The third area of advancement in regards to double eyelid surgery is thermal control. Most all surgeries involve some bleeding. It is crucial the surgeon be able to control bleeding without compromising the surgery and ultimately the final results. The eyelid in particular is extremely vascular and therefore, controlling bleeding during double eyelid surgery is crucial. The standard method used to control bleeding during double eyelid surgery involved a constant heat applied to the eyelid vessels. Due to the extremely thin nature of the eyelid skin, usage of constant heat caused a thermal spread to the adjacent eyelid tissue, which resulted in an internal burn. The use of laser technology ceased bleeding through constant heat but also caused scarring. Today, a major advancement in controlling bleeding is with a thermal control mechanism. Thermal control provides heat which is regulated by a sensor. This allows heat production to dynamically decrease and increase in order to control bleeding without overheating.
Another key point is to decrease bleeding in the first place. It is important to minimize bleeding internally as blood leads to inflammation within the tissue. The reason why bleeding leads to inflammation is that blood within the tissue requires white blood cells to enter and clean up the blood. The process of white blood cells physically and chemically cleaning leads to a cascade of inflammation. Furthermore, blood has serum which is a nutrient to bacteria. Bacteria proliferates by feeding off the serum within the blood. Therefore, there is a higher chance of infection and prolonged recovery as the white blood cells take longer to fight off bacteria. Thus, thermal control is not only about sealing the vessels efficiently with the least amount of tissue damage, but also to most efficiently minimize blood leaking to the surrounding tissue. This all leads to lower infection rate and faster recovery.
Furthermore, rather than stopping the bleeding vessel after the vessel is severed, the use of special electrocautery forceps seals the vessel before it bleeds, minimizing thermal damage. This technique requires thorough understanding of vascular anatomy and uber precision to execute. Although it is more time consuming, the patient benefits by having less internal burn and bleeding.
A burn on the external skin causes the skin to scar and thicken. Similarly, when the internal tissue is burned, it also creates an internal scar as the tissue thickens. This manifests externally by irregularities or bumpiness along the incision and internally by heaviness of the eyelid, the latter which leads to eyelid drooping and ptosis. Less weight or burden to the eye elevating muscle will make your eyelids feel lighter. The goal of eyelid surgery is to have the least amount of tissue damage and iatrogenic (surgically induced) thermal burn, both of which can lead to external visible scarring and internal scarring where one feels heaviness in their eyelid post-surgery. By controlling thermal injury and bleeding, a patient can receive optimal desired surgical results without the negative sequela of surgery.