Monday, February 28, 2011

Rhinoplasty Vancouver and Eyelid Plasty Techniques and Details

“The eyes are the windows of the soul”, says  an old proverb.

Of all facial rejuvenation operations, the blepharoplasty or eyelidplasty or sometimes rhinoplasty Vancouver is the most commonly performed and can have a very substantial benefit relative to the length of and recovery time of surgery.

What happens to make the eyes look older?

With age, the eyes may take on a tired or fatigued look due to several factors.  These may not strictly be related to age and are very commonly associated with your family background ( genetics) but are often interpreted as signs of age. The upper eyelids may appear to  develop considerable redundant skin, so much so that it may actually hang completely over the eyelids and rest on the eyelashes. In extreme circumstances, this  may cause some obstruction to vision towards the periphery of your visual field. If this extreme is reached, your medical insurance may cover part or all of the Vancouver liposuction cost.

In order to explain what goes on under the skin, we have to consider some of the anatomy of the eye.  The eye sits within the bones of the face floating in a cushion of fat cells.   Under normal circumstances, this fat is held in place by a strong but thin membrane or wall which runs from the eyelid down to the rim of the cheek bone in the lower eyelid and from the upper eyelid up to the brow.  In some individuals who are predisposed, this wall gradually or suddenly weakens and the fat begins to bulge into the skin of the eyelids both in the lower and in the upper eyelids. When we see bags under the eyes, this is merely the fat bulging into the skin causing a convexity below the natural border of the eyelid, and often down below the level of the edge of the eye socket bone.  This is often also seen just above the inner corner of the eye in the upper eyelid, and as increased puffiness or fullness in the rest of the upper lid not unlike rhinoplasty Vancouver.

The brow  and forehead sag

It is also important to be aware of the role sagging of the skin and deeper tissues of the forehead. Often what appears to be excess eyelid skin may be all or partly due to descent of the forehead, temple and eyebrows. Attempting to remove the apparent eyelid excess may result in an unnatural appearance or even chronic angry expression. Although a browlift may seem like a much bigger operation, recovery from the endoscopic ( minimal incision) type of browlift can be rapid and the effects may be well worth the extra extent of the surgery, especially when combined with eyelid surgery

Surgery Techniques
In performing an eyelid plasty, the surgeon trims the excess skin from the upper eyelid and approaches this bulging fat by splitting there retaining wall membrane, then trims the fat and carefully cauterizes any tiny blood vessels which could cause bleeding, allows the  stump of fat to return to its place and closes the incision with some fine stitches.   In the lower eyelid, if there is excess skin, this is trimmed via an incision immediately under the eyelashes. This incision usually becomes very difficult to see, in time.   It is uncommon to have a lot of excess skin to the lower eyelids and any attempt to lift the lower eyelid by means of trimming skin and pulling may result in the eyelid being pulled downwards and outwards creating a very unsatisfactory appearance. There can be white showing below the iris ( “scleral show”) or worse, the lid can be pulled down and away from the eye surface causing dryness, irritation, and tears spilling out from the lids on the the cheeks ( “ectroption”)   Surgeons are understandably cautious about removing skin from the lower eyelids. Often a precautionary internal stitch to support the outer eyelid corner  ( a “canthopexy”)  is used, rhinoplasty Vancouver.

Lower lid blepharoplasty to just remove the lower lid fat can be done from an incision on the inside of the lower lid, leaving no external scar.  If skin tightening is felt to be necessary, this can be done either with a skin only removal on the outside of the lid, leaving the important muscle layer and the septum ( retaining wall membrane) intact, and thereby reducing the risk of scleral show and ectropion.

Fat Conservation

Some surgeons now believe that excess removal of fat may lead to a rather hollow and operated look in later years. Techniques involving the traditional external incision but with repair and repositioning of the fat pockets have developed. The weak wall is repaired and the fat is partially removed with the remainder put back into position, or, the fact may be divided and used along the rim of the bone to fill out the lower lid hollows and the “tear trough” leading from the the eyelid down into the cheek. The operation may also be supplemented with fat grating to improve the contours using minute amounts of fat obtained by Vancouver liposuction lipoplasty

The choice of  what technique is applicable will depend on your own anatomy and the surgeon’s preference and experience with eyelid plasty and rhinoplasty Vancouver.

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