Blepharoplasty

Blepharoplasty (etymologically derived from the word eyelid and plastic meaning I give shape, shape something, giving it a better shape. Thus, with blepharoplasty we give better shape to the eyelids for aesthetic or functional reasons.

Our eyes are one of the first signs in which the signs of time appear. Imagine the upper eyelid like a balloon, which deflates with time. With time the skin loses its elasticity and relaxes, the fat protrudes and the eye muscle clamp becomes weaker. As age passes, this excess skin or fat prolapse on the eyelids makes us look tired.
In blepharoplasty, the skin is removed, which has been loosened and left over, as well as fat.
Thus, the eyes can acquire their previous shape and shape, without changing the natural shape of the eyes, which is the work of the specialist. Blepharoplasty can give a more youthful and relaxed appearance.

How is upper eyelid blepharoplasty performed?

On the upper eyelids, the loose skin, which is wrinkled and hung, especially on the sides, creates blinds and limits the field of vision. It can also create heaviness and headaches, but also aesthetic problems giving a tired and aged look. The excess skin and fat of the upper eyelid are removed through an incision hidden in the normal wrinkling of the upper eyelid. If, in addition to the excess skin, there is a fall of the upper eyelid, we also correct the muscle that lifts the eyelid. The incision is closed with a thin suture.

How do I treat dark circles and bags?

Eyelid bags and dark circles are two of the most common reasons why patients visit the clinic seeking a specialized opinion and treatment of their problem. On the lower eyelids, excess skin and fat prolapse create the image of “dark circles” or “pouch”, giving the impression of a tired look.
As you will see below there are several causes for the appearance of dark circles. Different causes can also create so-called bags on the lower eyelids.
The prolapse of orbital fat is one of the causes of dark circles.
The fat inside the orbit increases with age and moves forward.

Other causes of dark circles that can be diagnosed are:
– Structural shade – created by the shade of the eyebrow when it is further out from the lower bone boundary of the orbit, and by the relationship of the bone boundaries of the orbit with the eyeball.
– Inflammation (e.g. sinusitis);
– Allergies (allergic conjunctivitis, dry eye, blepharitis, etc.)
– Sagging skin and tendons.
– Skin thinning – this way the underlying rich vein network is revealed and the veins give a dark blue tinge resulting in dark circles.
– Sun damage – dark skin.
– Anemia
– Hormonal parameters
– Lack of sleep, sleepless nights, drinks, fluid retention, etc.

Each of the above factors should be considered by Dr. Nikolaos Trakos. Each factor can play a different role in the problem of each patient.
Before a renewal plan is drawn up all the causes should be assessed and a personalized plan for each patient should be drawn up. Some surgeons only know one technique in an operating room, and they will use that standard technique that they have, exactly, the same in every patient who appears in their office for assessment. The problem with this generalized approach is that if the same technique is used in everyone, the results may be undesirable.
The correct one is that different techniques should be used depending on the case.
As you will see, not everyone can be helped by minimally invasive technical treatments, but not everyone will need surgery. Our philosophy and approach is that there are many ways to rejuvenate the lower eyelids, and the best treatment for you will be different from that of your friends or neighbors.
Lower eyelid blepharoplasty can correct the bags in the lower eyelids.

How is lower eyelid blepharoplasty performed?

Blepharoplasty on the lower eyelids treats the bags of the lower eyelids. After the age of 35, part of the bone is lost in the middle face and thus the structural support of fat and soft tissues is reduced. With time, a hymen, called a diaphragm, weakens under the eye, retreats downward the fat to the orbital boundary, and increases the fat inside the orbit. As a consequence of these architectural changes fat protrudes and appears as a pouch.

Over time a fat hernia is created, and the treatment in the early stages is the injection of hyaluronic acid into the lower limit of the orbit and the middle face to create a support, fill the created groove, and also cover the deficit of tissues.
In more advanced stages we need to remove the fat and spread it to the bottom of the orbit. This is called lower eyelid blepharoplasty. This is done through an incision in the conjunctiva of the lower eyelid, as you see in the picture.

If excess skin is removed. The removal of the skin is done by a fine incision which is performed just below the line of the eyelashes and extends to a natural wrinkle which heals extremely well. So this incision is hidden and it is not visible in the end.

When only skin is removed, and there is no excess fat, the procedure is known as skin removal blepharoplasty.
If the relaxation of the lower eyelids is also caused by the loosening of the supporting ligament at the orbital border, it will be necessary to have a stretching operation of the lower eyelids (canthoplasty or canthopexy), in order to acquire their previous shape and shape and without changing the natural shape of the eyes, which is the work of the specialist. Blepharoplasty can restore a more youthful and restful appearance.

An essential element of any surgical procedure, especially cosmetic surgery, is providing the patient with sufficient time for information.

What are the factors associated with the aging of the lower eyelids, creating bags and dark circles?

An important part of the initial assessment of your problem is about genes. The imprint of life is done by our parents. It is very common for some patients to report that they have the same eyes as their father or mother or another relative. Particular importance is given to anatomical differences: changes in anatomy such as the position of the upper and lower eyelids, the angle of the eyes mainly or outside, the position of the eyebrows, cheeks and forehead, as the relative position of the eyes with the bones of the face (what we say if the eyes are outward or inward) are very important things that the specialist should appreciate. For example, some patients have eyes and will need a different treatment from someone or someone who has deep eyes. The aging process is significantly different in everyone and depends on the anatomical differences between individuals.
During the initial assessment-examination, the particular factors associated with the aging of the eyelids and how bags are created in the lower eyelids will be noted, in order to create a personal plan for you. Below are these factors:
Skin changes: over time, but especially in people who are smokers and even passive, the eyelid issue becomes thin and loses its elasticity. Also, due to frequent eye rubbing, the skin relaxes and thus creates excess skin, on the upper eyelids and lower eyelids. Another mechanism concerns people who sleep under the pads, face or side, and causes chronic stretching of the skin of the eyelids and its subsequent relaxation. Some of them develop loose eyelids (loose eyelid syndrome with significant eye problems).
Prolapse-hernia of the orbital fat: There is a structure called diaphragm, located on the eyelids, which helps the contents of the orbit from moving forward.
One reason that bags are created on the lower eyelids is that this structure weakens over time, and the fat, which should normally be inside the orbit, moves forward.

Tumor loss: With age there is a progressive loss of volume on the face. This is an important reason why some people get bags under their eyes. We need to identify this important parameter during the initial assessment.
Fall of the average person or cheeks: due to gravity and as time passes, the tissues on the face fall. This is another reason to make the bags of the lower eyelids even more intense.
Lack of sleep: The sleep process is not only important for resting our body and spirit, but is also essential for getting rid of the metabolism products that are created on the face during the day, but also for moisturizing the facial tissues. It is recommended that each person sleep at least 7 hours a night. Studies show that coffee and alcohol combined with lack of sleep will lead to significantly accelerated aging.
Sun exposure: It is never too late to start using a good sunscreen. Sun exposure can not only lead to skin cancer, but can significantly accelerate aging. We recommend sunscreen with SPF 25+ protection index every day. Even on a cloudy day we should put a normal sunscreen cream, since the clouds filter only 20% of the solar ultraviolet radiation. Much more in Greece, which is a country full of sun, the use of sunscreen is even more important. You should also ensure that the product is protected for both UV-A and UV-B UV radiation.
Diet: Green vegetables have too many antioxidants and other ingredients that can slow down the aging process. A balanced diet is essential.
Allergens: If your eyelids sometimes swell and “eat” or are red, you may be allergic, which makes the bags of the lower eyelids and dark circles worse.

Are there any creams that could help in dark circles?

There are many reasons why black circles of the eyes are created. Identifying the specific cause is the most important and effective way to address the problem. During the initial examination Dr. Trakos will identify the cause and show you the required treatment. If you need a specific eye cream, he will recommend it.

What can personalized blepharoplasty achieve?

The eyes will become more relaxed and will gain a liveliness after eyelid surgery, gaining a better shape. The result is a more relaxed look of the eyes. You will look fresher or fresher – since men have a right as well as women – as if you were just returning from a vacation. Even so, the surgery will not remove all the wrinkles around the eyes, especially the wrinkles created with laughter on the outside side of the eyes, in the so-called goose foot.

Very often the results are so natural that friends and colleagues will comment on how fresh or well you look, without realizing that a surgery has been performed. The blepharoplasty of the lower eyelids can be done from inside the eyelid without an external incision, so that there is no visible scar or incision, correcting the bags of the lower eyelids caused by the hernia of fat.

What do you mean by personalized blepharoplasty?

Many plastic surgeons apply the same technique in the same way for all patients. This is like visiting a hairdresser who makes a single specific type of haircut or hairstyle without personalizing it on the head and face of each one.
The Art of Blepharoplasty needs to be unique and personalized for each patient personally. The physiognomic characteristics of each patient are studied by the specialist, and through a proper assessment and the history of the family photo album to understand the expectations of each different patient.
In the past, even today, excess fat was removed from the orbit as part of the blepharoplasty causing a hollow orbit – empty orbit and a sick appearance. We know that juvenile eyes are distinguished by naturalness and symmetry. That’s why Dr. Nikolaos Trakos personalizes the treatment plan for each patient individually in order to achieve a youthful and harmonious result.

What is the best age usually for an upper eyelid blepharoplasty?

Eyelid surgery is usually performed in patients aged 50 or over, although it can be performed earlier, such as in 20 or 30 in cases where there is a predisposition in the family for loose and drooping eyelids or in people who due to racial origin, such as Asian, have hooded eyelids.

Will there be scars on my eyelids?

The incision on the upper eyelids is made through the normal wrinkling of the upper eyelid, so that it not only hides, but also heals very nicely. The same applies to the lower eyelids. Scars can occur when the surgeon who operates the eyelids is not familiar or does not have enough experience with surgery in this delicate area. Because of Dr. Trakos focuses on ophthalmic plastic surgery, you can be sure that you will have a specialist who looks after the eyes in the most specialized way.

I can't put makeup or shade on the upper eyelids like I used to put in the past. Will blepharoplasty help?

This is one of the most common complaints we hear in the clinic. As mentioned above, the excess skin of the upper eyelid relaxes over time, especially in smokers, and “cools” the eye making the make-up and shade of the upper eyelid can not be seen. After blepharoplasty, patients suffer no more from this problem, they are very happy with their appearance, and their upper eyelids and eyes are highlighted.

Does the insurance cover this operation?

Your health insurance can cover the cost of upper eyelid surgery if these cause functional problems such as significant limitation of the visual field. After the initial examination by Dr. Trako can inform you if you are eligible for insurance coverage and if further tests are needed to be eligible. A complete ophthalmological examination with a full eyelid study will certify this potential suitability, and will require photographing and authorization from your insurance company before surgery to proceed.

Why choose Dr. Trakos?

Dr. Trakos’ contribution to the field of anterior segment and cataract surgery, as well as to the treatment of vision problems, has changed the lives of many people by improving their sight and quality of life.

How long does a blepharoplasty last?

A typical upper eyelid blepharoplasty usually lasts 1 hour. For the lower eyelids it is from 1-2 hours.

What type of anesthesia is used?

Most eyelid procedures can be performed under local anesthesia without the need for hospital stay. If desired, local anesthesia can be performed with sedation. During sedation, a relaxing drug is administered by an anesthesiologist, so that the patient falls asleep. The amount of the drug is modified as appropriate. After the patient falls asleep, an anesthetic is injected into the skin in the area where it is to be operated. During the operation the patient does not understand what is happening. For the lower eyelids, general anesthesia may be preferred.

How is rehabilitation after surgery?

Depending on the patient’s previous medical history there will be a similar degree of swelling and bruising around the eyelids for about 1 week.
It is important to avoid intense physical activity during the first week after surgery, although most patients can return to work after 5 to 7 days if they wish.
Fine stitches are removed after 5 to 7 days.
There is some slight discomfort in the eye after surgery. Ice packs are recommended for the first two to three days to reduce swelling. Arnica Montana tablets, 3 days before surgery and 7 days after surgery, may help reduce edema and bruising. The bruise from the 4th-5th day can be camouflaged with a special make-up applied to the skin.
A special ophthalmic antibiotic ointment is prescribed, which is used some days after the operation.
You can’t wear contact lenses for at least 1 to 2 weeks after surgery, because the eyelids may feel heavy and uncomfortable and you can’t apply or remove the contact lens with ease, and the eyes may experience some degree of dry eye. It is therefore important to examine the patient who is a candidate for blepharoplasty both before surgery and after the specialist in a special ophthalmological lamp-microscope. Some patients experience blurred vision or sensitivity to light for a few days, so it is so important to have an eye examination before surgery to be prepared by Mr. Trakos in case you have subclinical signs or symptoms of blepharitis or dry eye syndrome. In this case it is advisable to give you a treatment before surgery for your most appropriate preparation.

Is there anything less invasive than a blepharoplasty that can renew me?

Yes, indeed, about 50% of patients, interested in eye-to-face renewal do not need surgery, and benefit from minimally invasive operations such as hyaluronic acid, which restores tumor deficiency, Botox or Dysport, radio frequencies, Lasers and Plasma.