People often say that the eyes are the windows to the soul. Your eyes as they look can say a lot about how you feel inside. However, for some people, the look can be deceiving. As you get older, the skin around your eyes starts to sag, due to the loss of skin elasticity and an increase in fat pads. This process can result in permanently tired, sad, irritated or aged-looking eyes, regardless of how you feel. Fortunately, at the Zamarian Clinic, we offer blepharoplasty London to combat these signs of aging and give you a brighter, more vibrant appearance.
There is no right age, but at age 40 there is already excess skin that can be removed with eyelid plastic surgery. From the age of 50 onwards, there is also an excess of fat pockets, and then blepharoplasty surgery with skin and bags removal is indicated.
In general, during the evaluation with Dr. Zamarian, he will indicate some of the treatments needed during your blepharoplasty:
Excess skin on the upper and lower eyelids is estimated and removed, resulting in a more youthful look, without the tired look of before. In some situations of reconstructive surgery on the face, this skin is ideal for facial grafts, resulting in an excellent aesthetic appearance, as it is thin and has excellent integration with the receiving area. This excess skin may exist only on the upper eyelids, or be present on the lower eyelids as well. Therefore, the evaluation of the plastic surgeon is very important. This removal of skin on the upper eyelids results in a scar that is well positioned in the crease, in such a way that it is hidden while the person has their eyes open. The removal of skin from the lower eyelids is carried out close to the eyelashes, just below them, and is equally disguised. Dr. Zamarian has performed a technique called "pinching" for this removal, in order to avoid eyelid retraction, called ectropion.
In the upper eyelids, we have two compartments of fat bags: medium and medial. The medial bags, closer to the nose, are whiter than the medium fat bags, which are yellow. In the lower eyelids, there are three fat pockets: medial, middle and lateral. As in the upper eyelids, in the lower eyelids the medial pouches are white. During the resection of the pouches, Dr. Walter Zamarian Jr. takes care to preserve the anatomy of the eyes, seeking a natural result and removing the tired aspect of the eyes.
When the lateral corners of the eyes are low, due to laxity of the lateral canthal ligaments, which occurs naturally with senility, Dr. Zamarian associates eyelid plastic surgery with the canthopexy technique, which consists of placing a stitch in the lateral corner of each eyelid, elevating the lateral corner and securing the stitch in the periosteum of the orbital rim for greater support and maintenance of the result.
During the consultation, Dr. Zamarian assesses the position and shape of the eyebrows, after all they represent the upper frame of the eyes. Furthermore, if only the skin was removed, without any method of fixing the eyebrows, they would tend to fall out after blepharoplasty. Therefore, during blepharoplasty, Dr. Zamarian performs a technique learned from the team of periosteal plastic surgery at Escola Paulista de Medicina, which consists of making an incision in the orbicularis oculi muscle, superiorly laterally, up to the periosteum. Then, he stitches the upper edge of the muscle to the periosteum, elevating the tail of the eyebrows, preventing their fall with the removal of skin. Small asymmetries in the positioning of the lateral thirds of the eyebrows can be improved with this technique. In some cases, however, it may be necessary to complement with a removal of skin close to the eyebrow, above it, for cases where the fall is more important and does not resolve only with these internal points.
In cases where there is a fall of the eyebrows, especially in the lateral corner of the same, which does not improve with the internal points mentioned above, Dr. Zamarian chooses to make a small incision close to the eyebrow hairs, removing a triangle of skin, with a suture facing the hairs. This raises the tail of the eyebrows and lessens excess skin on the side corners of the upper eyelids. This incision results in a scar of only approximately two to four cm in length, close to the eyebrow and, in most cases, practically imperceptible.
The Castañares surgery was conceived by a plastic surgeon who removed a spindle of skin above the eyebrows (close to them) to completely elevate them. This technique left an apparent scar, mainly in its medial third. Dr. Zamarian uses a miniature version of this surgery which, as it is lateral and has minimal extension, has excellent results without constraints on the scar. As most of the time what matters is the fall of only the tail of the eyebrows, this minor surgery is enough to achieve the expected result. More recently, Dr. Zamarian has performed a different design from Minicastañares: Modified Vineyards. In this technique, the removal of skin goes beyond the lateral edge of the eyebrows, resulting in a scar that is part of the eyebrows, but, on the other hand, the result is a much more effective elevation of the tail of the eyebrows.
In cases where a full brow lift is required, Dr. Zamarian opts for one of two techniques: either the Castañares, with a scar above the eyebrows, or the frontal (forehead) lift, which is also effective and results in unseen scars remaining on the scalp.
In the past, it was believed that the lower eyelids could only be treated by removing skin or fat. Several years ago, plastic surgeon Sam Hamra drew attention to the treatment of dark circles through the mobilisation of fat pockets through the marginal arch. That way, instead of removing the bags, he passed them to the front, to fill in the dark circles. More recently, with the advent of equipment to make fat thinner and thinner for grafting, the use of deep microfat or more superficial nanofat proved to be the most advanced techniques for the treatment of dark circles. In addition, when nanofat is used, it also has the ability to rejuvenate the skin of the lower eyelids. Dr. Walter Zamarian Jr. has years of experience in treating dark circles with nanofat grafting, with exceptional results. He can evaluate you during the consultation and indicate what would be the best way to treat your eye area, with charming and natural results.
During the medical consultation, Dr. Walter Zamarian Jr. will evaluate if your eyelids have excess skin, fat pockets, the position of the eyebrows and the quality of the skin of the eyelids, especially the lower ones. This evaluation is very important for the correct surgical planning, and adequate choice of techniques to be used in each case.
Dr. Zamarian routinely requests blood, urine, electrocardiogram and surgical risk tests, in order to properly assess the health of each patient and correct some tests if they are altered before surgery, in order to perform the surgery with maximum safety. These exams are:
Dr. Zamarian performs the blepharoplasty surgery under general anaesthesia, as it allows adequate oxygenation of the patient and offers complete assurance that the patient will not wake up during the procedure.
Dr. Zamarian makes incisions along the natural creases of the upper eyelids. For lower eyelid surgery, the incisions are flush with the eyelashes. The skin is separated from the deep tissues in blepharoplasty, the fat pads are removed, and excess skin is removed, to create a brighter, more youthful appearance of the eyes. Finally, the incisions are closed with very thin sutures to minimise scarring. The London blepharoplasty plastic surgery usually takes 40 minutes to be performed by Dr. Zamarian. If canthopexy or mini-castañares are necessary, these are performed concomitantly with the described surgery. To complete the results, it can be combined with a facelift, lip or chin augmentation, or one of our body contouring procedures.
On the upper eyelids, the scars are positioned right in the crease or fold that forms when we open our eyes. Thus, the scars are invisible when a person has his eyes open, and when he closes his eyes, they are almost invisible because they are confused with the furrow itself. On the lower eyelids, the scars are positioned close to the eyelashes, also without leaving visible marks. In cases in which the lower eyelids are operated via the transconjunctival approach, the incision is not external and the scars do not exist on the skin, with the benefit of removing fat bags without leaving scars on the skin. However, this technique is reserved for cases in which there is no excess skin on the lower eyelids, which occurs in some patients up to 50 years of age.
Right after blepharoplasty, there is a need for compresses with cold, wet gauzes for the first 12 to 24 hours after surgery to minimise swelling and bruising that may occur. The ideal temperature is obtained by letting ice drain in a vat and wetting two gauzes, folded in half, in the water that melts from the ice, then placing them over the eyes. Other necessary care includes raising the headboard by 30 degrees, not lowering the head to avoid swelling or bleeding, in addition to applying an Epitezan ointment on the stitches until they are removed, to accelerate their healing. It is recommended to sleep on your back during the first month and avoid physical exertion in the same period. It is only after six months that you can get sun without risk of staining the scars, and after the third month you can get sun in the early morning and late afternoon with sunscreen factor 30 or 40 on the scars.
Immediately after the surgery, the difference can already be noticed. For the final result, without residual edema (swelling), normally two months are needed, which coincides with the date on which the postoperative photos are taken.
Yes. Dr. Zamarian uses adrenaline to perform blepharoplasty plastic surgery in London. Thus, there is less bleeding during the surgery, the eyes swell very shortly after the blepharoplasty, the purple is much smaller and the recovery is very fast. The recovery from eyelid plastic surgery is so fast that the stitches are completely removed in three days, to avoid marks on the eyelids. The maximum swelling after surgery occurs in 24 to 48 hours, but even during this period, the patient is able to open his eyes normally and see calmly.
Dry eye is a very common condition and often goes unnoticed. Some patients with dry eye who undergo eyelid surgery may experience minor discomfort after the surgery, such as a feeling of sand in the eyes. The treatment is simple, just with eye drops to keep the eyes moist and lubricated and the symptoms disappear in two to three days, most of the time.
No. The skin of the eyelids is the thinnest in the human body and, for this reason, there is no possibility of forming keloids after blepharoplasty surgery. In fact, it's plastic surgery where scars are better, aesthetically.
Patients with Graves' disease (hyperthyroidism) have their eyes wide open and the eyeballs protruding (exophthalmos). The extrinsic musculature of the eyes is also affected, being a little more rigid than normal. Eyelid plastic surgery can be performed on these patients, as long as you pay attention to some very important details:
In his Clinic, located in the north of Paraná, Dr. Zamarian treats several cases of patients of oriental origin who wish to undergo eyelid westernization surgery, many of them of Japanese or Chinese origin, with or without miscegenation. The main characteristic of the oriental eyelid is the lack of adhesion of the upper eyelid skin to the upper edge of the tarsus (cartilage that maintains the shape of the eyelid opening). This adhesion configures the crease of the upper eyelid, that is, when the eastern eye opens, the skin on the upper eyelid is loose (moved away from the tarsus by a layer of fat) and does not fold the crease, in addition to another feature called of medial epicanthus. During the westernization of the eyelids, Dr. Zamarian recreates the sulcus of the upper eyelids by suturing with separate stitches, fixing the orbicularis oculi muscle to the aponeurosis of the levator palpebrae superioris muscle. In selected cases, he also treats the medial epicanthus. The result is quite natural and does not diminish the beauty of the oriental features, preserving their features, only attenuating them and allowing a better opening of the eyes.
Dr. Zamarian makes an incision in the upper eyelids, removing a small excess of skin. Then, a strip of orbicularis oculi muscle is removed, which helps in reconstituting the palpebral crease. The septum is opened and the upper border of the tarsus is exposed, which is a cartilaginous tissue that supports the curvature of the eyelids. Four very delicate stitches are given on each eyelid, adhering the skin to the upper edge of the tarsus, recreating the fold of the upper eyelids. A continuous suture is performed to bring the edges of the skin together, completing the westernization of the eyelids.
Elid ptosis is the drooping of one or both eyelids and can occur for several causes, including: congenital (present at birth), traumatic, senile (laxity due to age), neurogenic, myogenic, among others. Blepharoptosis or eyelid ptosis is characterized by the situation in which the upper eyelid covers more than 2 mm of the upper cornea. Dr. Zamarian assesses the degree of palpebral ptosis and the function of the levator palpebrae superioris muscle to choose the surgical technique that best fits the treatment of each case. The techniques used include plication of the levator palpebrae superioris muscle, Müllerectomy conjunctiva and frontal suspension. Eyelid ptosis surgeries are performed by Dr. Giovanni André Pires Viana, from São Paulo, professor of Oculoplastics, at the Escola Paulista de Medicina. As these procedures are less frequently sought after, Dr. Zamarian prefers to have them performed by Dr. Giovanni, who treats cases of palpebral ptosis almost daily, and has extensive experience in order to make your case as symmetrical as possible. We always think about what is best for you, the patient.
To learn more about blepharoplasty and other plastic surgery modalities that Dr. Walter Zamarian Jr. performs in Londrina - PR, please contact Clínica Zamarian and schedule an appointment.
Cosmetic plastic surgeon in Brazil
Rua João Wyclif, 111, Sala 1702
Londrina - PR
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