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About Face

Chapter Three The Eye Region Upper and Lower Lid Surgery Forehead-lift The Single Lid (Oriental Eye) Permanent Lash Enhancement

As often happens with cosmetic surgery, there are other uses that have been refined as a result of technical progress. Medical tattooing, for example, can also be used to treat “white spots”, the patches that show a loss of pigmentation, often on the back of an elderly patient’s hands. With properly selected and blended dyes, the patches can be made to match perfectly with the surrounding skin.

One other use of medical tattooing has proved less than successful, however. Though it would seem to be a logical use of the procedure, tattooing to produce a permanent lip liner is a little risky. A lot of people have a serious allergic reaction to the reddish-colored dyes, which contain iron oxide.

Aside from scleral show or ectropion, the most serious complication that can arise after blepharoplasty is blindness, though such a possibility is extremely rare. If an incised fat pat starts to bleed into the orbit behind the eye, it could cause compression and a loss of blood supply to the eye, resulting in blindness. This is thought to happen when a patient has premature hardening of the eye arteries and these fine little arteries open up and start to bleed. Before a patient undergoes blepharoplasty, I strongly advise a visit to an ophthalmologist, who will check the back of each eye for potential problems.

Another complication might be asymmetry, when a blepharoplasty makes one eye slightly different in shape to the other. In most cases, this is not a serious problem, as few people in the world are born with perfectly symmetrical eyes to begin with. In fact, they are not identical on either side of an imaginary, central line; they are asymmetrical. But obviously there is a tolerable degree of asymmetry, and this can usually be achieved by taking precautionary stops before the operation.

I have my patients sit up straight on the operating table while I outline with a felt pen exactly where the offending fat pads are, and where I intend to cut. Once the patient is lying down, the fat pads often disappear, so the pen lines serve as an important guide once the operation is underway. (I use this same method to give myself a blueprint for most of the operation I do. It wouldn’t be wise to ask a patient to sit up halfway through a procedure just so I could remember the distribution of facial features before we started.)

And finally, a complication might arise from blepharoplasty if a surgeon removes too much upper eyelid skin and the patient is unable to properly close the eye. Blinking enables use to disperse the natural liquid that forms a film over the eyeball. If it’s a particularly bad case, the patient might suffer from “dry eye” when the eyeball dries from constant exposure to the air without blinking. Some patients have a natural dry eye tendency which should be assessed before surgery. The operation to correct this problem involves grafting skin from a site behind the ear onto the too-short eyelid to give it back its proper length and the use of eyedrops and ointment to keep the eye lubricated.

All of the complications I’ve mentioned - scleral show, ectropion, asymmetry, dry eye, tearing and blindness - are rare occurrence. Perhaps one percent of patients might be susceptible to developing complications to varying degrees, and even this low number depends on the individual patient’s health to begin with. Blindness, especially, is a comfortably remote possibility. But it’s important that you know how delicate a procedure blepharoplasty is. Make sure you are completely confident in your surgeon and don’t be afraid to ask for references from one of the professional associations.

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