Eyelid Aesthetic Surgery

Definition and Purpose

Eyelid aesthetics (blepharoplasty)is a surgical procedure that is performed to remove excess skin and fat tissue from the upper and/or lower eyelids, giving a younger and more vigorous appearance to the eye area. With the progression of age, excess skin and bagging can occur on the upper eyelids, and fat deposits and skin wrinkles called “under-eye bags” on the lower eyelids. This condition can give the person a tired, sad expression; it can even narrow the visual field when the upper eyelid drooping is at an advanced level, leading to functional problems. Thanks to eyelid surgery, the lower eyelids are removed, the bags in the lower eyelids are corrected and the eye area becomes smoother. As a result, the person acquires a more rested, energetic and youthful expression of gaze. Although blepharoplasty can usually be performed alone, it is also a common approach to combine it with other rejuvenation surgeries, such as a facelift or eyebrow lift. This operation aims to restore the former vigor by removing the excess of existing tissues, rather than changing the structure of the eye (such as the almond eye shape).

How Is It Done?

Eyelid surgery can include the upper eyelid, lower eyelid, or both together. The operation can be performed under local anesthesia and sedation or under general anesthesia according to the patient's preference and the surgeon's recommendation. In upper eyelid surgery, the surgeon plans the incision line to remove excess skin so that it coincides with the natural eyelid fold. In this way, the surgical scar is hidden in the eyelid fold. After the incision is made, the excess skin in the upper lid is measured, carefully removing or redistributing the accumulated adipose tissue, if any, under it. Then the necessary tightenings can be made in the muscle tissue, and the incision is closed with fine stitches.

There are more than one technique involved in lower eyelid surgery:

• If there is a noticeable excess of skin on the lower lid, a horizontal incision is made just below the eyelashes, providing access to the skin and subcutaneous tissues (transcutaneous method). Through this incision, protruding fat pads on the lower cover are made visible. The surgeon either partially removes these fat deposits or spreads them towards the sunken areas in the lower eye socket and repositions them (redistribution of fats is important to ensure a natural transition in the lower eyelid). If necessary, support stitches are also placed on the loose muscles and connective tissues of the lower eyelid, increasing the tension of the lower eyelid. Finally, the excess strip of skin is measured and removed and the incision is closed with very thin sutures.
  
  
• If the skin surplus is too small and only fat bags are a problem, an incision can be made through the lower flap through the pink mucosal surface called the conjunctiva (transconjunctival method). In this technique, there is no visible trace on the outside; the lower lid fat is removed from the inside or spread. However, this method does not interfere with excess skin in patients with skin sagging, so it is not suitable if skin sagging is present.
  
  

During both upper and lower eyelid surgeries, small additional rejuvenating interventions can usually be performed around the eyes as part of the procedure. For example, to increase the tone of the outer corner of the lower cover canthopexy by applying a so-called hanging procedure, the lower lid is prevented from remaining too loose after surgery. Again, oil injection or eyebrow lifting can be integrated into the area between the upper lid and the eyebrow if needed.

At the end of the operation, very thin stitches are usually inserted into the incisions. These stitches remain on the skin on the upper lid, under the lash line on the lower eyelid or (in the transconjunctival approach) within the cap. The top of the eyes is usually not closed, but the suture lines can be supplemented with sterile thin tapes (strips). It is taken to the patient's room by applying a cold compress to the eyelids. The duration of surgery is average in cases where the upper and lower lid is performed together 1-2 hours is in the vicinity.

Who is it suitable for?

Eyelid aesthetics are generally preferred in individuals who have significant aesthetic or functional problems with their eyelids, usually middle-aged and older. The characteristics of ideal candidates can be summarized as follows:

• Those with Upper Cover Sagging: People who have difficulty applying makeup due to the accumulation of skin on the upper eyelids, or even in advanced cases, the skin fold on the eyelid descends to the lash line, narrowing the field of vision. These individuals may have eyes that appear more open and large with blepharoplasty, while their visual fields can also be enlarged.
  
  
• Bottom Cover Bagging and Those With Rings: People with swellings (fat bags) under the eyes, which constantly give a tired expression, and pits under them that lead to shading. With lower eyelid aesthetics, these bags can be removed, and the transition in the under-eye area is made smoother, giving the face a vibrant look.
  
  
• People With Decreased Skin Elasticity, Wrinkled Around Eyes: Patients with pronounced wrinkles and sagging on the skin of the lower eyelid, experiencing “wrinkling” under the lid when smiling. Excess skin removal during lower blepharoplasty in these individuals ensures a smoother lower cap-skin combination.
  
  
• General Oral Health Good Ones: Those who do not have serious health problems that prevent them from receiving anesthesia. Candidates with controlled conditions such as hypertension, thyroid disease, without bleeding-clotting disorders. In addition, extreme caution should be exercised when planning blepharoplasty in patients with ocular disorders such as glaucoma, significant eye dryness, and consultation with the ophthalmologist should be carried out if necessary.
  
  
• Those with realistic expectations: People who are aware that they will achieve a more youthful and rested appearance after surgery, but who do not fall into the expectation of being “perfect”, aiming for an appropriate change in facial structure. It is also important for them to know that the scars of surgery will be properly hidden, but a completely traceless operation is not possible (especially in the fold of the upper lid, the scar may remain in the form of a thin line, it will become indistinct over time).
  
  

Usually people who have these problems over the age of 35 are candidates for eyelid aesthetics, but it can also be practiced in their late 20s or 30s in those who have a genetic problem with bagging at a younger age. Having candidates share their pre-surgery expectations clearly with their surgeon and being informed about the limits of the operation is key to a healthy outcome.

Possible Risks and Complications

Blepharoplasty is an operation with a low complication rate when performed by experienced surgeons. However, due to the sensitivity of the eye area, careful monitoring and prevention of problems that may occur is necessary. Here are the main risks that can be seen in eyelid aesthetics:

• Bruising and Swelling: As with any surgical procedure, bruises and swellings due to trauma occur in the tissues after eyelid surgery. Especially in the first 2-3 days it can be noticeable around the eyes, sometimes descending to the cheeks. This condition is an expected process and is not considered a complication; with the application of cold and the position of the head on high it will improve greatly in 1-2 weeks.
  
  
• Dry Eye and Temporary Blurred Vision: There may be dryness on the surface of the eye due to the inability of the eyelids to close completely or the less frequent blink reflex after surgery. Patients may complain of a feeling of dryness, stinging or blurred vision. In this case, artificial tear drops and ointments are used. It is usually a temporary condition and will improve when the valves recover and return to normal function. In addition, ointments used on the surface of the eyes in the first days after surgery can also make vision blurred temporarily.
  
  
• Hemorrhage (Retrobulber Hematoma): It is a very rare but serious complication. Symptoms such as sudden eye pain, decreased vision, pushing forward in the eyeball can occur if a vessel in the back of the eye causes bleeding pressure. This is a condition that requires immediate intervention because, if left untreated, it can lead to vision loss. Detailed bleeding control is performed during surgery to reduce the risk of bleeding and the patient is closely monitored for the first 24 hours.
  
  
• Infection: Infection occurs rarely in eyelid surgeries. Symptoms include redness, purulent discharge, increased swelling and pain. In the early period, it is treated with strong antibiotic drops and oral antibiotics. It is very rare for the infection to spread and cause serious eye problems.
  
  
• Valve Disorders (Ectropion/Entropy): Due to the removal of excess skin on the lower eyelid or due to scarring, the lower eyelid may remain facing outwards (ectropion) or vice versa can turn inward (entropion). In case of ectropion, the lower lid cannot fully contact the eyeball, and tears may flow from the eye, dry eyes may develop. In mild cases, recovery is achieved through massage and skin stretching exercises, while in severe cases, a second correction surgery may be required. Entropy, on the other hand, can lead to contact of the eyelashes with the eye, which again may require surgical correction. These complications occur very rarely with proper surgical planning and removal of the appropriate amount of skin.
  
  
• Double Vision or Vision Changes: Very rarely there may be temporary double vision complaints after eyelid surgery. It is usually associated with swelling of the muscles around the eyes and resolves on its own. Permanent vision problems, on the other hand, are extremely rare and are usually the result of a serious complication such as bleeding.
  
  
• White Dots on the Skin (Milia): Small white blisters (milia) can sometimes form, especially along the upper eyelid incision line. These are tiny cysts that are common in the healing process and can usually be easily removed with a needle tip during the first check.
  
  
• Trace and Color Change: Since the upper cover incision is hidden in the natural fold, it often leaves an indistinct mark. If an under-eyelash incision was made on the lower lid, this thin line, which was initially slightly pink, fades over time. Some patients may rarely develop hypertrophic scar and remain noticeable scar, if deemed necessary, it can be revised after a few months. In the first months after surgery, there may be slight color darkening or light-colored areas on the incision line, which usually return to normal within 6-12 months.
  
  

Most of the complications after blepharoplasty can be managed without permanent damage, especially if the patient follows the doctor's instructions, either do not appear at all or appear. Therefore, it is very important to strictly follow such recommendations as the use of eye drops after surgery, the application of ointments given, eye hygiene and protection from trauma.

Healing Process

The healing process of eyelid aesthetics surgery is relatively quick, and patients usually return to their daily lives in a short time. Immediately after surgery, there may be small bands around the eyes instead of bandages, and the application of cold compresses is started. A slight tingling and slight stinging sensation in the eyes is normal. Lying with the head high on the first night reduces edema.

The first 2-3 days: Swelling and bruises around the eyes during this period are most intense. Especially in the morning, the eyelids can be more swollen. Cold gel pads or ice bags should be applied several times a day at intervals of 10-15 minutes (taking care not to contact ice directly on the skin). The eyes are moistened with artificial tear drops recommended by the doctor, while the ointment with antibiotics is rubbed into the seam lines and into the eye at certain intervals. If there is a slight feeling of pain or discomfort, simple painkillers will suffice. Although it is possible to read books or look at screens in the process, there may be quick fatigue in the eyes, so it is better to do it short-term and take frequent breaks.

First Week: After about 5-7 days, the stitches in the upper and/or lower lid are removed at the control appointment. It is necessary to keep the eyelid area dry until the stitches are removed, be careful when bathing (usually the first 3-4 days it is recommended to wash from the waist down instead of a full shower, when washing the hair, the head is thrown back so that it does not touch the water). After the seams are removed, the tapes, if any, are also removed and the residual contact with water becomes free. By the end of the first week, the bruises turn yellow-green in color, and pronounced swelling begins to descend. If the patient feels well, he can return to light daily activities during this period. But it is necessary to wait for work that can increase blood pressure, such as heavy exercise, bending, heavy lifting.

Week 2: Around 10-14 days, many people come to the condition that they have undergone an operation that is noticeable from the outside. The remaining light bruises can be covered with makeup, the puffiness is greatly reduced. If a person works in a desk job, they can usually return to work at the end of 1 week or at the latest in 10 days. This period may vary depending on the scope of the procedure performed and the individual speed of recovery. In the second week, light exercises such as walking can be started, but activities that will still raise blood pressure (such as lifting weights) should be avoided.

1 Month and After: After 3-4 weeks after surgery, the eyelids reach their almost normal appearance. There may still be a slight pink trace or a very minimal swelling, which will also gradually disappear. During this period, patients can return to all their normal activities. Since the eyelids are very sensitive, protecting the scars of surgery from the sun is an important issue in the long term. It is advisable to wear wide sunglasses when going out in the first months, apply a 50 SPF sunscreen. The full maturation of the traces and their final form is approximately 6-12 months can last; at the end of this time they usually remain in the form of vague, thin white streaks.

In eyelid aesthetics, the results are permanent for many years; however, as the aging process continues, there may be some relaxation again over the years. Usually, top cover aesthetics give an effect of 10-15 years, while bottom cover bags often do not repeat. Steps such as regular sleep after surgery, healthy eating, caring for the skin around the eyes will help maintain the acquired youthful appearance.

Eyelid Aesthetics at Central Hospital Istanbul

Eyelid surgery at Central Hospital Istanbul is performed by our experienced aesthetic surgeons who master the anatomy of the eye area. Before surgery, our patients are evaluated together with our ophthalmologists. In this way, if there is an existing eye dryness, glaucoma or other ocular discomfort, the surgery plan is shaped accordingly or the necessary measures are taken. The patient's upper valve inferiority and the degree of lower valve bagging are carefully analyzed, determining the optimal surgical technique (e.g. classical or transconjunctival approach). Expectations are discussed; alignment is made between the outcome desired by the patient and what is medically possible.

Our surgeries are performed in a fully equipped operating room environment, in sterile conditions and using advanced microsurgical instruments. Our surgeons take care to complete the procedure with minimal trauma, approaching the tissue as gently as possible during the operation. This, in turn, contributes to the fact that bruises and swelling after surgery are minimal. Thanks to fine sewing materials and techniques, scars become almost invisible after healing.

Patients who have undergone eyelid surgery in our hospital can usually be discharged on the same day after resting for a few hours in their comfortable room. Before discharge, our team of specialists gives our patients detailed information on cold application, medication use and how to apply eye drops. They are told individually what they should pay attention to in the first days, in which cases they should call the hospital. In addition, control appointments are scheduled (typically on the 5-7th day, such as the suture intake and the first check-up, followed by the 1st month check).

The postoperative follow-up process at Central Hospital Istanbul is meticulously carried out. At each check-up, our surgeon evaluates the recovery, answers the patient's questions, and makes additional recommendations on care. Our patients can contact us directly when they have any concerns during the recovery period and are promptly informed.

In aesthetic interventions, our goal is not only to achieve a good surgical result, but also to ensure that our patients feel safe and comfortable throughout the process. Our patients who undergo eyelid aesthetics enjoy their new appearance with a healthy recovery process with special attention and professional approach to the person offered by Central Hospital Istanbul. The fact that they have a brighter and younger look is one of our greatest sources of happiness.

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