients with blepharoplasty look natural very quickly, while others take a long time to be accepted. This is because in addition to the patient’s own condition, the details of post-operative care are also crucial to a fast and slow recovery.