Dermatochalasis surgery

When the skin in the area of the eyelids sags, this can not only be a burden from an aesthetic point of view, but can also result in health impairments. This is especially true for the area of the upper eyelids. The sagging tissue can bulge over the eyes and exert counter-pressure when the eyes open. This can promote chronic headaches or lead to eczema of the skin. Restriction of the visual field is the most common medical reason for treating excess skin on the upper eyelid. 

In medical terminology, the sagging of the eyelid skin is called dermatochalasis. The loss of elasticity can usually be treated well in an operation of the upper eyelids, a so-called upper eyelid blepharoplasty. In a surgical procedure, the excess skin of the eyelids is removed using a laser or scalpel. 
 

What is dermatochalasis?

The term dermatochalasis literally means sagging of the skin (from Greek dermato = skin, chalasis = sagging). It is a malpositioning of the eyelids that can occur in young and older people alike, so it is not just a symptom of old age. 

Patients with dermatochalasis may suffer from recurrent swelling of the eyelids caused by painless oedema. Over time, the repeated swelling causes the connective tissue to slacken. As a result, protrusions of the skin can gradually form. Most often, the upper eyelids are affected by dermatochalasis, resulting in drooping eyelids. However, the swellings can also occur in other areas of the eye regions, so that bags form on the lower eyelids, for example. Surgery for dermatochalasis is usually necessary when drooping upper eyelids restrict the field of vision or cause health problems. 
 

How can dermatochalasis be treated?

Dermatochalasis is treated surgically with an upper eyelid blepharoplasty. This is a surgical tightening of the eyelids, which can be done with a scalpel or laser, depending on the extent of the drooping. 

There is no alternative to surgical correction for pronounced excess skin. 
 

What is the procedure for dermatochalasis?

Before the dermatochalasis operation:

Once your ophthalmologist has made the decision to perform an upper eyelid blepharoplasty together with you, you will be informed in detail about all the details of the operation. You will be told how the operation will proceed and what to bear in mind during the aftercare. You will also be informed in detail about possible risks and side effects. It is important that a preliminary ophthalmological examination is carried out to make sure that you are suitable for the operation. In individual cases, blood-thinning medications such as Xarelto or Marcumar may also have to be discontinued before the operation. The doctor will discuss this with you in advance. 

You should come to your operation appointment without make-up and, if possible, accompanied. The doctor will discuss with you whether you should have an inpatient or outpatient operation. Due to the swelling and the medication, you are not allowed to drive yourself on the day of the operation, which you should take into account in your planning. 

Blepharoplasty procedure:

Dermatochalasis surgery is usually performed under local anaesthesia with what is called sedation. An anaesthetist administers painkilling and sedative medication via the arm vein. The anaesthetist is present throughout the operation. He monitors your vital signs and makes sure you are comfortable. 

Surgery under general anaesthesia is not usually necessary. When a blepharoplasty is performed on the upper eyelid, the surgeon makes an incision in the skin in the area of the upper eyelid furrows. The suture is therefore usually only visible when the eyes are closed. Since the skin of the eyelid is very thin and has a good blood supply, only very fine scars usually form, which are usually no longer visible after a short time. During the operation, the excess eyelid skin is removed and also a narrow strip of the musculature in order to evenly tighten the entire eye area. If necessary, protruding fatty tissue is also removed. 

When correcting the lower eyelids, the incisions are made close to the lash line, where they are usually almost invisible after healing. Here too, the surgeon removes the excess skin and, if necessary, the protruding fatty tissue. 

In the last step, the skin incisions are sutured and covered with a fine plaster bandage. The operation takes just under an hour for both eyes. 

After the operation:

After the upper eyelid blepharoplasty, you will stay in the clinic for one night for observation or be cared for in the surgery outpatient clinic for a few hours and then discharged home. 

In the following days, the eyelids will still be swollen, which you can alleviate by applying cooling pads. After one week, the stitches are removed and it is checked that the healing process is free of complications. The healing process varies greatly from person to person. 

After 1 to 2 weeks, most patients are already fully fit for work and business again. 
 

What should be observed after a dermatochalasis operation?

After blepharoplasty you should take it easy for a few days. Unnecessary touching or rubbing of the eyelids should be avoided at all costs. To counteract the initial swelling, you can carefully cool the treatment areas. For this purpose, only cooling pads from the refrigerator and not from the freezer should be used. We recommend that you sleep with your upper body slightly elevated at first. 

Two days after the stitches have been removed, you can use make-up again and conceal the last traces of treatment in this way. You should refrain from sporting activities for 7-10 days after the operation. If you normally wear contact lenses, it is advisable to change to glasses for a few days after blepharoplasty. 
 

Are there any risks associated with blepharoplasty surgery?

Blepharoplasty is a routine procedure in our eye clinic, which our specialists have been performing regularly for many years. Complications are therefore rare, but as with any operation, they can never be completely ruled out.

In addition to the general risks of the operation and anaesthesia, which we will inform you about in advance of the operation, in individual cases there may be unsatisfactory scarring. However, this is very rare due to the fine skin of the eyelid which is well supplied with blood. In addition, the incisions are made in such a way that the scars are only visible at the edge in the area of the smile lines when the eye is open. We will also give you detailed instructions for wound and scar care. 

Occasionally, problems with eyelid closure occur after dermatochalasis surgery. However, this is usually only a temporary phenomenon. If eyelid closure is weak, you may experience eye dryness and also increased lacrimation. If you already suffer from dry eyes before the operation, you should discuss this with the surgeon before the operation. 

Swelling and bruising are normal after dermatochalasis surgery and are no cause for alarm. Usually, such side effects subside after a few days. 

Even with the greatest surgical care, there may be some asymmetry in the area of the eyelids postoperatively. No natural face is completely symmetrical. However, in rare cases, surgical correction may be necessary to compensate for asymmetry. 
 

What is the prognosis after dermatochalasis surgery?

With dermatochalasis surgery, permanent results can be achieved in the vast majority of cases. The excess skin and tissue are removed to such an extent that the normal eyelid contour is restored. 

Depending on the individual predisposition and due to the natural ageing of the skin, sagging may occur again over the years. As a rule, however, this is the case after about 10 years at the earliest. If necessary, the dermatochalasis operation can be repeated at a later time.