But a good surgery should create natural and symmetrical eyelids that are pleasing to the eye. There are many methods of eyelid surgery, each with its own indications, and the following two methods are commonly used clinically: the buried wire method and the incision method.
1. Buried suture method
A special surgical suture is inserted from the eyelid to the conjunctiva where the eyelid needs to be done, and then back through the eyelid, tying the knot and burying it under the skin. The advantage of the buried thread method is that it is simpler to operate, and compared with the incision method, the postoperative reaction is light, recovery is fast, there is no obvious scar after surgery, and it is easy to correct when the effect is poor. The disadvantage is that it is not suitable for young people with thin upper eyelid skin, no laxity and little subcutaneous fat.
2. Incision method
The eyelid is cut open and sutures are used to fix the levator muscle fascia to the dermis and subcutaneous tissue where the double eyelid is needed. The main advantage is that it is widely adaptable and can be used for all types of single lids. The local anatomy is clearly visible during the operation and the procedure can be performed accurately. The skin or orbital fat can be removed at the same time, and the results are reliable and long-lasting. The disadvantages are: the operation is complicated, the damage is large, and the recovery is slow. It is difficult to repair if it fails. There are incisional scars on the upper lid skin after surgery, and even scarring may occur. The incision method is currently the main type of cosmetic blepharoplasty.
Complications of blepharoplasty and their causes, prevention and management
1. Bleeding and hematoma
Causes: Most often caused by incomplete intraoperative hemostasis, excessive addition of epinephrine to the anesthetic, or by suture needles penetrating larger blood vessels.
Prevention: Avoid unnecessary trauma as much as possible during surgery, and stop bleeding thoroughly during surgery. It is important to continue postoperative antihypertensive therapy in patients with hypertension to prevent bleeding. To prevent delayed upper lid hematoma formation after blepharoplasty, patients should be instructed to avoid rubbing and squeezing of the eyelid.
Treatment: Prompt treatment is given with compression to stop bleeding and application of hemostatic drugs. If the hematoma is small, it can be allowed to absorb on its own or be given a hot compress to facilitate absorption. For larger hematoma or suspected pulsatile bleeding, the wound should be opened in time to eliminate the hematoma, find the bleeding point, and give ligation to stop the bleeding. At the same time, give the corresponding medication.
2.Infection
Causes: Surgery in the presence of infection foci around the eye or the operating area; poor disinfection of skin, instruments and sutures; sloppy surgical operation, poor aseptic concept, exposed nodes of the buried wire method, and excessively long operation time, etc.
Prevention: Pre-operative indications, inflammation of the eye, other diseases, and frailty should not be used; strict aseptic operation should be performed to minimize the operating time; incisional blepharoplasty should be performed to prevent threads, cotton or other unclean foreign objects from being left in the incision; and sweat should be prevented from contaminating the incision and causing infection during the hot season. Postoperative antibiotics should be administered orally or in antibiotic drops, as appropriate.
Treatment: Postoperative infection, mostly occurs at the incision or line knot, in mild cases, local clean disinfection with iodophor and ethanol should be given several times a day; if septic infection of the incision occurs, the lines should be removed immediately in advance, local clean change of medication and systemic application of antibiotic treatment. If the infection is serious, once it is complicated by orbital cellulitis, active measures should be taken and a large number of broad-spectrum antibiotics should be given immediately in combination with treatment. Local hot compresses and physiotherapy should be applied to prevent the infection from spreading and causing serious consequences.
3.Swelling
Causes: Local reactive swelling of surgery; postoperative obstruction of venous lymphatic return; postoperative complications of infection or bleeding.
Prevention: Operate carefully and gently, avoiding circumferential ligation as much as possible to avoid affecting the venous and lymphatic return to the upper lid; avoid the occurrence of local infection or bleeding.
Treatment: Swelling is more severe at 2 to 3 days postoperatively. The suture method is lighter and the swelling goes down quickly; the incision method is heavier and the swelling goes down slowly. The swelling of the upper lid will gradually subside over time. If the swelling is caused by infection or hematoma, anti-infection treatment and hot compresses and physical therapy should be used to promote absorption of the hematoma.
4. Exposure of the nodes
Causes: This occurs after a buried blepharoplasty because the nodes are not buried deeply enough or the threads are too long when they are cut.
Prevention: A sharp knife can be used to slightly enlarge the pinhole during surgery, the ligature should be loosely tied and the thread should be cut as short as possible, and the skin at the pinhole should be lifted after surgery so that the knot can be buried in the skin. If the knot is difficult to be buried under the skin, the needle hole can be expanded and slightly separated to help the knot to be buried under the skin.
Treatment: Once the knot is found to be exposed, it can be removed at a later date, and if it affects the shape of the eyelid after removal, it should be replaced.
5. Rejection
Cause: The rejection of sutures by the body.
Prevention: Use finer sutures with less tissue reaction and ask the patient in detail if they are allergic before surgery.
Treatment: Once rejection has occurred, the sutures should be removed promptly and treated symptomatically.
6. Full skin splitting at the blepharoplasty line
Cause: Infection at the sutures or tight ligatures causing local skin weave congestion, edema, impaired circulation, skin necrosis and cracking.
Prevention: Clean the sutures after surgery to prevent infection and closely observe the local situation; remove the sutures promptly if congestion and edema occur due to tight ligation of the sutures; strengthen anti-infection measures if infection is present.
Treatment: immediate removal of sutures, local cleaning and disinfection, anti-infection treatment.
7.Corneal injury
Causes: Sloppy operation or rough corneal pad abrasion of the cornea; suture method with full layer through the eyelid, suture needle mistakenly piercing the cornea; postoperative complications such as upper lid ectropion and incomplete lid closure, resulting in dry corneal exposure and keratitis.
Prevention: The surgeon should be familiar with ocular anatomy and operate carefully.
Treatment: Once the complication of corneal injury should be treated according to the ophthalmology routine to prevent serious consequences or even damage to vision.