Condition: Periocular dermatochalasis 2017-10-20T16:42:08+00:00

Periocular dermatochalasis

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There are different treatment options available for this condition and the most common ones are listed below:

  • Dermatochalasis
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Periocular dermatochalasis

What is Periocular dermatochalasis?

Periocular dermatochalasis is the medical term for eyebags caused by excess skin. It most commonly affects the upper eyelids where the skin fold loses elasticity and drops both outwards and down onto the eyelashes, known as ‘hooding’.

Dermatochalasis can cover the normal upper eyelid show and interfere with the application of eye makeup, such as eyeshadow and eyeliner. It can contribute to mascara running as the skin is touching the upper lid lashes. It can cause watering eyes from the exfoliation of skin cells and debris dropping into the eyes from the excess skin. Where there is lateral hooding, this can cause light streaming at the lateral corner of the eye where excess tears will drip down laterally.

The main functional symptom of dermatochalasis is interfering with vision. In particular, lateral hooding can impair the upper visual field. If this occurs, it is then a clinical indication for surgery as opposed to an aesthetic/cosmetic procedure.

The treatment for upper eyelid dermatochalasis is eyelid blepharoplasty.

If there is associated brow ptosis, causing a secondary dermatochalasis, then brow surgery is performed first or at the same time as the blepharoplasty.

Dermatochalasis in the lower lids most commonly occurs with some fat prolapse, or eyebags, a cosmetic aesthetic problem and does not impair vision. If there is lid laxity with the lower lid dermatochalasis, there may be signs of eyelid sag or ectropion and symptoms of watering.

Lower lid dermatochalasis is treated with lower lid blepharoplasty which is titrated to patients’ individual needs depending on the the proportion of skin excess, fat prolapse and lid laxity.Dermatochalsis occurs with increasing age and is more common in patients who smoke and those with a familial predisposition to loose skin around the eyes.

Video: Condition Periocular dermatochalasis explained

Examination

The examination of dermatochalasis is essentially the examination of eyebags.

Prior to surgery, a full ophthalmic examination is necessary. This includes checking visual function as well as undertaking tests to exclude eyelid and eye surface conditions such as blepharitis, dry eye, eyelid laxity or any other conditions that could be exacerbated by a blepharoplasty. The patient’s entire face and eyelids are examined during the consultation.

A visual field test may be required to determine the extent of visual impairment from eyebags or other conditions.

It is common for photographs to be taken both before and after the procedure.

The patient will be asked how the eyebags affect them, determining whether the problem is cosmetic or also affects vision. It is also useful for the patient to provide photographs taken prior to the eyebags becoming noticeable, for instance from two to five years younger, to aid in understanding the individual cases.

Treatment

The treatment is the same as for eyebags.

A blepharoplasty can be done for cosmetic purposes or to improve vision. The purpose of a blepharoplasty is to correct excess folds of skin (dermatochalasis) and drooping eyelids (eyelid ptosis), or to reduce baggy lower eyelids. Fine wrinkles can be treated with laser resurfacing or a gentle chemical peel if desired.

A periocular and facial trichloracetic acid peel can performed at the same time as blepharoplasty surgery. Regular tretinoin treatment can greatly improve the quality of the skin.

Upper eyelid blepharoplasty

Incisions are typically made in the upper eyelid skin crease, where they heal best and scarring remains well hidden.

The incision is made along the natural eyelid skin crease a few millimetres above the eyelashes. The height of the incision varies in men and women and is commonly placed lower in Asian blepharoplasty patients who have a naturally low skin crease, unless ‘Westernisation’ is requested.

An elliptical piece of skin and muscle is removed using a blade and a Colorado needle, which greatly reduces bleeding and helps keep tissue damage to a minimum. The skin incision is then closed using delicate sutures.

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Frequently Asked Questions

A blepharoplasty is done to remove a small amount of skin (and sometimes fat) from the upper or lower eyelids. Exactly what is done is tailored to the patient’s individual needs.
The surgery itself is not painful. If under local anaesthetic, this involves a small injection which stings, however effort is taken to avoid any excess discomfort.

You should take a few days off work, if you’ve had upper lid surgery, you should probably take a week off, and for lower lid approximately 10 days. The eyelids should be cleaned daily, with antibiotic ointment onto the skin incision sites and with ice pack application. Lubricant drops may need to be added to the eyes for comfort as blinking may be difficult after the surgery.

Yes. It is recommended you take about one to three weeks off following surgery, depending on the nature of the procedure. Your oculoplastic surgeon will advise you.

Yes. The first follow up is between four and ten days after surgery, when the incision sites will be inspected and any sutures removed if required. The second follow up is usually about six weeks after your blepharoplasty surgery. There may be a final follow up after three months.

As with any surgery, blepharoplasty carries some risks. Dry eye, bruising, swelling or redness are more common. More serious conditions such as blurred vision or infection are very rare but can occur. It is essential that you read all information provided about your blepharoplasty surgery and its risks. Once satisifed that you understand the aims and risks of your blepharoplasty surgery, and you have had the opportunity discuss any queries or concerns with your oculplastic surgeon, you can go ahead with your surgery.

The upper eyelid blepharoplasty is usually performed under local anaesthetic, which means you are awake. However, many patients prefer local anaesthetic with sedation or general anaesthetic, particularly for the lower eyelid blepharoplasty.

This depends on the patient’s individual needs. It is easier to monitor the postoperative course and the vision if the patient stays overnight after blepharoplasty surgery, particularly after a lower eyelid blepharoplasty.

You should read all this information thoroughly, which lists the possible risks. You will be given a consent form to sign and the Oculoplastic Surgeon will discuss these possible complications with you. Some complications are very rare and some are more common. If you do not understand what the Oculoplastic Surgeon is saying, you should say so and ask any questions or discuss any worries you may have about your proposed surgery before signing. Once you are satisfied that you understand the aims of the blepharoplasty surgery, what will happen and the possible risks of blepharoplasty surgery, then you should sign the consent form.