Before the surgery:
You asked me to remove the excess skin or pockets (or both) at the level of the eyelids.
The “pockets” that we can see on the lower eyelids, but also often close to the nose to the higher eyelid, are in fact fatty hernias. It is the fat located normally around the eye that protrudes forwards when the cover which retains it distends. For certain people, this membrane is weaker and the “pockets” appear earlier. This special fatty deposit is sensitive to the variations of water in the body and can deflate and inflate very quickly.
At the present time, only surgical ablation can solve the problem.
I will ask you to consult your ophthalmologist to detect a possible operational counter-indication of ocular origin.
The surgery:
I told you that on the lower eyelids, the incision is done just above the eyelashes, while prolonging it if needed slightly into a wrinkle. I will carefully remove the fat and the surplus of skin to retighten the lower eyelid. The scar, under the lashes, will immediately become almost invisible.
On the upper eyelid, I will remove the excess of skin, the fold formed above the lashes, and if necessary, the excess of fatty tissue, especially close to the nose. The scar will be in the middle of the eyelid and thus dissimulated when the eye is open. The eye closed, the scar can be visible during a few weeks, a small red line, sometimes for three or four months, but using make-up is possible eight days after the operation.
I explained to you that the anaesthesia would be mixed, a local anaesthesia with a short drowsiness during the injections and that you will spend the night following the operation in the clinic. Your eyes will be protected by a cold compress to avoid postoperative swelling.
Often, I go through the interior of the lower eyelid (conjunctival route) to remove the fatty pockets. There will then be no scar.
For crow’s feet wrinkles of the lower eyelid, this operation can be associated with laser treatment (known as resurfacing). This laser treatment can be practised at same time as the surgery.
Post-operative issues:
Many patients who undergo the operation have a comfortable night, but some complain about a slight painful feeling of tension which is easily removed by use of a painkiller. If you feel significant pain, it is necessary to inform the nurse immediately.
The next day I will check that every thing is all right and you will be able to leave the clinic.
The eyelids swell very quickly and you will perhaps be anxious about it but the swelling goes down rapidly. A slight weeping of the eye also obstructs your reading for a few days. You will come back 5 to 7 days after the intervention to have your stitches removed, don’t forget to put on a lot of cream before you arrive; it makes the removal easier because it becomes painless. You will then be able to apply warm compresses which will accelerate the re-absorption of the oedema and the bruises.
A week after the intervention it is possible that you’ll hardly have any visible traces. It is also possible that you’ll still have bruises, on the lower eyelid, but they will disappear in approximately three weeks.
You will of course be able to use make up after the removal of the stitches. You should avoid exposing yourself with eyes closed to the sun for two months. With your eyes open, and even better with glasses, you do not risk anything.
It will take approximately four months for the scars to soften and whiten, for the result to be final. At that point, you will come back to see me; I want to see final result.
What can be of concerne in the post-operative period?
1. A conjunctivitis can occur (the feeling of having sand in the eye). A preventive treatment of eye lotion is systematically administered in the days which follow the intervention but if such an irritation re-occurs, you must call me. This event will then be without consequence.
2. A sub-conjunctival bruise: the conjunctive (white part of the eye) can become infused with blood. It is of not serious but this appearance can last for up to ten days.
3. A scar visible on the external part of the upper eyelid. This scar normally disappears in two or three months. It can be dissimulated under make-up after the removal of the stitches. A red aspect to the scar can last beyond the second or third month and requires a massage of the scar using a corticoid cream in order for it to disappear.
4. Herpes on the skin of the lower eyelid treated by laser. An antiviral treatment (Zélitrex) is systematically administered for preventive purposes.
5. An impossibility or difficulty to abruptly close the eyelids, due to a slight separation of the external angle of the eye which does not apply perfectly any more to the eyeball. These symptoms will disappear rather quickly.
6. A swelling of the conjunctive (chomosis) which will disappear in 1or 2 weeks.
To conclude:
An important fact: you will have the same look after the intervention (+ + +)
You won’t be disappointed if you have understood that this intervention does not remove the crow’s feet leg wrinkles and also can’t remove all the wrinkles of the lower eyelid, which have developed over a long period of time. They are only attenuated by the regain of skin tension.
This regain of tension can only be moderate, because it is better keep some wrinkles rather than to expose yourself to the risk of a lowered or deformed eyelid.
This intervention does not remove the internal ring, close to the nose, on the lower eyelid.
This intervention will give you a decent result for many years. A second operation is always possible without any problem, but it is rarely necessary.
Dr Thierry BONVALLOT