AN eyes and brow qxd brow liner

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					       eyes
     and brow


      Tel: 020 8735 6060
www.plasticsurgerypartners.co.uk
                                                                                                                          eye lid surgery & brow lift
    Often the first signs of ageing are                                                The ageing eye Anatomy
    crows feet, drooping eyebrows and                                                  Ptosis                                                             Forehead
                                                                                       (drooping)                                                         creases
    bags under the lower lids.                                                         of eyebrow                                                         (frontalis
                                                                                                                                                          muscle)
                                                                            Before
    Case time: upper eyes LA day case 1 hour                                           Fat Bags
    lower eyes GA day case 11/2 hours
    Recovery time: 1 week upper, 1 week lower                                          Ptosis                                                             Glabella
                                                                                       (drooping)                                                         (with frown
                                                                                       of eyelid                                                          lines)

    Eyelid Surgery (Blepharoplasty)                                            After
                                                                                       ‘Crows Feet’
    The ageing eye Anatomy                                                                                                                                Medial
                                                                                                                                                          canthus
                                                                                       Lateral
                                                                                       canthus
                                                                                                                                                          Deep
              3                                                                                                                                           Nasojugal
                                                                                       Orbicularis
                              1                                                                                                                           crease
                                                                                       muscle
                      4                                                                under skin
     2                                                                                 (in magenta)
                                                                                                                                                          Punctum
                                                                                                                                                          (opening) of
                                                                                       Sclera: white of eye.        Malar bag (white): water   Fat Bags   tear duct
                  5                                                                    Subconjunctival oedema       and festoon (folds) of                (one also in
                                                                                       (see complications) Sceral   orbicularis muscle                    the upper
                                                                                       show: White between iris                                           eyelid)
                                                                                       and lower lid
                                  Early treatment          Late treatment
     1 Glabella frown lines       Botox                    Brow lift
     2 Crows feet                 Botox                    Lower lid surgery
                                                           Skin Resurfacing
     3 Brow ptosis.               Dynamic facial           Endoscopic
       Droop                      sculpting with Botox     Brow lift
     4 Skin excess and
                                              Upper eyelid reduction
       fat upper eyelid
     5 Bags. Lower eyelid         Transconjunctival fat    Lower Eyelid reduction,
                                  Excision + Laser         fatdrape, Canthoplasty

2                                                                                                                                                                        3
                                                                                                                                        eye lid surgery & brow lift
    Anatomy of the standard upper and lower Blepharoplasty                                           Technical terms used                        ■ SCLERAL SHOW:
                                                                                                     in eyelid surgery                             White shows under the pupil/iris.
                                                                                                     ■ PTOSIS:                                   ■ ECTROPION:
                                                                                                       Drooping of the upper eyelid. It may        Lower lid pulls away from the
                                                                                                       require repair of the levator muscle        eyeball.
                                                                                                       (muscle acts like a curtain that lifts    ■ SNAP TEST:
                                                                                                       upper lid).
                                                                                                                                                   Gently pulling the eyelid away from
                                                                                                     ■ TEARFILM:                                   the eyeball. Normally snaps back
                                                                                                       The lacrimal gland produces a liquid        quickly.
                                                                                                       film that covers the eyeball (it          ■ NASOJUGAL FOLD:
                                                                                                       consists of water and oil). Lack of a
                                                                                                                                                   Deepening at side of nose under
                                                                                                       tear film causes an uncomfortable
                                                                                                                                                   lower eyelid. If dark it can be
                                                                                                       dry eye.
                                                                                                                                                   lightened with laser or Chemical
                                                                                                     ■ EPIPHORA:                                   resurfacing. If very marked (deep) it
                                                                                                       Tears: Caused by excess production          can be filled with fat.
                                                                                                       from irritation or blocked drainage.
     Artistic representation of skin laxity and fat deposits assessed and corrected during surgery
                                                                                                     ■ BLEPHARITIS:
                                                                                                       Red inflamed eyelids.
                                                                                                     ■ CONJUNCTIVITIS:
                                                                                                       Red inflamed lining of the eyeball.
                                                                                                     ■ DIPLOPIA:
                                                                                                       Double vision.
                                                                                                     ■ CANTHOPLASTY/CANTHOPEXY:
                                                                                                       The support of the lower eyelid is
                                                                                                       critical. In older patients support of
                                                                                                       lower lid is often poor. Any surgery
                                                                                                       requires supporting the lid by hitching
                                                                                                       it up in the area of the crows feet.
                                                                                                     ■ FESTOONS. MALAR OR
                                                                                                       SECONDARY BAGS:
                                                                                                       Lower bags on the cheek which are
                                                                                                       not helped by normal lower eyelid
                                                                                                       surgery.
                         Eyelid skin excess excised and lines of skin closure.
               In the lower eyelid the incision can sometimes be made on the inner lid



4                                                                                                                                                                                          5
                                                                                               eye lid surgery & brow lift
    Medical Considerations                                           Upper and Lower Eyelid Reduction

    Lower Eyelid Bags:
    ■ CONGENITAL/FAMILIAL
      Some young people may have a family history                             Pre - op                  Post - op
      and develop lower eyelid bags.
    ■ SMOKING:
      Causes premature aging of the skin, crows feet
      and early swellings in the upperand lower eyelids.
      Also causes malar bags.                                                 Pre - op                  Post - op
    ■ SUN:
      Causes premature aging of the skin and crows feet
      from contracting the eyelids.
    ■ THYROID DISEASE:
      Overactive: Produces prominent eyes (Exophthalmus).                     Pre - op                  Post - op
      Underactive: Produces ‘puffy’ lids and malar bags.
    ■ OEDEMA:
                                                                     Upper Eyelid Reduction
      Heart failure and renal disease can both lead to swelling
      of the lids.
    ■ VISION:
      Eyelid surgery can occasionally and temporarily alter the
      vision. This is because the release of weight on the eyeball
                                                                              Pre - op                  Post - op
      may change the shape of the eye itself for a few weeks.




                                                                              Pre - op                  Post - op




                                                                             Pre - op                   Post - op



6                                                                                                                            7
                                                                                                             eye lid surgery & brow lift
    Upper Eyelid Surgery                                                  Lower Eyelid Reduction                       Eyelid Surgery
                                                                                                                       Complications
    Local Anesthetic Procedure.                                           Aesthetic Plan:
    ■ The plan is to remove the excess skin/muscle/fat                    ■ Remove eyelid bags.                        Early:
      in the lid.                                                         ■ Harmonise lower lid/cheek junction.        ■ Swelling of upper and lower eyelids.
    ■ Skin markings are made with the patient sitting.                    ■ To lift the lower lid to a more youthful   ■ Bruising.
    ■ Scars are positioned in the crease of lid.                            position.                                  ■ Watering of
      NB. The height of eyebrows and eyelid                               ■ It is not an operation for skin creases.     eye (epiphora)      In the short term
      creases are often asymmetrical.                                                                                                        responds well to
                                                                          ■ Malar bags may be made worse by            ■ Grittiness
                                                                                                                                             covering with pads
                                                                            surgery (festoons should be improved)        of eyes.
    Operation Steps:                                                                                                   ■ Temporary blurred vision. Caused by
    ■ Removal of a strip (or ellipse) of skin +/- muscle.                 Operations:                                    eye cream used after surgery.
    ■ Fat assessment +/- removal from its location                        ■ Classical incision under eyelashes in      ■ Severe pain in the eye. Corneal
      in two bags.                                                          position of eye liner.                       abrasion. Responds in 24-48 hours to
    ■ Levator aponeurosis repaired if ptosis present.                                                                    eye drops.
                                                                              - Fat bags excised
    ■ Skin repaired with running or continuous suture.                        - Fat drape to correct nasojugal fold
                                                                              - Lid support
                                                                                                                       Medium Term:
    After Operation:                                                                                                   ■ Altered vision. Changes in the
                                                                              - Excess skin conservatively excised
                                                                                                                         pressure on the eyeball changes
    ■ Gentle eyepads to stop movement with blinking and to                ■ Transconjunctival fat excision (incision     shape of lens. Recovers in 5-6 weeks.
      prevent drying.                                                       on the underside of the lower lid).
                                                                                                                       ■ Subconjunctival oedema.
    ■ Sutures removed on the 4th or 5th day.                                +/- CO2LASER or chemical resurfacing
                                                                            of the eyelid skin.                        ■ Scleral show/ectropion.
    ■ Sit up to help swelling. In bed use initially 3 or more pillows.
                                                                          ■ Canthopexy or Canthoplasty are
    Complications:                                                          sometimes planned in eyelid surgery to     Long Term:
                                                                            correct or secure the position of the      ■   Eye shape change.
    ■ Discomfort. Watering of the eyes, grittiness.                         outside corner of the eye.
                                                                                                                       ■   Scleral show.
    ■ Difficulty with eyelid closure particularly at night. Improves as
      swelling settles and scars soften.                                                                               ■   Dry eye.
    ■ Numbness of the eyelid: Normally lasts 5-6 weeks. Take this                                                      ■   Blindness very rare.
      into account when applying make up.
    ■ Occasionally cysts appear in scar.




8                                                                                                                                                                 9
                                                                                                                       eye lid surgery & brow lift
     Pre-Operative Preperation                                                      ■ Try to sleep upright on 3-4 pillows for     ■ An outpatient appointment will be
     ■ High doses of Vitamin E and Multivitamins to be                                1 week, then you may start reducing the       made for you to see the consultant
       stopped two weeks pre-operatively and not to be                                pillows. This is to try to reduce any         4-6 weeks following surgery.
       commenced until two weeks post-operatively.                                    swelling you may have. After sleeping       ■ During the first week after the
                                                                                      you may find that the swelling may be         operation should you experience
     ■ Take one Arnica tablet four times per day (not with                            more obvious in one eye than the other,
       meals or drinks) one week prior to surgery and                                                                               severe pain, unusual swelling,
                                                                                      this may be due to which side you have        bruising or oozing from the wound,
       continue for ten days following surgery. Also take                             had you head turned to whilst sleeping.
       Vitamin C 1000mg (or 19) for two weeks prior to                                                                              or develop a higher temperature,
                                                                                      Again this swelling will subside.             you must inform the practice at the
       surgery. You can continue this for two weeks post
                                                                                    ■ Any bruising takes approximately 14-21        earliest opportunity.
       surgery as Vitamin C has an antioxidant and anti-
                                                                                      days to resolve, and complete resolution
       inflammatory effect.
                                                                                      of swelling 4-6 weeks. Ask our nurse to
     ■ Avoid taking Aspirin, Neurofen and any other flu                               show you our massage routine.               Any problems, please contact
       remedies containing Aspirin for two weeks prior to                           ■ Arnica tablets should be taken for a        Plastic Surgery Nurse Consultant,
       surgery and two weeks post-operatively. If any post-                           further 10 days post op if desired.         Mon-Fri 8-5p.m. 020 8735 6060
       operative pain relief is required please take tablets
                                                                                    ■ Contact lenses may be worn providing
       containing Codeine and/or Paracetamol, ie Panadol or                                                                       Other contact information for all
                                                                                      the swelling around the eyes has
       Solpadeine.                                                                                                                hospitals including out of hours for our
                                                                                      resolved.
     ■ If taking Aspirin/Warfarin for a medical condition please                                                                  Plastic Surgery Nurse Consultants will be
                                                                                    ■ Sometimes following this procedure,
       contact the Practice as soon as possible for advice, as                                                                    provided at the time of booking surgery.
                                                                                      swelling may occur to the thin membrane
       these will need to be stopped prior to surgery.                                covering the eye (subconjunctival
     ■ Avoid alcohol for forty-eight hours prior to surgery.                          oedema). Notify the nurse if this should    Teaching Experience
     ■ If you have any other concerns about medication you are taking                 occur. This can take 4-5 weeks to resolve   and Presentations
       please contact the Practice for further advice.                                sometimes less. Cover eye at night and      ■ Anatomy Course. Royal College of
     ■ You may need to purchase Vaseline and vitamin E oil, to be applied             use frequent artificial tears.                Surgeons of England. Eyelid Surgery.
       to your scars after your sutures have been removed (four to five days        ■ No swimming for 2-3 weeks following         ■ Operative Surgery Course Stamford
       post op). These can be purchased from a good pharmacy or chemist.              surgery. No strenuous exercise for            Hospital. May 2001.
       You will also need cotton buds for application to avoid contact with           4-6 weeks.
                                                                                                                                  ■ Complications of Blepharoplasty.
       the scars. It is also advisable to wear some lighter coloured lens           ■ You may wear make-up after 7-10 days
                                                                                                                                    British Association of Plastic
       sunglasses after your surgery for all-day protection.                          and use hypoallergenic or non-perfumed
                                                                                                                                    Surgeons. July 2003.
                                                                                      moisturisers (be very gentle when
                                                                                      applying). However, Vaseline appears to     ■ Complications of Blepharoplasty.
     Blepharoplasty - Discharge Information                                           be very effective and more comfortable.       British Association of Aesthetic Plastic
     ■ You will be given an appointment to attend the dressing clinic 4-5 days        You can apply the Vaseline with cotton        Surgeons. September 2003.
       following surgery for removal of your stitches and the small tapes on your     buds to avoid contact with the scars.       ■ Eyelid surgery is the most commonly
       eyes, before you are discharged from hospital.                               ■ You may bathe your eyes with warm very        performed operation by PSP.
     ■ Most of your swelling will be in the first 48-72 hours following surgery,      dilute salt water and cotton wool           ■ Plastic Surgery Partners have
       then it begins to subside. The swelling may be a little slower to go in        if they start to become ‘sticky’ or feel      performed over 1500 eyelid
       warmer conditions.                                                             gritty. Be very gentle when doing this.       operations in the last 30 years.
10                                                                                                                                                                             11
                                                                                                                      eye lid surgery & brow lift
     Brow Lift                                                                      Brow Lift Recovery and                        Brow Lift Teaching and
                                                                                    Complications                                 Experience
     Brow Lift - Indications
     ■ Low or asymmetric brows.                                                     Recovery:                                     Teaching:
     ■ Creases at bridge of nose (glabella frown lines).                            ■ Skin clips, sutures. Screws removed         ■ Operative demonstration.
                                                                                      at 12 days.                                 ■ Pan Thames training plastic
     ■ Excess skin in upper lids caused by low eyebrows.
       In particular lateral hooding of the eyes.                                   ■ Return to work in 2 weeks.                    surgeons. April 2001.
     ■ NB. Males have a much lower brow height                                                                                    ■ Face lift Master Class. Wellington
       than females.                                                                Complications:                                  Hospital. Royal College of Surgeons
                                                                                                                                    1997,1998.
                                                                                    ■ Black eyes. Swelling.
                                                                                                                                  ■ Facelift Masterclass West London
     Brow Lift - Procedure                         Brow muscle   Brow    Temporal   ■ Numbness of the forehead.
                                                     released     lift      lift                                                    Clinic October 2008.
     ■ Done as GA. Day case.                                                        ■ Inability to raise eyebrow, usually
     ■ Marked out pre-op.                                                             temporary.
                                                                                    ■ Small bald patch around a scalp incision.
                                                                                                                                  Procedures Performed:
     ■ 3 small Incisions (about 1 cm long)
                                                                                                                                  ■ In the last 12 years 312 brow lifts.
       on each side of head in the hair                                             ■ Very occasional pain in the forehead.
       bearing scalp thus not seen.                                                   Funny sensation in scalp.                   ■ Last year            42 brow lifts.
     ■ Through one incision an endoscopic
       camera is passed. Through a second
       incision a metal dissector is
       manipulated (endoscopic key                                                  Brow Lift
       hole surgery).
     ■ The forehead is dissected off the
       frontal bone under direct vision avoiding
       any nerves.
     ■ The frowning muscles at the base of
       the nose are weakened and divided.                                                          Pre - op                                Post - op

     ■ The brows are then lifted up and held in
       the new position by fixation (sometimes
       with a screw) in the scalp which is
       removed after 10 days.

                                                                                                   Pre - op                                Post - op




12                                                                                                                                                                         13
                                                                                                                eye lid surgery & brow lift
     Pre-Operative Preperation                                               Brow Lift Discharge Information             ■ You may wash your hair after
     ■ High doses of Vitamin E and Multivatins to be                         ■ You will be given an appointment to         discharge from the hospital.
       stopped two weeks pre-operatively and not to be                         attend the dressing clinic following        Only bend your head backwards,
       commenced until two weeks post-operatively.                             discharge at 10 days for removal of         over the sink, ensuring that the area
                                                                               your clips/screws from your scalp by        behind the ears is dried well by
     ■ Take one Arnica tablet four times per day (not                                                                      passing a cotton wool bud or ball
       with meals or drinks) one week prior to surgery                         the nurse.
                                                                                                                           along the crease behind the ear.
       and continue for ten days following surgery. Also                     ■ The condition of your skin may              The area in front of the ear should be
       take Vitamin C 1000mg (or 19) for two weeks prior                       change following this procedure, i.e.       dried well with a clean towel. Get
       to surgery. You can continue this for two weeks post                    your skin may feel drier or ‘itchy’.        someone to help you.
       surgery as Vitamin C has an antioxidant and anti-                       You can moisturise your skin as
       inflammatory effect.                                                    normal if this is the case.               ■ Try to avoid hot beverages or hot
                                                                                                                           baths as this tends to make the
     ■ Avoid taking Aspirin, Nurofen and any other flu                       ■ Most of the swelling should be in the       face flushed.
       remedies containing Aspirin for two weeks prior to                      first 24/48 hours following surgery,
       surgery and two weeks post-operatively. If any post-                    then it begins to subside. Note that      ■ Avoid strenuous exercise for 4-6
       operative pain relief is required please take tablets                   the swelling is a little slower to          weeks following surgery, and no
       containing Codeine and/or Paracetamol, ie Panadol                       subside in warmer conditions.               swimming for 2-3 weeks following
       or Solpadeine.                                                                                                      surgery.
                                                                             ■ Try to sleep on 3-4 pillows for
     ■ If taking Aspirin/Warfarin for a medical condition please               1 week, then you may start reducing       ■ You may wear make-up and use skin
       contact the Practice as soon as possible for advice, as                 the pillows. After sleeping, you may        care products (be gentle when
       these will need to be stopped prior to surgery.                         find that the swelling may be more          applying) after 4-5 days if you desire.
     ■ Avoid alcohol for forty-eight hours prior to surgery.                   obvious in one side of your face than     ■ An outpatient appointment will be
                                                                               the other, this is dependant on gravity     made for you to see the consultant
     ■ If you have any other concerns about medication you are                                                             2-4 weeks following surgery.
                                                                               and to what side you have your head
       taking please contact the Practice for further advice.
                                                                               turned to whilst sleeping. Again this
     ■ You may need to purchase Vaseline and vitamin E oil, to be              swelling will subside.                    Any problems, please contact
       applied to your scars after your sutures have been removed
                                                                             ■ Bruising may take approximately           Plastic Surgery Nurse Consultant,
       (four to five days post op). These can be purchased from a good
                                                                               10-14 days to resolve and swelling        Mon-Fri 8-5p.m. 020 8735 6060
       pharmacy or chemist. You will also need cotton buds for application
                                                                               sometimes longer.
       to avoid contact with the scars. It is also advisable to wear some                                                Other contact information for all
       lighter coloured lens sunglasses after your surgery for all-day       ■ During the first week after the           hospitals including out of hours for our
       protection.                                                             operation should you experience           Plastic Surgery Nurse Consultants will be
                                                                               severe pain, unusual swelling,            provided at the time of booking surgery.
                                                                               bruising or oozing from the wound
                                                                               site or if you develop a fever, you
                                                                               must inform the practice at the
                                                                               earliest opportunity.




14                                                                                                                                                                   15
              how to contact us
              Tel: 020 8735 6060
              www.plasticsurgerypartners.co.uk




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    Plastic Surgery Partners
        55 Harley Street,
       London W1G 8QR
      Tel: 020 8735 6060
www.plasticsurgerypartners.co.uk

				
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Description: AN eyes and brow qxd brow liner