Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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Eyelid surgery is typically performed in an accredited ambulatory surgery center or a hospital setting. The environment is sterile and equipped with advanced monitoring technology. The patient’s comfort and safety are paramount, with continuous monitoring of heart rate, blood pressure, and oxygen saturation.
The eyes are protected with corneal shields during the procedure, mainly when lasers are used. The entire face is prepped with an antiseptic solution, and sterile drapes are placed. This rigorous preparation minimizes the risk of infection.
For upper eyelids, the surgeon follows the pre-marked lines in the natural crease. A radiofrequency device or scalpel is used to excise the skin. A strip of orbicularis muscle may also be removed to sculpt the lid.
For the lower eyelid, using the transconjunctival approach, the incision is made within the lower lid. The surgeon gently dissects down to the fat pads. If skin needs to be removed (subciliary approach), the incision is made just below the lash line, extending slightly into the crow’s feet area.
This is the most artistic phase of the surgery. The surgeon identifies the three fat pads in the lower lid and the two in the upper lid. For removal, the fat is gently teased out and cauterized at the base.
For repositioning, the fat is released from its capsule but left attached to its blood supply. It is then transposed over the orbital rim and sutured into place to fill the tear trough. This requires meticulous technique to ensure the fat survives and stays in position.
Absolute hemostasis (stopping all bleeding) is critical in eyelid surgery. Even a small amount of bleeding can cause a hematoma that threatens vision. The surgeon uses bipolar cautery to seal every tiny vessel.
Closure is performed with excellent sutures, often thinner than a human hair. In the upper lid, the skin edges are brought together to reform the crease. In the lower lid, the skin is draped gently without tension to prevent pulling the lid down.
After the surgery, an antibiotic ointment is applied to the eyes and incisions. Cold compresses are placed immediately to minimize swelling. The patient is moved to the recovery room and monitored until the sedation wears off.
Vision will be blurry due to the ointment. There is usually minimal pain, more of a tight or sore sensation. Patients are discharged once they are stable and alert, usually within an hour or two.
The first two days are the peak of the inflammatory response. Swelling and bruising will increase before they decrease. Patients are instructed to keep their heads elevated at all times, including while sleeping, to reduce fluid accumulation.
Ice packs should be applied for 15-20 minutes every hour while awake. Activities should be restricted to essential movements only. Reading or watching TV might be difficult due to blurry vision, so listening to audiobooks is recommended.
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Pain is generally mild. Most patients manage well with extra-strength acetaminophen (Tylenol). More potent narcotics are rarely needed and can cause nausea. Avoiding aspirin and ibuprofen is still crucial to prevent late bleeding.
Patients may experience a gritty or dry sensation in the eyes. Artificial tears are used frequently during the day to keep the eyes moist, and a thicker ointment is used at night.
Keeping the incisions clean is vital. Patients are taught to clean the suture lines gently with saline or diluted hydrogen peroxide using a cotton swab. Antibiotic ointment is then applied thinly.
Showering is usually permitted after 24 hours from the neck down. Face washing should be done gently with a washcloth, avoiding the eyes. Crusts should not be picked at, as this can cause scarring.
Sutures are typically removed 5 to 7 days after surgery. This is a quick and generally painless appointment. Once the sutures are removed, the patient may feel more comfortable, but the incisions remain fragile.
Steri-strips or surgical tape may be applied to support the incision for a few more days. At this stage, the incisions will be pink and visible, but they can usually be covered with sunglasses.
Between week 1 and week 2, patients enter the “ugly duckling” phase. Bruising may turn yellow or green as it resolves. Swelling may be asymmetrical, making one eye look different from the other.
This is normal. The eyes may feel tight, and the patient may have difficulty closing them completely at night. This lagophthalmos is temporary and resolves as the swelling goes down. Patience is the primary prescription during this phase.
Light walking is encouraged from day one. By week 2, most patients can return to desk work and light social activities. Makeup can usually be applied to the incisions after 10-14 days.
Strenuous exercise, heavy lifting, and bending over (which increases intracranial pressure) should be avoided for 3 to 4 weeks. Contact lenses can usually be resumed around week 2 or 3, depending on comfort.
While rare, patients are educated on the signs of complications. Severe pain, loss of vision, or massive swelling on one side indicates a hematoma and requires emergency attention. Signs of infection include increasing redness or discharge.
Chemosis, a swelling of the transparent membrane over the white of the eye (looking like a blister), is a common, benign, but annoying issue that resolves with lubricating drops and time.
You can, but your eyes will tire easily, and the ointment might make your vision blurry. It is better to rest your eyes for the first 2-3 days. Audiobooks or podcasts are a great alternative.
Use a recliner chair or stack 2-3 firm pillows on your bed to keep your head elevated at a 45-degree angle. You can place pillows on your sides to prevent rolling over. This is crucial for reducing swelling.
Yes, bruising is very common. It usually starts red/purple, then fades to yellow/green. It typically resolves within 10 to 14 days. Some people bruise more than others.
Try to avoid crying if possible. Crying can cause swelling and congestion in the eyes, prolonging your recovery and making you uncomfortable. It won’t ruin the surgery, but it will set back your swelling resolution.
You will be “socially presentable” with sunglasses after a week. With makeup, you can go out after 2 weeks. However, you won’t look “normal” or photo-ready for about 4 to 6 weeks, when the majority of the swelling is gone.
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