Clinique de chirurgie plastique et esthétique Mario F. Bernier

BLEPHAROPLASTY… Eyelid surgery

The eyes play a vital role in our facial expression. They are used for expressing our feelings and emotions. The structures surrounding the eye, that is, the upper and lower eyelids, are responsible for projecting these emotions.

As time and the years add up, the eyelids get heavier and start looking puffier by the day. We start looking more and more like an ageing, tired and energy-less individual. Blepharoplasty to the rescue!

THE EYELIDS … Anatomy and ageing

The very first signs of ageing can normally be detected around the eyes. The skin covering the eyelids becomes thinner, wrinkly and loses its elasticity, thus creating a skin overlap (fig. 1). The muscles surrounding the eyes lose their tonus and plumpness (become thinner).

In some people fatty tissue begins appearing on the upper and lower eyelids to the point of causing protruding bags underneath the eyes (fig.2), whereas people with very little fatty facial tissue will have a tendency to have hollow, dark-ringed eyes.

Several factors may influence the ageing process of the eyelids:

• Overexposure to the sun
• Genetic predisposition
• Muscular tonus
• Certain factors relating to health problems such as allergies, heart or thyroid gland troubles may also come into play.

CHANGES IN UPPER AND LOWER EYELIDS DUE TO AGE
	From childhood to teenage years	From the twenties through the forties	From the forties to the fifties	The sixties and over
Skin texture	• Firm • No wrinkles • Upper eyelids well rounded and prominent	• First fine wrinkle lines • Gradual appearance of crow's feet	• Extra skin on upper eyelids • More visible wrinkles and crow's feet	• Much build-up of extra skin on upper eyelids • Deep wrinkles • Abundance of permanent crow's feet
Muscles	• Orbicular muscle is firm • Eyelids have good tonus	• Slight loss of muscular tonus	• More loss of muscular tonus	• Advanced loss of muscular tonus • Ectropion (pulling down of lower eyelids)
Fatty Tissue	• No fatty tissue bulges or • No hollow or dark-circled lower eyelids	• First small bulges of fatty tissue or • First dark rings due to excessive fatigue	• Bags (fatty tissue build-up) or • Hollow-looking eyes (eyes receding into cavity) • Permanently hollow lower eyelids	• Prominent bags with fatty tissue or • Eyes receding further into cavity

SURGERY … The importance of expertise

An analysis of the tissues surrounding the eye makes it possible to define the degree of ageing. A diagnosis then determines the appropriate surgical procedure and the steps to achieve optimal results. There are several ways of carrying out a blepharoplasty. The incisions or scars, for example, may appear similar but in fact, they are not. Close attention to minute detail and meticulousness, delicate handling of tissues, technical skill, knowledge and critical judgement on the part of the surgeon greatly influence the final results.

Blepharoplasty is usually done under local anaesthesia and in certain cases, under partial anaesthesia (deep state of sedation). The intervention takes about 1 hour.

Surgery of the upper eyelid

An incision in the shape of a crescent is made along the palpebral slant (normal fold of the upper lid) and completely masks any scarring that may occur. The excess skin is removed and the skin is stitched closed again.

One week after the surgery, Dr. Bernier will remove the stitches.

Surgery of the lower eyelid

An incision is made along the edge of the lower lid under the lash, making the scar, if any, almost invisible. Fat is then withdrawn or repositioned, the skin is re-draped, excess skin is removed and the incision closed. In certain types, often very young people, the lower lid can slant in such a way that they appear sad or shy. This can be easily corrected by a Canthoplasty. This type of surgery makes it possible to reposition the external angle of the eye, to raise the lower lid and partially correct the sunken part of the eye.
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When there is no loose skin, the fat can be removed using the transconjunctival method (inside the eyelids), which leaves no scar.