Oculoplastics - plastic surgery of eye lids or blepharoplasty

Dare to open your eyes wider!

Plastic surgery of eyelids is recommended and very effective manipulation to prevent sagging eyelids and bags under the eyes that makes person to look older and appear tired without actually being tired, and also frequently prevent them to become encumbering to vision.

These surgeries can be performed due to medical indications but also in the cases when they are meant for the improvement of the outer appearance. Surgery is performed by the certified ophthalmologist and surgeon – dr.Iveta Mežatuča, who has practiced in Denmark, Estonia and the USA under the supervision of eye plastic surgeon Michael A.Burnstine, M.D. Plastic surgery of eyelids helps to regain more cheerful, younger and rested appearance. Usually surgery is performed under local anaesthesia and patient is able to return home within few hours after the surgery. It can also be done in general anesthesia, consulting and arranging it previously with your doctor.

Oculoplastics is an area of ophthalmic medicine that involves various types of plastic surgery on or around the eye. Such surgery is performed by an ophthalmologist – a surgeon specialising in the medical and surgical treatment of eye diseases

Oculoplastic surgery can be performed for both cosmetic and medical reasons.

The group of cosmetic problems that oculoplastic surgery is used to treat includes all changes in the eyelid that do not affect human health. This category includes, for example, an excess skin fold around the eyelid that has formed over the years and gives a tired look as well as “bags” over and under the eyes. Cosmetic disorders also include small skin neoplasms, most commonly papillomas that do not touch the eyeball, small uninflamed cysts as well as small, yellowish formations on the skin of the eyelids, which are usually made up of cholesterol or other lipid depositions.

Medical changes affect the patient’s vision. An example would be a distinct excess skin fold, usually observed among the elderly, that obstructs the patient’s vision due to a drooping eyelid or ptosis that partially or even completely covers the pupil.

Medical oculoplastic surgery is also used to treat conditions affecting the eyelid; for example, when the eyelid folds inwards (entropion), and the eyelashes constantly scratch the eye, causing inflammation and irritation, or when the eyelid turns outwards (ectropion), as a result of which the eye is constantly watering and inflamed, since the mucous membrane of the eye is not shielded from the surrounding environment. Medical reasons also include improper lash growth (trychiasis), which causes constant eye irritation.

Tumours are another, possibly life-threatening, medical problem. Therefore, sometimes, a neoplasm that a patient may consider to be small requires serious surgery with extensive reconstruction.

Oculoplastic surgery is also needed after facial nerve paralysis, where the eye has to be replaced with an implant, as well as for various tear duct pathologies and cases of orbital diseases.

The doctor should be aware of any allergies, including allergies to medicines. The doctor should also be informed about any medicines that the patient uses on a daily basis. For example, medicines that decrease blood pressure should also be taken on the day of surgery, while blood-thinners should not be taken for a week before surgery and for a few days after, unless this would pose a risk to the patient’s health. If surgery is performed under local anaesthesia, the patient usually does not need to undergo any specific medical examinations. For the elderly and people with heart conditions, however, it is advisable to have a cardiogram before major surgery to rule out any complications during this period. In certain situations, when surgery must be performed under general anaesthesia, a broad range of examinations, including a cardiogram and a lung X-ray, must be carried out beforehand. A general practitioner’s opinion on the patient’s general health is also required.

In most cases, oculoplastic surgery is an outpatient procedure. This means that the patient will undergo surgery and then go home immediately or within a few hours after the procedure. Depending on the type of surgery, the eye may be covered with a bandage (usually until the next morning), and patients also sometimes receive sedative medications before surgery,  therefore, it is not recommended for patients to drive home after the operation.

Usually, the surgery takes place under local anaesthesia – an analgesic medication is injected directly under the skin in the area due to be operated on. The injection itself can be a bit painful, but only for a brief moment. The surgery is painless.

For oculoplastic surgery in which both eyelids are operated on and in complicated cases, general anaesthesia is used. Also, where the patient is very nervous, he or she can agree with their doctor beforehand for the surgery to be performed under general anaesthesia.

Depending on the complexity of the surgery and whether one or two eyelids are being operated on, surgery can last from a few minutes to up to two hours.

Usually there is no pain after the surgery. There may be tenderness or a feeling of tightness, swelling and bruising around the affected eye that usually disappears within two weeks. To relieve these symptoms, cold applications, minimal physical activity and blood pressure control are recommended. In general, anything that causes the blood vessels to widen is to be avoided during the recovery period. The wound should be kept clean to prevent infection.

Depending on the type of surgery, absorbent or non-absorbent sutures may be applied. Non-absorbent sutures are usually taken out by a doctor within 5-14 days after surgery. Removal of sutures is a painless procedure. Absorbent sutures will disappear within 14-30 days; however, they can irritate the affected area during the absorption period.

Postoperative scars may fade after only a few weeks or up to 6 months. While the affected area is healing, it should be protected from sunlight; otherwise, pigmentation may persist for a long time. Patients who tend to have keloid scarring should consider cosmetic surgery.