Eyelid Surgery in Turkey

Eyelid surgery, known in medical literature as blepharoplasty, is an aesthetic and functional operation in which excess skin that has lost its elasticity, weakened muscle tissues, and fat pads that have herniated forward in the eyelids are reconstructed using microsurgical methods. This surgical procedure removes the tired appearance that develops around the eyes due to the effects of time or genetic factors and gives the face a natural, rested vitality. It restores the field of vision, which has been restricted by sagging tissues creating mechanical weight, to an ideal level. This rejuvenation procedure, which repairs the opening and closing dynamics of the eyelids, not only refreshes the external appearance but also provides a lasting treatment that directly supports the eye’s protective barrier function against external factors and visual comfort in daily life.

What Are the Basic Eyelid Functions That Should Be Known Before Eyelid Surgery?

The eyelids are, by their structure, a barrier with highly complex dynamics that controls the contact of the optical system with the external environment. One of their main functions is to protect the eyeball against external trauma, foreign substances such as dust, and disturbing levels of intense light. However, another equally important function is to regularly distribute the tear film over the cornea, the outermost transparent layer of the eye, with every blink. Thanks to this distribution, the ocular surface remains continuously moist and clear vision can be safely maintained.

When the structural anatomy of the eyelid is examined, it is seen that this system is divided into two main functional sections, anterior and posterior. The anterior part includes the skin and the circular muscle fibers immediately beneath it. This muscular structure is a dynamic mechanism that enables the eyelids to open and close. The posterior part contains the firm cartilaginous connective tissue that allows the eyelid to remain upright and the inner membrane that comes into contact with the eyeball. Between these two main layers lies the septal membrane, a thin partition that helps keep the fat pads in the eye socket behind. Loss of elasticity in these structures with advancing age is considered the beginning of anatomical changes that may require surgical repair.

How Do Signs of Aging Affect Vision in a Way That May Require Eyelid Surgery?

As the years pass, the continuous effect of gravity, genetic predispositions, and environmental factors cause tissues to lose their elasticity. As the barrier membrane forming the eyelids becomes thinner over time, the fat pockets that normally act as cushions within the eye socket begin to shift forward. In this process, medically referred to as dermatochalasis, excess skin and prominent bagging appear.

Although this condition is often perceived only as an aesthetic problem causing a tired expression, it can actually significantly reduce a person’s visual comfort. When the excess skin fold descends to the lash line and creates weight, it physically narrows the visual field, especially in the upper and outer portions of the eye. This mechanical obstruction, which restricts images coming from above much like the brim of a hat, causes patients to unconsciously use their forehead muscles continuously. As a result of this effort, the eyebrows are constantly kept elevated, and when this continues throughout the day, certain disturbing symptoms may occur. These symptoms generally include:

• Eye fatigue
• Narrowing of the visual field
• Forehead tension
• Headache

How Is Pseudo-Sagging Distinguished From True Drooping When Deciding on Eyelid Surgery?

The overall success of eyelid surgery depends on correctly identifying the source of the problem. One of the most critical distinctions is whether the patient’s problem is merely skin laxity or true eyelid drooping caused by actual muscle weakness. In cases of excess skin, the main supporting edge of the eyelid remains in its normal position, while only the skin above it stretches and sags downward.

In true eyelid drooping (ptosis), however, the problem is not in the skin but in the main muscle that lifts the eyelid or at the attachment points of this muscle. As a result of the muscle separating from its normal position, becoming thinner, or losing function, the lower edge of the eyelid descends downward over the pupil. If this distinction is not made and only skin removal is performed on a patient with ptosis, the actual drooping of the eyelid may become visually much more noticeable because the weight of the skin has been removed. Therefore, before the procedure, millimetric measurements such as the distance between the eyelid margin and the light reflex are made, and it is determined whether the problem originates only from the skin or from the muscle so that the surgical plan can be shaped accordingly.

Which Basic Tests Are Included in the Evaluation Process Before Eyelid Surgery?

The surgical planning stage does not consist solely of a superficial aesthetic evaluation. The main purpose of detailed examinations is to minimize the possibility that the planned procedure may harm the ocular surface and overall visual health. Using special devices called biomicroscopes, the integrity of the corneal surface, the functioning of the oil glands at the eyelash roots, and the overall stability of the tear film are examined in detail.

If the patient has borderline tear deficiency or a hidden dry eye syndrome caused by evaporation, the surgical plan should be adapted more conservatively according to this condition. Even if the eyelid remains open by only a very small amount during sleep after surgery, the existing dry eye condition may worsen further. For this reason, some basic tests are used before the procedure to understand tear quality and the mechanical condition of the eyelid. The tests performed are:

• Tear production measurement
• Tear break-up time
• Eyelid elasticity test
• Eyelid tension test

How Do the Basic Surgical Steps Progress During Upper Eyelid Surgery?

Modern upper eyelid surgery involves a detailed microsurgical approach in which the natural anatomical layers are preserved as much as possible, replacing traditional methods in which tissues were removed indiscriminately. The procedure is generally performed under local anesthesia containing agents that also help reduce bleeding. During the operation, protective shields are placed over the corneal surface to protect the eyeball from surgical instruments and light.

The surgical incision is planned along the natural eyelid crease so that the scars become less noticeable after the procedure. After the skin incision is made, the underlying muscle structure is treated with as much respect as possible and is largely preserved. Preserving the muscle supports the continuation of the normal blinking reflex after surgery and reduces the likelihood of a hollow appearance developing in the eyelid over time. When the deeper tissues are reached, the herniated fat pockets are accessed and adjusted in accordance with anatomical boundaries. The most delicate point that must be considered in this area is not to confuse the tear-producing gland with fatty tissue. If the lacrimal gland has sagged, it is generally not removed; instead, it is suspended with special sutures and repositioned in its original anatomical location, and the procedure is completed with aesthetic sutures.

How Is the Eyelid Surgery Process Shaped in Cases of True Muscle Weakness?

If weakness in the muscle that lifts the eyelid is detected in addition to skin sagging during the preliminary evaluation, the surgical plan is expanded to correct this condition. Using the same incision line, the deeper layers of the eyelid are reached. The tip of the muscle that lifts the eyelid and has weakened over time is carefully released and readapted to the firm cartilaginous tissue that forms the structural framework of the eyelid.

Performing this process under local anesthesia has an important advantage. During the procedure, the patient may be asked to open and close the eyes so that the height reached by the eyelid and the curve it creates can be observed in real time. In this way, the level of symmetry between the two eyes can be brought to a more harmonious point. After the eyelid height is adjusted to a functionally and aesthetically appropriate level, the incision is closed. Repairing the muscle tissue not only provides a more lively appearance but also significantly increases the patient’s comfort during the day by expanding the visual field upward.

What Are the Characteristics of Scarless Approaches in Lower Eyelid Surgery Planning?

Very important developments have taken place in lower eyelid surgery in recent years, and the aggressive tissue removal approaches used in previous years have largely been abandoned. In the past, excessive amounts of skin and fatty tissue were removed to eliminate lower eyelid bags, and this could cause a hollow expression in patients at older ages. Today, tissue-preserving techniques that soften the transition to the cheek are preferred instead.

Especially in patients whose skin elasticity has not yet been completely lost and who only have fatty bagging, internal approaches that leave no visible scar from the outside are preferred. In this technique, the outer skin is not touched, and the entire procedure is performed through the pink-colored membrane on the inner surface of the eyelid. In older patients and in those with very prominent excess skin, a different approach is used through an incision made just below the eyelashes. The main approaches used are:

• Transconjunctival method
• Subciliary method

Why Is Fat Repositioning Preferred in Lower Eyelid Surgery?

One of the key points of modern lower eyelid aesthetics is to use the fat that forms under-eye bags as an efficient support material rather than removing and discarding it completely. The herniated fat pads causing the bags are released and shifted toward the hollow area extending from under the eye toward the cheek, known as the tear trough.

This repositioning procedure is called fat transposition. With this method, while the swelling in the lower eyelid becomes flatter, the hollow and shadowed area immediately below is supported by the patient’s own natural tissue. The risk of under-eye hollowing, tired appearance, and sunken appearance seen with older methods is significantly prevented with this technique. The transition between the eyelid and cheek gains a smoother, step-free form, adding a more rested expression to the face overall.

Why Are Support Procedures Applied to Lax Eyelids Important During Eyelid Surgery?

Additional precautions need to be taken in patients whose lower eyelid connective tissue is structurally lax or has lost its resistance to gravity with advancing age. If the procedure is started directly without strengthening the support mechanisms of the lower eyelid, the tissue reactions that occur during healing may pull the eyelid downward. This may cause the white part of the eye to appear more than normal or may allow the eyelid to turn outward, creating conditions for the cornea to dry out.

To minimize such problems, eyelid-suspending procedures are added to the surgery. Depending on the degree of laxity, the outer corner of the eyelid is attached to the orbital bone with a special suture or a small strip of ligament is created to provide tension to the eyelid. These steps aim to prevent possible deformities by keeping the lower eyelid close to the eyeball during the healing period. The supportive and strengthening techniques used are:

• Canthopexy
• Lateral tarsal strip

What Precautions Are Taken During the First Days After Eyelid Surgery?

The healing process after the operation progresses in parallel with the body’s natural repair mechanisms, and the first few days are a period that requires particular attention. During this early period, cold compresses are applied at regular intervals to limit tissue edema and mild bruising that may occur. Cold application causes the blood vessels to constrict and significantly reduces fluid leakage into the tissues.

Keeping the head elevated above heart level while resting helps the edema disperse more quickly under the effect of gravity. To prevent disruption of healing and to avoid an increase in intraocular pressure, patients are asked to avoid actions that may strain them during the first days. Some actions that should be avoided are as follows:

• Exercising
• Lifting heavy objects
• Bending forward
• Straining

What Should Be Considered When Returning to Social Life After Eyelid Surgery?

The prominent edema and swelling of the first days generally begin to regress from the third day onward. Sutures placed for aesthetic purposes are usually removed around the fifth or seventh day once tissue healing has reached a certain level. After this process, patients are generally able to return to their daily social lives or work by the end of the first week.

Because the tissues around the eyes are still healing during this period, it is recommended to avoid eye makeup and contact lens use for a while in order to eliminate the risk of infection. After one month, temporary firmness at the wound site begins to soften and skin tone starts returning to normal. During this maturation period, it is very important to prevent the scar from darkening due to sun exposure. Protective measures recommended when going outside during this period include:

• Wide-brimmed hat
• Sunglasses
• Sunscreen
• Artificial tear drops

What Problems May Eyelid Surgery Involve in Terms of Possible Risks?

Although these operations frequently produce satisfactory results, some unwanted conditions may occur because the procedure is performed anatomically very close to the organ of vision. It is important to be aware of the possibility of these situations and to manage the process correctly. One rare but important condition is the accumulation of blood behind the eye due to backward leakage from blood vessels in the surgical area. This situation requires rapid intervention, and procedures aimed at reducing pressure around the eye are urgently performed to relieve the optic nerve.

Another condition is the inability of the eyelid to close as a result of excessive stretching or removal of the skin. In this situation, the ocular surface is left unprotected, becomes dry, and may show signs of irritation. When detected early, the process can largely be managed with intensive eye drop treatments and protective gels applied at night. Once healing is complete, minor additional revisions may be performed if necessary to relax the eyelid. Some problems that may generally be encountered include:

• Bleeding behind the eye
• Incomplete eyelid closure
• Dry eye
• Double vision

Why Should an Ophthalmologist Be Consulted When Planning Eyelid Surgery?

Although this procedure is often perceived externally as an aesthetic facial rejuvenation procedure, it is actually a complex surgery that requires focusing on the physiological health of the eye in the background. Having the procedure planned and performed by an ophthalmologist who has received comprehensive training in ocular anatomy, tear dynamics, and corneal health adds an additional level of safety to the process. In this way, the goal is not only to achieve a more refreshed appearance; the eye’s refractive balance and moisture level are also kept protected throughout the operation.

Specialists working in the field of ophthalmology are experienced in protecting the eyeball located beneath very thin tissue layers during surgery, ensuring the safety of sensitive surrounding areas while anesthesia is administered, and rapidly activating measures that protect visual function in the event of a possible anatomical reaction. They approach the tissue by analyzing how even a small change in the eyelid may affect the cornea.