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Reconstructive and cosmetic eyelid surgery

Eyelid surgery (palpebral surgery) encompasses all procedures designed to treat excess skin, malpositions (ectropion and entropion), benign lesions, and malignant tumors of the eyelids. These procedures fall within the specialty of the oculoplastic ophthalmologist. ENT specialists and plastic surgeons also perform some cosmetic procedures, but they cannot manage potential postoperative changes to the ocular surface. The ophthalmologist, on the other hand, performs both reconstructive (functional surgery) and cosmetic procedures to improve the appearance of the eyes.

What eyelid surgeries are available?

A distinction must be made between eyelid surgery for cosmetic purposes and surgery for reconstructive purposes. The main procedures are:

Cosmetic eyelid surgery:

  • Blepharoplasty – Surgery for excess skin (dermatochalasis) and bags of the upper and lower eyelids.

  • Botox and hyaluronic acid injections – Aesthetic treatment of the eyes and face by filling wrinkles and relaxing muscle spasms.

Eyelid reconstructive surgery

  • Chalazion incision – Removal of a meibum (fatty substance) cyst on the eyelid. This is the most commonly performed eyelid surgery.

  • Ptosis correction – Surgery for a drooping upper eyelid.

  • Entropion treatment – Surgery for an inward-turning eyelid that rubs against the eye.

  • Ectropion correction – Surgery for drooping eyelid margins.

  • Tumor excision – Removal of a benign or malignant tumor from the eyelid.

  • Floor fracture reduction – An operation aimed at limiting eye ptosis and diplopia caused by a fracture of the orbital floor.

  • Botulinum toxin for blepharospasm – Toxin injections intended to relieve involuntary and painful contractions of the orbicularis oculi muscles.

How much does eyelid surgery cost?

  • Here again, a distinction must be made between eyelid surgeries for aesthetic purposes and those for restorative (functional) purposes.

  • Reconstructive surgery is covered by social security and your supplemental health insurance. You will only have to pay any additional fees charged by the surgeon and anesthesiologist that are not covered by your supplemental insurance.

  • Cosmetic procedures are not covered by social security or private health insurance. Therefore, you will have to pay for all hospitalization costs, the surgeon's fees, the anesthesiologist's fees, as well as post-operative treatments.

What do eyelid surgeries involve?

Eyelid surgeries are generally performed under local anesthesia. With the exception of chalazion incision, they are all carried out on an outpatient basis in the operating room.
The main principles of eyelid surgery are:

  • Creation of pre-operative drawings using felt-tip pens.

  • Anesthesia of the eyelid with Xylocaine to relieve any pain.

  • The incisions are made in such a way that they are hidden in the folds of the eyelids when closed.

  • Performing the necessary treatments: strengthening a muscle or tendon, removing fat deposits, repositioning eyelashes,…

  • Skin closure with non-absorbable sutures.

Recovery and convalescence

  • It is advisable to take about a week off work (or vacation in the case of cosmetic surgery) to recover from eyelid surgery.

  • The stitches are removed between the 7th and 10th day.

  • For about 10 days, it may be obvious on your face that you have just had eyelid surgery.

After the operation you will probably need:

  • Sleep with pillows for a few days to reduce swelling.

  • Apply a cold compress or mask to your face for a few days to help reduce any bruising – You can try a packet of frozen peas wrapped in a clean cloth.

  • Gently clean your eyelids with saline solution followed by healing ointment or eye drops.

  • Wear sunglasses and a cap to protect your eyes and eyelids from the sun and wind.

  • Take paracetamol or another prescribed painkiller to relieve any pain.

You should avoid:

  • Intense activities and swimming for 15 days.

  • Smoking – Tobacco slows down healing and irritates your eyes.

  • Wearing contact lenses or rubbing your eyes.

Side effects of eyelid surgery

Some minor, annoying but inconsequential side effects are to be expected.
After eyelid surgery, it is common to temporarily experience the following effects:

  • Swollen, numb eyelids that are difficult to close at night.

  • Irritated, sensitive or watery eyes for a few weeks.

  • Bruises (bruises) with the appearance of a real black eye.

  • Inflammatory scars – They eventually fade and become almost invisible.

  • A temporarily blurred or double vision.

  • Slightly asymmetrical eyes and eyelid openings.

Complications of eyelid surgery

In rare cases, the operation can lead to more serious, unforeseen side effects, with a risk of lasting damage. The main complications to remember are:

  • Damage to one of the eye muscles

  • Eyelid retraction – It moves away from the eye due to abnormal scarring and turns outwards (scar ectropion)

  • A corneal lesion (ulcer or abscess) due to failure of the eyelids to close and prolonged exposure of the cornea.

  • A major hematoma compressing the eyeball.

  • The formation of a blood clot in a vein of the globe.

  • A nosocomial infection – Preseptal or orbital cellulitis

  • An allergic reaction to the anesthesia.

The oculoplastic surgeon will explain the likelihood of these risks and complications, and how they will be treated if they occur.
The ophthalmologist is the specialist best equipped to manage any potential ocular risks and complications of eyelid surgery.

Sources:
https://eyewiki.org/Category:Articles
https://www.cahiers-ophtalmologie.fr/
https://snof.org/
https://couf.fr/

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