Tuesday, 26 July 2011


Published in City Times

Treating your baggy eyes and sagging confidence
Words: 1470

Are your eyes looking tired, wrinkled or puffy despite you following a good skincare and eye care regimen? Are genetic factors playing villain in causing these ageing effects prematurely in you? Do you feel you are being robbed of your youthful appearance and your confidence level at an all-time low? Well, then Blepharoplasty may be the answer to your problems.

Blepharoplasty or Eyelid surgery is a procedure to rejuvenate the eye and involves removal or readjustment of fat, removal of excess skin and muscle from the upper and lower eyelids. Blepharoplasty enhances your appearance and boosts your self confidence by addressing the problem of “ageing” eyes which make you look more tired and older than you actually feel.

Bagginess in the eye, hollowness under the eye or under-eye circle, deep lines under the eye, crease around the eyes, sagging eyebrows and drooping eyelids resulting from excess skin dropping over the eyelash and forming a hood-like covering, are all conditions amenable to treatment with Blepharoplasty, the main goal of which is more cosmetic than functional, says Dr.Sanjay Y.Parashar, Specialist Plastic Surgeon, UniCare Medical Centre, Dubai.

The best candidates for eyelid surgery, explains Dr.Parashar, are physically healthy men and women who have realistic expectations from the procedure. Most individuals undergoing the procedure are around 35 years or older. Doubtlessly there are non surgical procedures such as botox and filler injections available today that can solve the early problems of sagging brows and wrinkling around the eyes. Surgery then is ideally indicated for people who have very loose skin in either or both eyelids which gives a kind of coating on their eyelids, thereby tending to make the eyes look smaller and sad and in those individuals in whom the fat pops out, giving the eyes a very puffy and tired look.

In respect of drooping eyelids, not all situations are correctible by blepharoplasty. For, drooping eyelids could actually cause functional problems like restricting vision. In a situation where the whole eyelid curtain itself drops down, it is remedied by being lifted up in a procedure termed eyelid correction surgery, involving tightening muscles from the sides. But Blepharoplasty comes in useful when the drooping eyelids are caused by the excess skin which actually drops over the eyelash and forms a hood-like covering. This happens especially in individuals advanced in age who have lax skin and in those people who have lost a lot of weight, the fat has gone away and the excess skin over the eyelid actually covers like a second eyelid curtain, says Dr.Parashar.

A few medical conditions make blepharoplasty more risky. They include eye pathology, uncontrolled high blood pressure and diabetes, cardiac & renal problems and people who are on a lot of medication, especially steroids. Also, people who have dry eye problem and those who are unable to retain tears in the eye region don’t make good candidates for eyelid surgery because their problems may worsen from surgery.

Dr.Parashar cautions that all individuals seeking the surgery should first be evaluated for primary eye problems by an ophthalmologist, to see if they have proper vision, if the eye muscles are functioning well, if the eyeballs are moving well. He reiterates that any eye pathology is not an indication for the surgery. Prior to surgery, a potential candidate’s complete medical history is taken, blood tests done and some visual tests are also done to ensure he/she is safe for the procedure.

The actual surgery may take between one and two hours and is mostly done as an outpatient procedure with individuals going home the same day. It is performed under local anesthesia and patients are mildly sedated. The typical procedure involves the surgeon making incisions following the natural lines of one’s eyelids, in the creases of the upper lids and just below the lashes in the lower lids. The cut, especially in the lower lid is designed in such a way that the scar so formed, will not be visible in the future. Working through this incision, the surgeon removes excess fat and trims the sagging skin and muscle. Also, if the brow is sagging, it is lifted as well, working through the same incision. The incision is finally closed with fine, removable stitches which are removed 3-4 days later.

Depending on the nature of their job, people are back to work between 2 days to 2 weeks following surgery.

Explaining the rationale of the procedure, Dr.Parashar clarifies, “The philosophy of blepharoplasty has changed since its inception. We don’t necessary remove the excess fat or cut the excess skin out as was earlier done. Instead, wherever possible, we readjust or reposition the fat to obtain a youthful skin glow. Where the skin, particularly in the upper eyelid is lax on account of a sagging brow, we lift the brow rather than remove the skin around the eyelid. Sometimes, especially in younger people, when they have a pocket of fat beneath their lower eyelids but don’t need to have any skin removed, we go in for a transconjunctival blepharoplasty. This involves adjusting the fat by making a cut inside the lower eyelid such that the incision is not visible at all.”

As an after-effect of surgery, people may experience foreign body sensation in the eye, bruise, swelling, burning sensation on the incision line, itching, double or blurred vision, sensitivity to light, excessive watering, inability to close the lids while sleeping and consequent dryness of the eyes. These symptoms are temporary and may be experienced for a few days to a couple of weeks.

In the hands of an experienced and qualified surgeon, blepharoplasty is a very safe procedure and complications are very rare, usually minor and very much manageable, reassures Dr.Parashar. Very specific complications that can happen following surgery include the person’s inability to close the eyelid, permanently. This may happen if the surgeon does not estimate the amount of skin to remove and tends to over-remove it. A consequence of this would be exposure-keratitis - dryness of the eyes which can affect the cornea and conjunctiva and damage the cornea. But again, this condition may be rectified with secondary surgery.

Another very rare complication of too much skin removal is a condition called ectropion, involving the lower eyelids. This involves an altering of the position of the lower lid in relation to the eye globe which produces various untoward effects. This includes constant tearing since the sockets holding the tears cannot retain them anymore and exposure problems because of the eyelids being unable to cover the eyeballs.

Aesthetics may suffer when one side gets treated more than the other, resulting in asymmetry of the eyes.

Hematoma, or a pooling of blood outside a blood vessel, is another very rare surgical complication which can happen within the first 8 hours to 48 hours of surgery. It may also show up beyond this period of time if there is a precipitating factor as when a person suffers undue physical stress from bending or stooping low, especially to lift weight.

On the question of performing blepharoplasty in people with squints, Dr.Parashar opines that the surgery could be a double-edged sword. “Squint is not really a contra-indication in Blepharoplasty and such an individual can undergo the procedure for rejuvenating his eyes. But in such cases, we (the surgeons) need to actually visualize how their eyes will look after the surgery. Sometimes, some of the squints can be covered very well with the procedure; in other situations, by over-removing excess skin, we may actually accentuate the squint!”

Do’s and Don’t’s Following Surgery
To soothe the swelling and bruise following surgery, ice may be placed over the eyes for a few hours following surgery.
Patients are advised not to indulge in strenuous activities for about 2 – 3 weeks so as to avoid increased blood pressure. Bending, lifting and rigorous sports should be avoided.
Reading, TV viewing and working on the computer should be avoided at least for a couple of days.
Patients may use artificial tears if they sense too much of dryness in the eyes.
Painkillers may be used to deal with pain.
Contact Lens should be strictly avoided for at least 10 days to a fortnight following surgery.
The face may be washed the day after surgery. This should be more of rinsing by splashing water and wiping it gently with soft cloth.
The eyes may be lubricated for a few days with the use of appropriate ointment to prevent scruff and dryness in the region.
Prior to, and post surgery, the individuals should not use medication like aspirin, brufen and Vitamin E since they can cause more bruising and swelling.
Patients must consult the doctor immediately if they sense any untoward symptoms including excessive pain in the eyeball or eye region, swelling that is rapidly increasing, reduced vision and excessive dryness in the eyes.



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