Eyelid Surgery Sydney
Dr. Kippen - Expert Plastic Surgeon
The eyes and mouth make up the triangle of first view and expression when we look at or talk to someone. Age related changes associated with eyelids are often perceived as being tired, angry or unhappy.
Upper lids develop an excess of skin and muscle. Small fatty pouches develop especially on the nasal side of the lids. Bulges in the outer part may be due to dropping of the lacrimal gland. This is the tear producing gland. Skin excess is also influenced by the position of the eyebrows. An aesthetically pleasing eyebrow should be positioned at or just above the bony orbital rim. Maximal arching should occur at the outer edge of the colour part of the eye. Any droop or ptosis of the eyebrow adds skin to the upper eyelids.
Lower eyelids develop an excess of skin, muscle and small fatty pouches. An orbital septum is a structural layer that holds some of this fatty tissue back. Lower eyelid position is very important and the lid should be positioned at the level of the lower border of the coloured part of the eye. Any retraction shows the white or sclera below this coloured rim. It is the upper eyelid that predominantly moves downward with eye closure.
Each of these layers need to be addressed.
A full history precedes a thorough examination. Many seemingly unrelated medical conditions can effect eyelid surgery. A history of dry eyes or excess tears may be worse after surgery and may take as long as three months to settle down. This is especially apparent with air-conditioning, windy days or in aircraft.
Surgery can be performed under local anaesthetic or a combination of local anaesthetic and either sedation or general anaesthesia. This choice is determined by patient and surgeon preference, amount of correction required and the type of surgery planned. Local anaesthetic may contain adrenaline which causes small blood vessels to vasoconstrict or shut down, this helps to minimize bruising. Using local anaesthetic also reduces the amount of other anaesthetic agents used and means that the first few hours of recovery are pain free. The procedure can be performed as day surgery or an overnight stay.
For upper eyelid surgery, an elipse of skin is marked with the final scar to be hidden in the crease. This may extend out to the crows feet. A variable amount of muscle may be resected. This is superficial and excess muscle so it does not affect the eye opening. Small amounts of the fatty pouches are then removed. Careful control of bleeding points limits the bruising. Wounds are carefully closed with stitches. Cool packs help with swelling and bruising.
Lower eyelid incisions run just under the lash line to remain hidden and may also extend out to the crows feet. Muscle adjacent to the eyeball is preserved to maintain the position of the lower lid. Very little skin is excised to prevent droop. The orbital septum is then opened and the fatty pouches are either repositioned or a small amount of fat is removed. Limited fat is taken to prevent a hollow look. As the orbital septum is a structural layer it is repaired and may be tightened for additional support. Many surgeons add a temporary lifting stitch to support the lower eyelid. Small amounts of muscle and skin may be removed from the outside or lateral part of the incision so the direction of pull is upward.
After stitching the wounds are carefully taped. Most surgeons do not keep the eyes covered but use removable cool packs. A head up position helps with swelling. Pain is usually mild and most people describe an irritation or gritty feeling as opposed to pain. Eye drops and eye ointment is often used to help this. Stitches are removed early from 3 to 7 days. It is often necessary to massage the scars and learn a massage technique to lift the lower eyelid margin to compensate for a downward pull of healing and gravity.
All the risks associated with the procedure should be carefully explained and understood. Independent research should be encouraged and all questions fully answered. In general the procedure is very well tolerated. The commonest problems are swelling, bruising, dry eyes, visual changes, asymmetry, eyelid malposition, cysts, scar puckers and visible scars. Bruising often tracks downwards to the lower lids. Pigmentation of the skin is not treated by surgery.
In general the surgery is very well tolerated with a high degree of satisfaction. Recovery is usually quite short with a rapid return to activities, work and exercise.
