Transconjunctival blepharoplasty of the lower eyelids - how it is performed, consequences

As people age, the skin around their eyes undergoes aging.

Wrinkles form around it and it sags. The amount of subcutaneous fat and tissue swelling also increases.

The most gentle surgical intervention to eliminate these defects is considered to be transconjunctival blepharoplasty of the lower eyelids. It is used to make an incision in the conjunctival area. Therefore, after the procedure there are no scars or stitches. As a result, the patient’s swelling completely disappears, the skin becomes tightened, and the doctor also removes excess fatty tissue. Since the procedure is considered minimally invasive, the rehabilitation period is short.

Difference from standard eyelid blepharoplasty

In classical surgery, the incision is made on the outer surfaces of the upper and lower eyelids. This is done using a surgical scalpel. This technique is considered risky for the eyes and the skin around them. Therefore, many doctors advise against performing it, recommending the transconjunctival method.

Also, with the classical method, only general anesthesia is performed, which can cause many complications for the patient’s health. With the transconjunctival method, local anesthesia can be used.

With the classical method, the rehabilitation period is significantly increased, since the skin surfaces, blood vessels and nerves have been damaged.

That is why transconjunctival blepharoplasty is considered the safest and most justified method for facial rejuvenation. The surgeon gains access to the desired area through the mucous membrane and conjunctiva of the eye. There is no incision; instead, a puncture is made. Therefore, there are no stitches left, and the doctor does not damage the vessels and nerves.

How is the operation performed?

Depending on the indications and complexity of the task, local or general anesthesia is required. In most cases, a combination of anesthesia using intravenous sedation and local anesthesia is used.

The operation rarely takes more than an hour. Depending on whether the operation is performed on the upper or lower eyelid, the doctor makes an incision on the conjunctiva of the upper or lower eyelid, respectively. Tissue dissection is carried out using a scalpel or laser. The second method is preferable because it causes minimal tissue trauma and the operation is almost bloodless. Laser exposure instantly coagulates blood vessels and avoids blood loss. Through transconjunctival access, internal tissues are exposed, through which fatty hernias are excised and the skin is tightened.

Indications for surgery

First of all, surgical intervention is performed for patients who want to eliminate a cosmetic defect in the form of bags under the eyes, severe wrinkles, and sagging skin. The procedure is also indicated for the following conditions and diseases:

damage to the protective septum of the eye, hernia formation;
excessive drooping of the skin of the eyelids, which interferes with normal life activities;
stretching of the skin above and below the eye, as well as in the corner above the eyebrow;
excessive accumulation of subcutaneous fat, which forms large bags under the eyes.

If bags under the eyes are associated with severe sagging skin, the procedure will be ineffective and will only slightly improve the patient’s condition. With the transconjunctival method, it is possible to completely eliminate the bags only in the presence of excess adipose tissue.

What is eyelid blepharoplasty and in what cases is it indicated?

Blepharoplasty is one of the simplest and most popular operations in plastic surgery. This helps combat sagging skin folds on the upper eyelid and bags under the eyes. In addition, with the help of blepharoplasty, you can change the shape and shape of the eyes. As a person ages, the skin of the eyelids loses its elasticity and gradually sag, which contributes to the appearance of deep wrinkles. Fatty formations can also accumulate in it, which leads to excess skin.

Plastic surgery has been helping people deal with the problem of age-related changes in the eyelids for many years, using various methods, such as:

Blepharoplasty of eyelids (upper or lower);
Transconjunctival blepharoplasty of the lower eyelids;
Circular (or combined) eyelid surgery (lower and upper).

As many years of medical practice have shown, the skin of the eyelids heals quite quickly. Thanks to this, already six months after the operation, the stitches become completely invisible; they literally merge with the epidermis. In clinics, surgeons evaluate the final results of such operations within one and a half to two months. By this time, the swelling has completely passed and a scar has formed. As a rule, the postoperative result lasts a long time (from seven to ten years), but the duration of the effect can be affected by the patient’s lifestyle.

There are a number of indications for eyelid blepharoplasty. It can be:

Deep folds in the corners of the eyes;
Wrinkles in the lower eyelids;
Excess skin (or overhang);
Excessive fat deposits on the eyelids;
Swelling in the upper eyelids, giving a tired look.

Patients often come to the clinic for consultation with a plastic surgeon about a possible change in the shape or shape of the eyes. In such cases, doctors offer blepharoplasty, but only if there are no contraindications. Eyelid surgery is also used to eliminate any aesthetic defects (for example, these may be hereditary changes).

Contraindications

The procedure is not recommended for the following conditions and diseases:

minor age;
infectious and viral diseases in the acute stage;
presence of menstrual bleeding in women;
malignant neoplasms in any tissues and organs;
hormonal imbalance, pathologies of the endocrine glands;
any disturbances in the circulatory system;
increased bleeding time, decreased blood clotting;
increased intraocular pressure or glaucoma;
high blood pressure;
autoimmune disease (rheumatoid arthritis, systemic lupus erythematosus, autoimmune reactions in thyroid diseases);
dry eye syndrome – insufficient hydration in the absence or reduced secretion of tear fluid;
congenital or acquired immunodeficiency.

Some of these contraindications are temporary. When their effect is completed, the doctor can give a referral for surgery.

If the patient has a serious illness of the body, blepharoplasty is completely prohibited.

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.

Preparation for transconjunctival blepharoplasty

To carry out the procedure, the patient should undergo all studies and tests so that no side effects or complications arise during the operation or during the rehabilitation period.

Before the procedure, the patient should undergo tests:

general clinical analysis of blood and urine, blood biochemistry, coagulogram;
testing for hepatitis and HIV;
fluorography;
electrocardiogram.

If there are no contraindications based on these data, the patient is referred to specialist doctors. He must see an ophthalmologist, otolaryngologist, dentist, and neurologist.

Before the procedure itself, the patient should prepare:

2 weeks before surgery, it is prohibited to use medications that the doctor has not been warned about;
any medications that may thin the blood are discontinued;
you should not visit places with active sun;
It is prohibited to consume alcohol and nicotine 3 days before the procedure.

You should not wear makeup on the day of surgery. The patient should take a warm shower and thoroughly wash his hair and face. It is also recommended to take sick leave at work, since visiting her is not recommended during the rehabilitation period.

Blepharoplasty: before and after

Before prescribing the operation, the attending physician will necessarily interview the patient, examine him and give certain recommendations. After this, the specialist will prescribe a series of tests, based on the results of which he will be able to judge the absence of contraindications to this surgical intervention. If blepharoplasty does not pose a risk to a person's health, the doctor will discuss with him what anesthesia he will use - local or general anesthesia. In the first case, the patient is conscious throughout the entire operation, but does not feel discomfort, since a special drug is previously injected into the operated area, which causes numbness. General anesthesia is recommended for more complex blepharoplasty. The duration of such an operation largely depends on whether both eyelids will be affected or only one. If the surgeon is faced with a task of increased complexity, surgery can last up to two hours.

In this case, the day before the planned procedure, the patient should follow the following instructions:

Stop taking blood thinners to promote normal clotting during surgery. This point also applies to painkillers, which it is advisable to exclude two weeks before the planned procedure;
On the eve of the operation, do not eat heavy food;
Avoid excessive drinking and do not eat after midnight;
Do not apply cosmetics to your face on the day of surgery.

As a rule, the patient can leave the clinic soon after the operation without staying overnight, unless general anesthesia was used. During the postoperative period, it is important for a person not to neglect the doctor’s recommendations. For a short time, you may have to partially change your lifestyle. After surgery, as a rule, an antibacterial ointment is indicated, which is applied to the skin of the eyelids. On the first and second days after blepharoplasty, cold compresses are often recommended to relieve swelling and bruising, and on the third day, warm compresses are recommended, which promotes rapid healing.

During the initial stages of the recovery period, discomfort in the eye area is possible - this is a common but short-lived side effect. After a few days, the discomfort will pass, but complete healing will occur in about two weeks. Until this moment, it is highly undesirable to use any eye cosmetics. In the first days after surgery, you should refrain from using contact lenses until the swelling decreases. If the doctor used regular sutures rather than absorbable ones, a week after blepharoplasty they will need to be removed in the clinic where the operation was performed.

Blepharoplasty is an ordinary procedure in plastic surgery, but sometimes complications arise after it is performed. For example, the patient may complain of an inability to close the eyelids completely. This condition sometimes lasts up to several months. It is dangerous because it causes dry eyes. Usually, for this type of complaint, eye drops are prescribed, and in rare cases, special pads that are used during sleep. Other side effects are also possible, such as incorrect placement of the eyelids, the formation of noticeable scars, etc. But in most cases, blepharoplasty brings positive results and is easily tolerated.

On the website Ochkov.Net you can get acquainted with a wide range of contact correction products from world brands!

Carrying out the operation

The procedure is carried out quickly, the maximum time is 1 hour. But if there are complications, the time may increase. Before anesthesia is administered, markings are made on the face using a special marker. The doctor will use it to determine which areas need to be tightened and where the amount of fatty tissue needs to be reduced.

Next, the procedure is carried out in several stages:

Use of anesthetic in required areas of the face.
The use of epinephrine, which is an analogue of adrenaline. It reduces the risk of bleeding.
The surgeon makes a miniature puncture in the conjunctival area, which is located behind the eyelash growth area. No further incisions are made.
Using a special device, the doctor removes excess fat tissue.
The hole is stitched with suture material, which subsequently dissolves on its own. The surgeon will not need to remove additional suture material. In some cases, the surgeon may refuse to use suture material, then the hole will heal on its own.
The use of antibacterial, anti-inflammatory agents.

After completion of the procedure, the patient must remain within the walls of the medical institution for several hours. If no complications or side effects appear, he is sent home the same day. This is due to the fact that a small amount of tissue was damaged. The doctor does not need to perform additional manipulations.

The patient is advised to ask for help from close relatives or friends who will pick him up from the medical facility. This is due to the fact that after surgery, visual acuity may decrease for a short period of time. This will also avoid stress on human health immediately after the procedure.

Functional and cosmetic blepharoplasty - what's the difference?

Cosmetic eyelid blepharoplasty refers to surgery that is not medically necessary. This procedure occurs at the initiative of the patient who wants to change his appearance. Most often, the cosmetic type of eyelid correction is chosen by people aged 45 years and above, when signs of age begin to appear - baggy, sagging eyelids and others. As a person gets older, the skin in this area of the face tends to stretch and the muscles weaken. As a result, fat bags begin to form. Sometimes this problem can occur at a younger age. Such manifestations are often hereditary.

Unlike cosmetic, functional blepharoplasty is an operation that is performed for medical reasons. Functional eyelid lift is performed in most cases to remove baggy skin that sag, interferes with good vision and prevents a person from leading a normal life. Sometimes this can interfere with the process of wearing glasses and contact lenses. In such cases, surgery is also recommended by doctors. Other indications for this operation are discomfort in the forehead due to congestion of the muscles involved in the process of lifting sagging eyelid skin, as well as irritation caused by friction of the folds.

Rehabilitation period

To reduce the possibility of side effects and complications after surgery, it is important for the patient to undergo a proper rehabilitation period. The doctor warns the person in advance about its rules:

the use of antibacterial, anti-inflammatory drops, which prevent the spread of infection to the area of damage, and also relieve redness and swelling of tissues;
using moisturizing eye drops to prevent increased dryness of the mucous membrane and damage to the corneal layer;
prohibition on using cosmetics for 1 week after the procedure;
prohibition on visiting a sauna, bathhouse, sunbathing in the open sun, swimming in hot water for 2-3 weeks after surgery, this will prevent the possibility of bleeding;
Wearing sunglasses outdoors to prevent eye irritation from bright sunlight;
long sleep, no increased eye strain in the form of using a computer, telephone and other electronic devices;
You can go to work 1 week after the operation, but you must obtain permission from the attending physician;
significantly reduce physical activity, do not engage in active sports until the doctor’s permission;
You cannot wear contact lenses for 1 month after surgery.

After 1 week, as well as 30 days after the operation, it is recommended to visit the surgeon for a follow-up examination. If there are no side effects, the doctor will gradually lift the ban on any actions.

Day 1

The operation is performed under local or regional anesthesia. Therefore, the patient quickly comes to his senses.

Immediately after blepharoplasty, the patient is transported to a ward where his condition is monitored. A pressure bandage is applied to the eyes (for 5-6 hours).

If there are no signs of complications, he will be allowed to go home after a few hours. Naturally, the doctor will immediately identify a number of restrictions and issue a list of recommendations.

At first, the patient may be concerned about:

Burning feeling
Tingling
Mild pain at intervention sites
Sensation of a foreign object in the eye
Edema
Bruising
Bruises

But these are natural reactions of the body to intervention. All this is normal up to certain limits.

However, if the pain is severe, you should tell your doctor immediately.

Possible complications

During the procedure, as well as during the rehabilitation period, the following complications may occur in the patient’s body:

bleeding from the area of tissue damage;
corneal bruises, if they are minor, the doctor does not prescribe any medical manipulations, they resolve on their own; in case of extensive bruises, injections of drugs into the eyeball can be used;
internal hemorrhage near the eyeball, resulting in the formation of a hematoma that does not resolve for a long time;
damage to the tissues of the eyeball during surgery, which are the most dangerous for the condition of the patient’s visual organs;
severe bleeding that the doctor cannot stop for a long time;
formation of age spots under the eyes;
infection with a bacterial infection with the possibility of suppuration, the formation of cysts and abscesses, this is dangerous for the patient, since the bacterial infection can enter the blood through damaged vessels;
the appearance of chronic dry eyes with damage to the corneal layer, in this case the patient is prescribed moisturizing drops or injections into the eyeball with special preparations for life;
severe swelling that does not go away for a long time after surgery;
increased tearfulness, this condition subsequently disappears with tissue healing;
deformation of the eyelid, due to which it becomes inverted, which causes dry eyes, inflammation and redness of the surface layer;
excessive tissue scarring;
photophobia, accompanied by increased lacrimation, redness of the eyes and spasm of the eyelids;
decreased visual acuity, which most often recovers within 1 month after surgery;
increased intraocular pressure, which can subsequently form glaucoma.

If the patient chooses a highly qualified surgeon, the risk of complications is significantly reduced. But with health problems, especially in old age, certain risks remain. Therefore, doctors recommend a comprehensive examination of the body before the procedure.

How is blepharoplasty of the upper and lower eyelids done?

As a rule, blepharoplasty is performed quickly and painlessly. The postoperative period does not last long - in standard cases, the patient can go home on the day the operation was performed. He is being monitored on an outpatient basis.

When performing surgery in the area of the upper eyelids, the surgeon makes the necessary incisions in the places where natural folds form. Therefore, after such a surgical intervention, the scar remains invisible with open eyes. If the task is to remove excess skin, the doctor excises a spindle-shaped flap of skin. During surgery, depending on the wishes of the patient, the specialist can tighten the orbicularis oculi muscles, remove a fatty hernia, or change the location of the lacrimal gland.

Blepharoplasty on the lower eyelids is performed under the natural lash line. The doctor makes thin incisions, separating fatty tissue, muscle and skin. During lower eyelid surgery, fat deposits are removed and weakened skin is corrected. At the end of the surgical intervention, the specialist applies cosmetic sutures in the places where the incisions were made.

A separate method of eyelid correction is transconjunctival blepharoplasty, which is used in exceptional cases when the patient needs to remove excess fat deposits in the lower parts of the eyelid. This operation is most often indicated for young people. In the case of transconjunctival blepharoplasty, the surgeon makes a small puncture or a very small incision in the inner part of the lower eyelid and removes excess fat accumulations through the resulting hole. After such an intervention, there are practically no traces left, since the operation itself involves minimal manipulation on the outer (visible) side of the eyelid. The procedure will not affect a person’s facial expressions during the rehabilitation period, the scars will be invisible, and the recovery process itself will not last long. However, the operation does not involve any significant changes in the shape or shape of the eyes.

In the field of plastic surgery, there is such a thing as laser blepharoplasty.

In this type of operation, the usual surgical scalpel is replaced by a laser. This type of blepharoplasty has its advantages over other types of eyelid surgery, which is why it has become very popular in recent years. So, among its advantages are:

No scars. The procedure is practically bloodless. The laser leaves no marks and guarantees rapid healing.
Operational implementation. It is carried out very quickly - usually the doctor copes with the task in half an hour.
Expected Result. A plastic surgeon, using the laser correction method, better controls the process and monitors the progress of the operation.
Fast recovery period. After laser blepharoplasty, swelling is less than when using a scalpel. Accordingly, the period of postoperative rehabilitation is significantly reduced.

Transconjunctival (sutureless) blepharoplasty

The essence of the operation is that the surgical incision is located along the line of the conjunctiva, that is, on the inside of the lower eyelid. Hence the second name - “sutureless”, since sutures are not required after transconjunctival blepharoplasty: the dissected area located on the mucous membrane heals on its own.

In this regard, laser blepharoplasty is more profitable than traditional blepharoplasty - the surgeon removes excess fatty tissue through small punctures, which he makes with a laser beam. Under the influence of laser radiation, cellular processes are activated, provoking more intense tissue regeneration.

Accordingly, the rehabilitation period is significantly reduced: complete recovery occurs in three days, minor swelling and bruising disappear on their own within a week and a half.

In addition to all of the above, the laser is used by the surgeon to renew the skin of the lower eyelids, eliminate facial wrinkles and the first age wrinkles: after completing work on eliminating the hernia formation, the doctor performs laser resurfacing of the eyelids.

Laser transconjunctival blepharoplasty allows you to perform two operations in one operation: to eliminate a cosmetic defect in the form of fatty hernias and to tighten, make the skin of the lower eyelids more elastic and smooth.

It is recommended only for those patients who have not yet been diagnosed with age-related ptosis (tissue drooping) in the area under consideration, characterized by a significant amount of excess soft tissue.

To correct age-related aesthetic deficiencies in the periorbital area, more complex techniques are recommended that require large-scale surgical intervention using traditional surgical instruments.

You can learn more about transconjunctival blepharoplasty here

Progress of laser blepharoplasty surgery

The duration of the procedure is from 30 to 90 minutes (on average 45 minutes) and depends on the complexity and volume. Before performing the operation, I will select the appropriate technique to obtain the best results, taking into account your wishes, physiological characteristics and health status.

Step 1 - Anesthesia

Usually a combination of local anesthesia and light intravenous sedation is used, however, with a large volume of surgical intervention, the choice may fall towards general anesthesia. In our clinic, pain relief is always carried out under the guidance of one of the best anesthesiologists in the country, which guarantees your safety and the absolute safety of your health.

Step 2 - Cuts

The incision lines depend on the type of plastic surgery performed and are always located in the natural folds of the skin, which makes the seams and scars completely invisible to the prying eye!

Step 3 - Closing the Cuts

Sutures are usually closed:

Removable or absorbable threads
Leather glue
Surgical tape
When performing “seamless” laser transconjunctival plastic surgery, no sutures are required.

In the video: a 54-year-old patient diagnosed with hernias and excess skin of the upper and lower eyelids. Atony of the lower eyelids. In addition, the patient has a scleral gaze and a negative vector. In general, the conditions for blepharoplasty “cannot be worse.” Severe excess skin, hernias of the upper and lower eyelids are also visualized. The planned operation includes: circumferential blepharoplasty with myopexy and canthopexy in the lower eyelid area. This volume of surgery will minimize the risk of postoperative complications. A prerequisite for successful rehabilitation in such situations is anti-scar physiotherapy. As a rule, this is ultraphonophoresis with longidase.

Benefits of laser blepharoplasty

The laser blepharoplasty procedure is performed using a CO2 laser, which has a number of obvious advantages compared to a scalpel:

Its beam is transparent, which allows the surgeon to fully see the operated area (unlike traditional blepharoplasty, when the surgeon partially covers the operated area with a scalpel).
It cuts the tissue layer by layer (the depth of each cut is 2-3 mm), which significantly reduces the risk of damage to the eyeball, cornea and eyelashes.
It has pronounced coagulating properties: the radiation “seals” small blood vessels at the incision sites, minimizing bleeding of the operated area. This not only reduces the recovery period, eliminating swelling and bruising, but also helps the surgeon during the operation. The absence of blood allows him to clearly see the operated area, which makes laser blepharoplasty safer and faster than traditional blepharoplasty.
Under the influence of laser radiation, cellular processes are activated, provoking more intense tissue regeneration, which reduces rehabilitation time by almost 2 times
If there are fine wrinkles in the lower eyelid area, the procedure may be accompanied by laser resurfacing. The combination of these procedures makes it possible to achieve comprehensive rejuvenation of the lower eyelid area, which is not achievable with traditional intervention. Laser eyelid resurfacing is a technology of the future that is in service at our clinic.

Despite the obvious advantages, there are opponents of this method of eye rejuvenation. Basically, they appeal to the fact that the scalpel allows you to make a more even cut.

As a rule, I combine different techniques and I must note that despite the fact that the recovery period after laser blepharoplasty is shorter, the result of the operation, no matter how it is performed, will be the same.

Eyelid surgery can be performed either in combination with other anti-aging procedures (for example, facelift) or independently.

Rehabilitation after eyelid surgery

After eyelid surgery under local anesthesia, you can go home almost immediately; if you use general anesthesia, you can go home the next day.

Primary recovery takes 7-14 days.

Stitches (if any) are removed on days 4-7. It depends on the amount of work done, the type of seam and your skin type.

It is advisable to periodically apply cold compresses to the operated surface. Scars are noticeable at first, but become almost invisible after three weeks.
Bruising and swelling depend on the individual characteristics of the body. They can last up to 2 weeks. The bruises disappear within a week. Redness in the eyeball due to a burst vessel goes away within 2 weeks.
You can apply makeup after 10 days
Most patients return to work within 7-10 days
Some patients experience tearfulness or, conversely, dry eye syndrome. This can last several weeks - extremely rarely more than three months. Using eye drops significantly shortens the recovery period.

In the video: the patient immediately after surgery. In this form, the patient usually leaves the hospital for further outpatient observation.

The result of blepharoplasty after rehabilitation

In the photo: Patient before and after blepharoplasty of the upper and lower eyelids