Call it the zoom effect; right now, plastic surgery is on the rise. If how you look is affecting your self-image - you're not alone, says editor Trudi Brewer. Our go-to expert, Dr Tristan de Chalain, shares the most requested surgery and what to expect if you're considering this cosmetic enhancement.

Those wrinkles and drooping eyelids that may have never bothered you before are now considered part of our pandemic-era. With the demand for cosmetic intervention on the rise, the most popular procedure, an eye lift, is perhaps the most effective way to take ten years off your age. Here’s what to expect, from one of the best - Dr Tristan de Chalain.

What’s the top requested eye-rejuvenating procedure?

Without a doubt, the upper eyelid tuck or upper lid blepharoplasty. To explain what this is: As the face ages, the area around the eye is one of the first to show the passage of time, with loss of the fat pad beneath the lateral eyebrow and the tail of the brow flattens and droops. This condition, called dermatochalasis, displaces eyebrow skin into the upper eyelid, narrows and rounds the eye aperture and makes the eye look smaller. The overall effect is twofold: not only does the face look tired or grumpy, but in severe cases, the lateral visual field is impaired and restricted. This can make driving dangerous, as you may not see objects in the peripheral visual field, such as cars or pedestrians approaching from the side. Furthermore, as the eyebrow descends and lax skin piles up in the upper eyelid, the frontalis muscle (the muscle which covers part of the forehead and whose primary function is to elevate the eyebrow) has to work harder to keep the eyebrow up to minimize visual field restriction. This chronic activation throws the overlying forehead skin into activation creases, which become those transverse forehead wrinkles seen in the ageing face.

For these reasons, I often (in around 75 per cent of cases) do a minor lateral forehead brow lift surgery along with my upper lid blepharoplasty surgery. This is a simple procedure, placing a three-centimetre incision behind the hairline in the lateral forehead. The frontalis muscle is freed and tightened with two or three box sutures so that at rest, its length is shorter to enable it to better support the brow at rest. Then, redundant skin is trimmed away, and with the eyebrow in the correct position, attention is turned to the eyelid.

***Before & after upper eyelid plus a composite browlift surgery with Dr Tristan de Chalain.***

What advice can you give our following when researching eye lift procedures and finding the best surgeon?

Do your research, but be aware that eyelid surgery is a super-speciality of plastic and oculoplastic surgeons. Choose plastic or an ophthalmic surgeon who has a particular interest and is well-trained in this branch of surgery. Ask to see photographs of his or her previous cases and ask about possible complications. No surgeon who is appropriately qualified and seasoned will ever resent your asking about his or her suitability as a surgeon or your suitability as a patient candidate. Be aware that while conceptually simple, blepharoplasty surgery can be both tricky and finicky, and there are many traps for the unwary, which is why experience is such a valuable asset in a surgeon. Also, choose someone with whom you get on well and who puts you at ease.

How long does the procedure take, and what is the process?

The initial consultation is the opportunity to describe exactly what you perceive the problem to be and to voice any concerns you may have. It’s also time for the surgeon to examine you and identify any issues and their cause. At this time, there ought to be a discussion around the goals of the surgery, technical approaches to achieving these goals and any associated risks or possible complications. Most importantly, the costs should also be discussed. Surgery should only be confirmed and booked after a second consultation, for which you should not be charged. This allows you time to digest all the information you received at your first visit and be sure that the proposed surgery is really what you want. In my hands, I estimate about two hours to do bilateral upper lid blepharoplasties, coupled with a lateral composite brow lift, a procedure which I suggest to the majority of my upper eyelid patients. Upper lid blepharoplasty alone takes about 30 minutes per side. The procedure can be done under local anaesthetic, local with sedation (twilight anaesthesia), or a general anaesthetic.

In most cases, I will mark the browlift as a zig-zag incision behind the hairline, with the patient awake, upright and actively raising the eyebrows. No hair is shaved. Once the tail of the eyebrow has been positioned where it ought to be, the drooping eyebrow skin is effectively taken back up, and out of the eyelid. The eyelid can now be meticulously marked, and the redundant lid skin carefully removed. The idea is to take the redundant, excess skin, sometimes underlying muscle and even fat, and evert the eyelashes so that they are angled up and away from the eye; this gives the eyes a wide-awake, open look. Additional steps such as fat excision or injection, muscle trimming, correction of ptosis (drooping) are performed, when required, and the skin is sutured. The final skin closure should lie in a skin crease and be invisible with the eye open. Paper tape dressings are applied for one week, and the sutures are then removed at an outpatient visit.
The lower eyelid blepharoplasty in which bagginess and skin redundancy are most commonly treated presents different problems and surgical solutions. The lid can be approached from within the eyelid, thus leaving no surgical scars on the skin, and the loose or lax lid can be tightened to restore a youthful contour. In general, a lower lid blepharoplasty takes about one hour per side.

What are the risks associated with upper blepharoplasty or lower blepharoplasty?

As with any surgical procedure, there are risks associated with eyelid surgery, including infection, bleeding and scarring. That said, infection is rare, and bleeding usually manifests as bruising; scarring in the eyelid is generally almost invisible and inconsequential. The specific complications for eyelid surgery are a little more sobering but are fortunately rare. The biggest concern is the risk of possible blindness. This is almost unheard of today, with a better understanding of the blood supply to the eye. However, historically blindness has occurred with removing orbital fat pads and secondary bleeding from a vessel in the fat pad with blood accumulating behind the eye, putting pressure on the optic nerve. More recently, there have been reports of blindness following injection of fat or fillers into tiny blood vessels around the eye, which add pressure and block off the eye's arterial supply. Much more commonly, the tear film may be disturbed, with the cornea's temporarily inadequate lubrication, causing an irritated, "dry eye". Dissection around the eyelids can interfere with the eyelids' lymphatic drainage, resulting in fluid blebs on the sclera (the white outer layer of the eyeball), a condition known as chemosis, fortunately self-limiting. Finally, the surgeon must carefully estimate the amount of skin to be removed, taking excess skin results in visible scar lines and possibly tightness, which in the lower lid can cause the eyelid to be pulled down and away from the eyeball in what's called ectropion, (a sagging or outward turning of the lower eyelid). Fortunately, all these possible complications are rare, and the vast majority of patients have a rapid and problem-free recovery.

What advice can you give our following when researching eye lift procedures and the best surgeon?

Do your research, but be aware that eyelid surgery is a super-speciality of plastic and oculoplastic surgeons. Choose plastic or an ophthalmic surgeon who has a particular interest and is well-trained in this surgery branch. Ask to see photographs of his or her previous cases and ask about possible complications. No surgeon who is appropriately qualified and seasoned will ever resent you for asking about his or her suitability as a surgeon or your suitability as a patient candidate. Be aware that while conceptually simple, blepharoplasty surgery can be both tricky and finicky, and there are many traps for the unwary, which is why experience is such a valuable asset in a surgeon. Also, choose someone with whom you get on well and who puts you at ease.

***Before & after bilateral upper and lower eyelid surgery with Dr Tristan de Chalain***

What are the post-surgery rules for a speedy recovery?

Relaxing, lying down on your back with the bed's head raised or lying on two or three pillows speeds up recovery. Don't sit at a table or in bed, looking down at a device; this will promote swelling and bleeding, as the eyes are dependent. The face should be elevated so that fluid drains away from the eyes. Cold compresses or chilled eye pads help the first 24 to 48 hours. Exercise or exertion – anything that increases the pulse rate or blood pressure, should be avoided for the first two weeks. Bruising can be treated with Arnica or Hirudoid creams after the first 24 hours. Taking vitamin C will aid with collagen formation and speed up wound healing.

Will you have scars?

Scarring is inevitable since human tissue repairs itself by scar formation rather than regeneration. However, the good news is that scarring is generally ultra-fine, delicate and seldom problematic in the eyelids. Well-designed incisions, appropriately placed and meticulously repaired, will likely heal primarily to show close to invisible scars. However, scarring is determined by the patient's genetic makeup, which you should discuss with your surgeon before surgery, especially if you have a history of keloidal or hypertrophic (raised) scarring or have heavily pigmented or darker skins, which can make dark scars more visible.

What about downtime? How long would you need to stay home or be off work?

I advise my patients that they need 10 to 14 days' downtime. By two weeks, almost all the bruising and swelling will have settled, and they should be fit for social activities. I recommend avoiding eye-makeup for one-month post-surgery. I also make a point of reminding patients to be gentle with their skin around the eye area; it takes human tissue six weeks to get back to 85 per cent of pre-injury strength, so rubbing the eyes or playing contact sport should be avoided for at least eight weeks.

***Before & after upper lid plus browlift surgery with Dr Tristan de Chalain***

What about the results? When will you look at your best?

Healing time is open-ended as the scars will remodel and mature over six to 12 months. I generally take post-operative photographs at about three months. However, you should begin to see your surgery results as soon as the early swelling and bruising resolves within ten to 14 days.

How long does eye rejuvenating surgery last?

Depending on the surgery, most patients will enjoy visible benefits from blepharoplasty surgery for at least ten years post-surgery. Nevertheless, the face and its structures continue to age, and the changes engendered by the ageing process may mean you require further surgery over time.

For all eye surgery, expect to pay from $5500 per hour under general anaesthetic and $3500 per hour under local anaesthetic. Two hours of surgery is required for bilateral upper lid blepharoplasties plus browlift, one hour for upper ids alone, depending on the complexity of each treatment. Lower eyelids require an hour per side. These prices are a guide only; a consultation is essential.

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