An increasingly popular ‘facial rejuvenation’ procedure especially among older and Asian women, eyelid surgery has recently been updated. Instead of closing the wounds with surgical stitches, one doctor has begun to use fibrin glue, which he believes improves healing time.

History of Fibrin Glue

Fibrin glue has been around since the 1940s, yet it has mainly been used and studied in Europe. First approved by the U.S. Food and Drug Administration (FDA) in 1998, the agency expanded its approval criteria just last year to include controlling bleeding during surgery when standard techniques are ineffective or impractical. There is a major caveat, though; because fibrin glue is so expensive, each “use has to be justified,” Dr. Julian De Silva, a facial plastic surgeon, told the Daily Mail.

Used for years in neurosurgery, De Silva explains that it has proven most effective in repairing minute leaks around the brain. “In such an area, you cannot use stitches, so you need a very fine product that will work instead,” he told the Daily Mail. It has also commonly been used in spleen and liver trauma as well as to repair tears within the eye.

When applying the glue to a wound, a surgeon uses a special ‘double barrel’ syringe, which combines the product’s two main ingredients at the point of contact. One ingredient is a thrombin solution, which contains human thrombin and calcium chloride. The second is a fibrinogen solution, which prevents premature degradation of the clot that will result after the glue is applied, giving the skin a chance to heal on its own. When the two components are mixed together, they form a rubber-like mass that adheres to the wound surface and mimics the body’s natural clotting ability. Before De Silva began to use fibrin glue for eyelid surgery, he conducted a five-year study of the subject. According to the Daily Mail, not only did the glue reduce immediate trauma to the eye area, but some patients also looked almost completely healed within a week as opposed to the usual time — up to six weeks — involved in conventional stitching. As of six months ago, De Silva began offering the procedure to his patients.

How does eyelid surgery work?

Although breast augmentation has been the most commonly performed cosmetic surgery procedure since 2006, eyelid surgery may soon be vying for the number one spot, according to data supplied by the American Society of Plastic Surgeons. Blepharoplasty, as eyelid surgery is officially known, may rank third after nose reshaping, but unlike its two more popular rivals, the number of times this kind of surgery was performed in 2012 rose by a full four percent over 2011. It is popular among older women and men. By improving the appearance of the upper eyelids, lower eyelids, or both, eyelid surgery makes a person ‘look more rested and alert,’ claims the American Society of Plastic Surgeons, which lumps this procedure into a general category of ‘facial rejuvenation surgeries.’ Blepharoplasty is also popular among Asian women who use it to add a crease to their eyelid and so enlarge their eyes.

‘During the operation, an incision is made across the eyelid and some of the excess skin,” De Silva told the Daily Mail. After removing some fat as well as part of the underlying muscle, which slackens with age, he is ready to close the wound, which in the past might require up to 15 stitches. “Now I simply use glue under the surface of the tissue, bring the edges of the skin together and hold them together for approximately three minutes,” he stated in the same interview.

The total time of De Silva’s operation — this is not universal, other doctors may use slightly different techniques — is usually about 90 minutes under a local anesthetic. Because it is an outpatient procedure, patients leave that day and are able, if they wish, to carry on with their usual activities. Over time, the glue is reabsorbed back into the body.

But Is the Expense Worth It?

The use of this glue is pricey and may add quite a few dollars to the total cost of surgery. Surprisingly, the additional expenditure may well be worth it as the benefit is significant. A study, conducted by Ohio University's Department of Surgery, comparing postoperative eyelid position using fibrin sealant versus suture for wound closure in Müller's muscle-conjunctiva resection ptosis repair found equivalent lid position and symmetry when comparing the two. Much more importantly, though, major postoperative complications were reduced when using fibrin sealant.

 

Source: Czyz CN, Rich NE, Foster JA, et al. Comparison of postoperative eyelid position using fibrin sealant versus suture for wound closure in Müller's muscle-conjunctiva resection ptosis repair. Plastic and Reconstructive Surgery. 2011.