There are several areas which need be taken into
consideration to define the problems of sagging eyelids.
Extra skin, stretched out muscles, fat protrusion (which
causes circles and bags especially in the lower eyelids),
and drooping eyebrows are all factors which go into
the decisions on exactly how the eyelids must be repaired.
Any one or all of these situations may lead to the individual's
concern regarding their appearance.
Generally too much skin and stretched muscles are
the problems of the upper lid. There may be a smalll
collection of fat adjacent to the nose that compounds
this aged appearance. Often sagging eyebrows play a
major role in this area. The correction may be a simple
as removing extra skin and tightening the stretched
muscles. Usually a small amount of fat is removed at
the same time. The sutures are removed in four to five
days and swelling and the bruising are also minimal.
If the eyebrows and forehead play a major role in
the sagging of eyelids additional surgery is required
to lift the eyebrows. Frequently incisions are made
at the forehead hairline in order to lift the eyebrows
and to support the repositioning of the eyebrow. The
sutures holding the eyebrow lift remained for 7-8 days,
and there may be some additional swelling and bruising
accompanying this surgery.
The lower eyelids have three components that give
signs of aging. Skin, fat and a rough complexion must
all be evaluated. Anyone or all of these factors may
contribute to the eyelids that we may want changed.
Extra skin, the most obvious factor, can be removed
via an incision next to the eyelashes. The stitches
are removed at 4 to 5 days and, similar to the upper
lids, the discoloration fades quickly and the resultant
scars are almost impossible to detect after several
months. Makeup, applied after four to five days easily
camouflages the bruising.
The roughened complexion and fine wrinkles of the
lower eyelids and crows feet area are treated by light
lasering. The skin is smoothed and lasering results
in tighter eyelids. The trade-off is that the lasering
takes longer to heal, at first with minimal oozing and
crusting, and then with discoloration that takes several
months to fade, although makeup easily hides most of
the pigmented area.
Finally, the protruding fat of the lower eyelids can
lead to pouches that are unsightly and cannot be corrected
by skin removal alone. This lower eyelid fat is removed
by incisions made on the inside of the eyelids. This
conjunctival incision is made it to decrease swelling
and discoloration of the eyelids. I have been using
this approach for a number of years. It prevents the
potential problem of pulling down the eyelids margin
which in some instances require secondary surgeries
for correction. The trans- conjunctival incision leads
to faster healing with very small potential to cause
changes in the shape of the eyes.
Eyelids surgery can be performed under local anesthesia
with intravenous sedation or under general anesthesia.
Local anesthesia is used when either the upper eyelids
or the lower eyelids alone are operated. When all four
eyelids are operated, plus lasering, with or without
eyebrow lifts which involve the forehead, general anesthesia
is mandatory.
The surgery is performed in our outpatient surgery
hospital which is located in our office building. The
surgery center is licensed by the federal and state
government and is a fully licensed outpatient hospital.
My anesthesiologists are board certified physicians
who perform major surgeries in the Oklahoma City Area
as well as work with me in the outpatient surgery center.
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