Repeated blepharoplasty (eyelid surgery) in a clinic in Moscow


Let's look at what problems appear with age in the upper and lower eyelids.

To begin with, we note that swelling in the eye area is not an indication for blepharoplasty; in case of edema, the problems are solved by non-surgical and low-traumatic methods.

Wrinkles around the eyes and in the lower eyelid area can be corrected well with botulinum toxin injections and a number of non-surgical methods.

What problems are usually indicated as indications for non-surgical blepharoplasty:

Upper eyelid ptosis

  1. Dropping of fat packets, overhang of the brow area
  2. Loss of skin tone, sagging skin

Lower eyelid problems

  1. Lower eyelid hernias (bags under the eyes)
  2. Loss of skin tone, excess skin flap
  3. Manifestation of the nasolacrimal trough
  4. Edema formations

In order to understand which problems can be eliminated, and which promises are not entirely honest, you need to understand what eyelid correction without surgery is?

With age, the skin around the eyes loses tone, fat packets seem to “slide” down, and the orbicularis oculi muscle stretches.

The more regularly the patient takes care of the eyelid area, the less intensively these processes will occur. We recommend starting from the age of 30 to carry out preventive procedures aimed at strengthening the skin of the eyelids and the area around the eyes in general.

What is non-surgical blepharoplasty

If we use the term blepharoplasty (that is, eyelid surgery), we mean that this is a change in the area and/or geometry of the skin of the eyelids, which in turn automatically means that the procedure is “invasive” and traumatic.

Any procedures that do not have an intense effect on the skin (for example, microcurrents, RF lifting) cannot in any way be effective and cannot be called plastic surgery (!) of the eyelids.

On the Internet you can find many “interpretations” of this procedure ; let’s briefly consider the most common ones.

What procedures can be called non-surgical eyelid surgery?

The most effective and classic option for blepharoplasty without surgery is CO2 laser correction (laser blepharoplasty). Under the action of a laser beam, the skin is fractionally evaporated and compressed, thus reducing its area and the appearance of sagging and sagging. This is the correction option our cosmetologists offer. Rehabilitation – from 4 to 8 days, effectiveness – 5 (out of 5), course – 1-2 procedures every 10-15 months.

Contour plastic surgery of the lower eyelid area helps well in cases of nasolacrimal trench manifestation. This procedure will not help with loss of skin tone or bags under the eyes. In fact, this procedure cannot be called blepharoplasty, since the effect is not on the skin of the eyelids. Rehabilitation – absent, effectiveness – 3 (out of 5), one-time procedure.

Thermage or ultrasonic lifting are also not blepharo-procedures, since the effect is carried out on the deep layers; the procedure is good for lifting the oval of the face as a whole, but does not produce results locally in the area of ​​the upper or lower eyelid. Moreover, it is dangerous to carry out ultrasonic treatments in these areas. Efficiency – 1 (out of 5), one-time procedure.

Mesotherapy, collagen injections and “beauty injections” are most often used in the initial stages of age-related problems, when the density and elasticity of the skin is not yet significantly impaired. The drug most often mentioned is Mesoeye C71, which is usually injected into the lower eyelid area. As part of a complex correction, mesotherapy does contribute to improving the condition of the skin and improves microcirculation, but it cannot independently solve the problems of ptosis of the upper eyelid or remove bags under the eyes. Course – 2-5 procedures per year. Efficiency – 3 (out of 5) in the initial and middle stages. Collagen injections and biorevitalization will not help solve the problems of the upper and lower eyelids. Efficiency – 0 (out of 5).

peels only work if it is necessary to work on the quality of the skin. Peels are not able to remove excess skin tissue, correct sagging upper eyelids or bags under the eyes. Efficiency – 1 (out of 5).

The most effective methods (in our opinion)

Laser blepharoplasty: reduces sagging upper eyelids, removes wrinkles around the eyes and literally renews the skin. For full results, a course of procedures is often necessary. rehabilitation - 5-7 days after the procedure.

Contour plastic surgery of the lower eyelid area and nasolacrimal groove: allows you to hide and camouflage small hernias of the lower eyelid, effectively and permanently removes the depression under the eyes. The procedure is one-time without rehabilitation.

Sutures after blepharoplasty

Sutures after blepharoplasty are not always applied; for example, with transconjunctival access, a cooling bandage and a patch on the eyelids are sufficient. Thanks to the excellent blood supply to the conjunctiva, the wound heals on its own in the shortest possible time.

If the surgical approach is through skin folds or along the ciliated edge of the eyelid, absorbable suture material is used. Minor scars remain after any operation, but after blepharoplasty they are not visible because they follow natural folds.

Deception and inefficiency

So, without surgery with anesthesia, you can remove the manifestation of the tear trough; work with the quality and quantity of skin if there is excess; hide (camouflage) light bags under the eyes in case of a moderate manifestation of the problem.

But first of all, we want to say that every patient is unique ! Only during an in-person examination can a doctor recommend one or another method of correction.

No procedure can radically correct severe sagging of the upper eyelid stage 4 - only a scalpel.

There are a number of dubious proposals to eliminate problems in just one procedure and without a rehabilitation period.

As an example, consider a before/after photo on one of the information sites:

radio lifting is indicated as a procedure . If you try to find the same photographs on other sites , it turns out that the same illustration is given after microcurrents, and after medium peeling, and after patches, although most likely these are the results before/after botulinum therapy. See for yourself:

Do not rush to believe everything that is written on the Internet.



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How is the operation performed?

The surgeon pulls back the lower eyelid and makes a microscopic incision in the conjunctiva, below the lash line. After this, the fat sac itself is removed. The entire operation lasts on average no more than forty minutes. There are no traces of surgical intervention left in the eye area, and the shape of the eyes does not change.

Due to its low morbidity, such an operation can be performed both under general anesthesia and sedation. Sedation assumes that the patient remains conscious, but does not feel pain or psychological discomfort. The type of anesthesia is discussed in advance with the anesthesiologist before the operation. The doctor chooses the method of anesthesia based on the physiological and emotional state of the patient.

The operation can also be performed under local anesthesia, but then it may be difficult for the patient to remain calm and still, which is inconvenient for both the surgeon and the patient.

Check-up in a month.

Comparison of before and after results.

The patient asks me: “Sergei Vladimirovich, could you have removed more skin, you see, I still have a small fold left?” Of course, it was possible to remove it, but with a brow lift, a skin deficit would then arise. After all, a brow lift moves the skin of the upper eyelid higher. If, at the first stage, with eyelid plastic surgery, we remove all the skin, then at the second stage, after 6 years with a brow lift, we will not have enough skin to move the eyebrow upward, because the skin of the upper eyelid is also pulled up behind the eyebrow, so this a small excess was left specifically in the expectation that we will perform a brow lift in the near future, since there are indications for raising the eyebrows, that is, the patient has drooping eyebrows. When we plan such a 2-stage approach, we must take into account what we will have if we remove more skin, how the condition of the tissues will change, whether we will have enough skin for a brow lift if we remove it all, where we will end up with a seam after eyelid surgery if we then perform a brow lift. All these moments need to be predicted at the stage of eyelid surgery. If, on the contrary, we first perform a brow lift, and then 10 months later an upper eyelid plastic surgery, then we would remove as much skin as we need, since the tissue would already be moved due to the brow lift and we would not have to leave a small reserve of skin for centuries.

Comparison of results after 1 month.

Comparison of results after 6 months.

Comparison of results after 1 year.

How is an eyelid lift performed without surgery?

At the first appointment, the doctor examines the patient, collects a complete medical history, finding out whether there are any contraindications to non-surgical lower eyelid blepharoplasty. The doctor evaluates its effectiveness for a particular person. After this, the doctor and the patient decide on non-surgical blepharoplasty or choosing another method. Traditional surgery may be a more appropriate option.

The procedure for lifting an overhanging eyelid without surgery includes several main steps.

  • Makeup is completely removed from the face and eyelids.
  • An anesthetic – a special gel – is applied to the area around the eyes.
  • The eyeball is covered with a protective lens.
  • The skin near the eyes is polished.
  • The device for non-surgical blepharoplasty is customized according to the individual characteristics of the patient.
  • The doctor works with areas where there is excess adipose tissue: it is broken down.
  • When the process is complete, the area near the eyes is covered with cold compresses. Subsequently, the patient is asked to use antiseptic ointments to eliminate the risk of infection.

Why do age-related changes appear again after successful blepharoplasty?

Sometimes, after a certain period of time (usually 6 to 7 years), age takes its toll again. Even the most qualified and talented plastic surgeon is not able to stop the aging process and to maintain a young, attractive image, repeated use of the scalpel is necessary.


The patient underwent repeated blepharoplasty of the upper eyelid and lipofilling after previously performed eyelid surgery, which did not satisfy her.

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It is important to consider one more point. Plastic surgery does not stand still. It is developing very actively, new technologies, methods and materials are appearing. For example, the patient was not satisfied with the result of plastic surgery, which was performed several years ago. At that time, now outdated methods were used. In this case, repeated blepharoplasty in a modern modification can provide a much better aesthetic result. So, before, blepharoplasty involved radical excision of skin and fatty hernias. Whereas, at the moment, experts strive to preserve and replace fatty tissue in the periorbital region as much as possible. This is important because fat cells are responsible for youth and skin turgor.

Just five to seven years ago, unsuccessfully performed blepharoplasty could provoke sunken eyes, skeletonization, rounding of the eyelid, as well as the appearance of other problems. Now these risks are practically reduced to zero. All this became possible thanks to modern eyelid rejuvenation techniques. Today we harmoniously combine conservative tissue excision and lipofilling. Repeated blepharoplasty can correct the negative results of primary eyelid surgery, as well as significantly IMPROVE its aesthetic result.

Contraindications

The use of Plasma Pen, like most hardware and injection procedures, is prohibited in case of acute inflammatory process, infection, serious diseases - diabetes, epilepsy, herpes, autoimmune, oncological and mental diseases, blood clotting diseases. This procedure is not recommended during pregnancy, during breastfeeding, or when wearing a pacemaker. An allergic reaction to local anesthesia, taking blood thinning drugs and a tendency to form keloid scars can also become an obstacle.

And, of course, it cannot be used for non-surgical blepharoplasty if you have already had your eyelids tightened surgically before. If you try Plasma Pen before surgery, there is a high chance that the “before” will be replaced by “instead”.

Types of eyelid eversion

According to the etiological (cause-and-effect) criterion, ectropion is classified into the following categories:

  • senile (caused by age-related degradation of muscle and skin tissues, their stretching; pathology usually develops symmetrically in both eyes and, in the absence of adequate treatment, steadily progresses with age);
  • scar (forms as fibrous tissue grows after burns, ulcerative inflammation, trauma, etc.; since scar tissue is much larger than functional tissue, the contact of the conjunctiva with the eye is mechanically disrupted - the eyelid simply “moves away” from the eyeball, gaps appear, and lacrimal secretion increases fluids, etc. The dynamics and clinical picture of cicatricial ectropion largely depend on the localization of primary scarring);
  • paralytic (due to neuropathology and functional failure of the facial nerve, which controls the entire facial muscular system - from facial muscles to the motor system of the eyelid);
  • mechanical (occurs as a result of the progression of various oncopathologies; as in the case of cicatricial ectropion, as the tumor grows, mechanical contact with the eyeball is disrupted. In addition, cellular degeneration distorts the system of forces and mechanical stresses in the eyelid itself, as a result of which the resultant of these forces begins to increase pulls the conjunctiva away from the eye - instead of pressing it against it - and eventually turns the eyelid outward).

Dressing for 5-7 days.

On the dressing we see that the skin has healed perfectly, the process of epithelization has completely occurred. The seam looks like a thin narrow pink stripe, which will turn white over time and become even less noticeable. We see that the cut is located in the correct position, in the fold, which also ensures its inconspicuousness. But at the same time, we see that the skin fold at this stage is swollen, that is, there is a little more skin than needed due to swelling. The patient asks me: “Sergei Vladimirovich, was it possible to remove more skin?” How to answer this question? Of course it is possible, but then there would be a void in the upper eyelid, which would give age, rather than a rejuvenation effect. If I removed all the skin, we would get significant changes in the upper eyelids and this could become very unusual for the patient and the patient could be upset, but most importantly, there would be an emptiness effect. The skin of the upper eyelids is now swollen, stretched, and the skin hurts. But when 4 months pass and the swelling completely goes away and the skin of the upper eyelid shrinks. The excess that exists will go away in 4-6 months due to skin contraction. In addition, we need a small excess so that we can perform a brow lift in the future. If we completely remove all the skin and then we decide to perform an endoscopic brow lift, a situation may arise where there is not enough skin, there will be excess tension. In this situation, there will be contraindications for a brow lift, so in this case the skin is removed with the expectation that the next brow lift operation will be performed and the skin will be completely straightened, and there will be no excess, and there will be no emptiness of the upper eyelid, this is very important to plan sequence of the operation and at each stage to obtain a good aesthetic result.

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