Blepharoplasty : the eyelid surgery

Who needs it?

Generally, a person in his/her 40’s begins to notice aging in the eyebrows. They become heavy and fading. There appear pockets under the eyes and this is due to the multiplication of extra padding around the eye. It is a problem that appears sometime very early, if it is from genetic origin. Exposure to sun rays, lack of sleep, smoking or menopause can aggravate this phenomenon.

Aims

The objective of a blepharoplasty is  to change the drained aspect of the look into an appearance that is more relaxed and less tense.

For a blepharoplasty (eye lid surgery) at the upper part of the eye lids, all the superfluous skin should be removed, while leaving enough of it to allow the eye lid once closed to cover the hearing globe in an adapted manner. For a blepharoplasty at the lower part of the eye lids, the lower eyebrows must be corrected as they are visibly dangling and faded with consecutive small horizontal wrinkles due to skin muscle straining, but also fat hernia causing “pockets under the eyes”.

A blepharoplasty can be carried out separately, or accompanied with another cosmetic surgical operation of the face: frontal lifting, temporal lifting, cervical-facial lifting, say even a medical surgical therapy.

Before the operation

Your medical examinations

Between one week and one month prior to your operation, you must make an appointment with a medical tests laboratory in order to undergo a full pre-surgical check-up. A specialized ophthalmological examination will be required as a complement so as to identify a possible ocular pathology.

The tests results must be sent to us (by fax, or by e-mail) so that they can be seen and read by our anesthetist doctor. Depending on the test results, other examinations may be required. If you are unable to carry out your examinations before your departure to Tunisia, there is always a possibility to do that on the spot, the day before the operation. It must be known that if there is a contra-indication to your operation, the anesthetist doctor has the right to put off or cancel the operation.

No medication containing aspirin should be taken at least 10 days before the operation. You must mention any type of medication you may have taken. It is essential that you refrain from eating, drinking, and smoking for 8 hours before the operation.

Regarding your luggage, you must bring sunglasses, one or two scarves (to cover the bruises), a hat or cap, and full sun block cream.

Getting ready for the operation

You will be taken to your clinic the night of the operation, the time to get settled in your room, to take a shower if needed and to meet with the medical team: your surgeon, the anesthetist doctor, and all the health care staff. The operation takes place the following morning.  Very often, the night before the operation, the nurses will give you a kind of pre-medication in the form of a light tranquilizer to make sure that slightly anxious patients to face the operation with more fortitude.

Type of anesthesia

Three types are to be envisaged:

• Mere partial anesthesia in which an analgesic substance is locally injected in order to secure the lack of sensitivity at the eyebrows level.
• Deep partial anesthesia through intravenous administration of tranquilizers (“Vigil” anesthesia).
• Full anesthesia in classical fashion, during which the patient is put to full sleep.

The choice of any of these different techniques will be made after a discussion involving you, the surgeon, and the anesthetist doctor.

Duration of hospitalization

1 night

Total duration of stay in Tunisia

3 nights / 4 days

operation

The drawings of incisions will be carried out by the surgeon before anesthesia.For the upper eye lids, the incision follows the normal fold of the eye lid, it will then be hidden under a natural fold. Then any skin excess will be removed and if necessary the pockets of fat will also be removed. The upper eye lid surgery aims at eliminating any excess of skin, muscle and fat.

The incision will be located at half-height of the upper eye lid, in between the moving part and the one that is seated. The scar is therefore hidden. The surgeon will proceed with another cut of one part of the skin through an ablation of the small skin cushions that are quite visible.

For the lower eye lids, the incision will follow the edge of the eyelashes. At times, it is possible to go by the eye conjunctiva and in this case without any apparent scar. The fat pockets that cause protrusion are removed. Habitually, the amount of skin that is cut is minimal. The stitches are made using very thin threads, usually non-absorbable (to be removed after a few days).

Duration of the operation

Blepharoplasty surgery may last from 30 minutes to 1 hour, and at times one and a half hours.

After the operation

After the operation, medical supervision will be in the waking room, then in your room. Eye lid surgery is generally causing little pain. A bandage with ice compresses will be applied for some hours, limiting the development of eye lid edema. Compresses are to be changed very frequently during the first 24 hours. In some cases, the bandage /dressing can be occlusive, and can prevent you from opening your eyes for several hours after the operation.

Leaving the hospital is generally possible the day following the operation.

Post surgical effects

Ecchymosis and swelling will last ten days on average.

Eye drops will be applied for a few days to help oil the eye (artificial and antiseptic tears). Excessive watering may occur at the beginning of the healing process.

You must also wait all this time before considering wearing any contact lenses. You must avoid any source of eye straining for a few days (television, reading, tobacco). Sunglasses are recommended when going out. Make-up and cosmetics will be allowed after ten days.

Result

Definitive results will be possible after 3 months and will last for ten years.

Complications

Like any other operation, blepharoplasty presents some risks of complications during and after the cosmetic surgery, among which one must quote specifically:

Hematoma which requires immediate re-surgery under full anesthesia
Chemosis, or edema spare tire of the conjunctiva, representing very little risk
Round eye or ectropion or reversion of the lower eye lid – something that can last for several months, and at times it may require another operation but that happens very rarely.
Minor asymmetries and/or insufficient correction, something quite frequent that may occasionally require another operation for final touches, many months after the initial operation. Epidermal cysts over deep scars, fairly frequent.

Work interruption

There is no need for interrupting the work: the recovery stay spent in Tunisia following the operation is very beneficial and enables most of our patients to resume their professional activities as soon as they return home.

Fees

• The fees required for a 2 upper eye lid surgery : 1300 euros.
• The fees required for a 2 lower eye lid surgery : 1500 euros.
• Blepharoplasty involving the 4 eye lids : 1700 euros.