After a certain age, some problems may occur in the form of swelling or sagging skin in both the upper and lower eyelids. Under this heading, we will refer to some concepts related to eyelid problems and treatment approaches to eliminate these issues.
What is Dermatochalasis?
Dermatochalasis can be defined in general terms as sagging of the eyelid skin. It can affect both eyelids.
Why and who can get it?
- With aging, the eyelid skin becomes loose and loses elasticity.
- With the effect of gravity, the loosening of the skin tends to sag downwards.
- This condition may develop more clearly and earlier, especially in people who use excessive facial and eye expressions such as actors and vocal artists.
- People who have refractive errors such as myopia, hyperopia and astigmatism, yet didn’t use glasses or contact lenses to recover from this condition, may develop sagging eye skin over time and especially wrinkles around the eyes and forehead.
- Similarly, wrinkles and sagging occur around the eyes in people who work in jobs that require attention, such as tailors and painters.
- Computer users also carry these risks.
What is Blepharochalasis?
It is a type of valve swelling called angioneurotic edema of unknown cause, which occurs mostly in young women. As a result of repeated attacks, the lid skin becomes thinner and sagging occurs over time, just like in dermatochalasis.
Can Dermatochalasis be prevented?
As long as the aging can’t be prevented, it also cannot be prevented, but it can be delayed with some behavioral changes.
- Using as few facial expressions as possible in situations such as laughing, crying and getting angry.
- If there is an eye disorder such as myopia, hyperopia or astigmatism; wearing glasses or contact lenses, or having laser treatment.
- Wearing sunglasses in summer.
What is Eyelid Bag?
In fact, aging around the eyes is not just a loss of elasticity in skin. At the same time, loss of elasticity develops in the eyelid muscles and other tissues just under the muscle. There is also elasticity loss and weakening occur in the tissue called septum, which is located on both eyelids and acts as a barrier in the eyelid.
Normally, there are five fat pockets around the eyes, two on the upper lid and three on the lower lid. These fat pockets literally surround our eyes and are supported from the front by a thin and taut structure called septum. When there is a loss of elasticity or anatomical deterioration in the septum, these fat pockets around the eyelids herniate under the skin and form isolated swellings on the lid. Although this condition is often seen together with dermatochalasis and blepharochalasis, it can sometimes be seen alone. Although it is mostly seen on the lower lid, the oil pockets on the inside of the upper lid are also very often herniated.
Can my eyelids be healed with botox without surgery?
Botox can reduce wrinkles on and around the eyelids or provide a partial correction by lifting the eyebrows a bit. If there is sagging and excess skin, the surgery treatment is the best option.
Can it be fixed with filling?
There are some deep lines around the eyes, especially on the lower lid. A false correction can be provided by filling these areas, but it should be understood that this is not a final solution.
Can it be cured with surgical treatment?
Yes. In fact, it is the most accurate and definitive solution.
What to do before surgery?
Like every pre-surgery: Routine blood tests (especially in terms of any bleeding disorders and infectious diseases), The patient’s disease history is questioned and it is examined whether they are allergic to any medications.
Is the surgery operated with general or local anesthesia?
The surgery is mostly performed with local anesthesia. However, for patients who can’t lie on their back or who are extremely nervous and have fears, sedation or general anesthesia may be preferred.
In which area is local anesthesia applied?
If only upper surgery or lower lid surgery will be performed, local anesthesia is applied to the skin area. In cases where eyebrow lift surgery is performed with upper lid surgery, sedation or general anesthesia is applied. Direct nerve anesthesia, which we call block anesthesia, is performed in cases where the fat pockets are intervened beside lower eyelid surgery. The roots are anesthetized.
Is there pain during or after surgery?
After a good anesthesia is done, there is no pain during the surgery. After the operation, there may be a slight feeling of tension and pain that lasts for a day or two.
Can lower and upper eyelid surgeries be performed together?
There is no harm in performing upper and lower eyelid surgeries together. Only the surgery duration will be longer.
Will surgery be operated open or closed?
Open surgery is performed on the upper lid. Since the surgical incision area remains in the lid line, there is no scar left. It is possible to perform both open and closed surgery on the lower eyelid. This choice varies depending on the procedure to be performed and the decision made by your doctor. If there is only a fatty tissue herniation the closed surgery is preferred, whereas if there is excess skin along with the herniation; open surgery is a better choice.
Pre-surgical Consultation
During the examination, not only the eyelids, but also the eyebrows, forehead, mid-face area and even the entire face are evaluated as a whole.
Upper lid Blepharoplasty
- During the consultation, the upper lid skin is evaluated.
- The fat pockets are checked if there is prolapse arised.
- Eyebrow level status and any looseness in the eyebrow is evaluated. This is a very important situation. If there is slackness or drooping of the eyebrows, any intervention without intervening in the eyebrows will not give good results. In fact, a worse result may be experienced by reducing the eyebrow-eyelash distance.
- The area on the outside of the eye, which we call “crow’s feet” is evaluated.
- It is checked whether there is sagging or drooping of the valve, which we call ptosis. This is also a very important situation. Droopy eyelids are a completely different situation and the surgical approach is also different.
- The upper lid line, which we call the sulcus, is checked.
- The position of the tear gland is checked. If there is sagging in the tear gland and it is not corrected during surgery, it remains as a significant swelling after surgery.
- Tear ducts and mouth areas opening to the eyelid are evaluated. It is checked whether there is introversion or extroversion or there is a tendency to do so.
Lower Eyelid Blepharoplasty
- During the consultation, the lower lid skin is checked.
- Herniation is checked in the fat pockets.
- The lower lid eyelashes, the edge levels are evaluated, and their tendency to turn inward or outward is examined.
- The ability of the lower lid to cover the eye as desired is evaluated.
- Tear ducts and the areas adjacent to the eyelid are evaluated.
- The eye is examined for watery eyes.
- Midface is evaluated together with the lower lid.
When to return to normal life after surgery?
There is some edema and bruising on the eyelids after the surgery. It will gradually decrease and pass in about one week. Stitches can be removed and the patients can return to their normal life after one week.
What kind of drawbacks might surgery have?
- If there is a bleeding disorder, serious problems may occur both during and after the surgery.
- If too much skin or tissue has been removed from the upper lid, eyes may remain open after the surgery, especially at night, and this may cause serious problems in the eye. It is normal for it to remain slightly open in the early post-operative period, but if this persists, it may damage the eye.
- If the tear gland in the lid is damaged, there may be serious dry eye problems after surgery.
- Excess skin is removed from the upper and lower lids, the lower lid will be pulled downwards. This will cause lid gaping and tearing. External in the long run as a result of excessive contact with the world, the transparent layer inside the eye will be damaged.
- Problematic surgery may show itself as inward or outward turning of the valves.
- If the tear ducts are damaged, it will cause permanent watering and crusting.
- It should not be forgotten that ‘’Our eyelids are also the protectors of our eyes and have a functional structure. The aim shouldn’t only be to create a taut lid.’’