Eyelid Surgery

Eyelid Surgery, also known as Blepharoplasty, is a procedure to remove fat – usually along with excess skin and muscle – from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes – features that make you look older and more tired than you feel, and may even interfere with your vision. However, it won’t remove crow’s feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage.

Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.

About The Procedure

Cosmetic eyelid surgery, called blepharoplasty, is a surgical procedure to improve the appearance of the upper eyelids, lower eyelids, or both, and give a rejuvenated appearance to the surrounding area of your eyes, making you look more rested and alert.

Eyelid Surgery may help with:

  • Loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision
  • Excess fatty deposits that appear as puffiness in the upper eyelids
  • Bags under the eyes
  • Droopiness of the lower eyelids, showing white below the iris (colored portion of the eye)
  • Excess skin and fine wrinkles of the lower eyelid

You may be right for eyelid surgery if you have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves’ disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery.

Consultation

Your consultation is your time to ask the doctor about the procedure you’re considering, how he thinks it will work for you and any concerns you may have. We suggest you come prepared with your questions on paper so you’re sure not to forget to ask the questions that are important to you.

Questions to consider:

  • What is the simplest and safest surgery to help me achieve my goals?
  • How is the surgery performed?
  • What is the expected length of operation?
  • Are other options available?
  • What results can I expect, and how long do the typical results last?
  • Where will scars be located, and how noticeable will they be?
  • Will scars fade over time, and how long will this take?

When you arrive at the office, you will be asked to fill out a few pieces of paperwork. It is very important when asked about medications to put down all medications you take, including any supplements or aspirin-type regimens, since these items can impact your blood clotting and pressure. In addition, you need to be truthful about your use of tobacco and alcohol since this will affect your recovery and incision healing.

Before you see the doctor, a nurse or nurse practitioner will do an initial exam. You may be able to get a number of your questions answered while with the nurse.

Your surgeon will discuss several factors regarding surgery during your initial consultation, including your procedure, location, anesthesia and recovery. In addition, the surgeon will inquire about your concerns, priorities and motivations for pursuing surgery, as well as your fears.

The doctors are sure to address reasonable expectations for the outcome of your desired procedure, and they should explain what is possible and what is not possible.

After your consultation with the physician, you will meet with the practice manager to discuss procedure costs.

Pre-Procedure

There are a number of things to do prior to your procedure that will make your recovery as smooth as possible and ease your pre-procedure anxiety.

Your surgeon will give you instructions on what medications to stop taking and when prior to your surgery to prevent any unwanted side effects. Medications you shouldn’t take up to two weeks prior to your surgery include, but are not limited to, aspirin and products containing aspirin, alcohol and herbal supplements. Your surgeon may advise you to take Arnica Montana, Bromelain or vitamins A or K for swelling, bruising and to promote general healing.

It is important to remember to only take a supplement or herbal remedy if your surgeon advises it.

Your Pre-Op Checklist

  • Take pictures and make notes to discuss with your doctor. You know what you want, and he knows how to make it possible.
  • Make a list of post-op projects and gather what you need.Stop taking blood-thinning medications and supplements two weeks prior to surgery (aspirin, Motrin, fish oils, vitamin E) and don’t take them two weeks after surgery.
    • Books to read
    • Photo projects
    • Journal
    • Sewing
    • Vacation planners
  • Start using anti-bacterial soap in the shower a few days before surgery and following surgery.
  • Remove all fingernail and toenail polish.
  • Fill prescriptions you’ll need, including antibiotics and pain medications.
  • Purchase over-the-counter eye drops and eye gel for overnight (GenTeal seems best and it is found at major drug stores like Walgreens)
  • Pick up Bacitracin for incision areas and Colace to keep your bowels moving during recovery.
  • Clear your calendar for a month post-op
  • Arrange for caretakers: you, kids, plants and pets need to be taken care of during your recovery. You will not be able to lift, reach, bend over or be too active for some time.
  • Prepare your recovery area so your head is elevated. A recliner works wonders for this. Also stock your recovery area with:
    • Blankets
    • Water
    • Phone
    • Lotion
    • Tissues
    • Remote control
    • Reading material
    • Laptop
    • Any other item that will make you feel comfortable during your recovery
  • Make a to-do list of things you want to get done prior to surgery and start! You won’t be able to accomplish as much post-surgery. Some items you may want to get done include:You will want to stock up on groceries or cook meals prior to your surgery. Many patients enjoy the ease of frozen meals, yogurt, pudding, fruits, soups and anything else that is easy to prepare.
    • Clean the house
    • Catch up on gardening
    • Laundry
    • Give the dog a bath
    • Clean the litter box
    • Wash your car
  • Stock up on ice packs, frozen peas and frozen gel packs. You’ll want to use them early and often on your face, neck and ears. It will definitely feel good and keep the swelling down.
  • Pack a receptacle with a lid and towel in your car for the ride home from the hospital just in case you feel nauseous. You may want to add a pillow and blanket, but be sure to set up on the ride home to help with the nausea and swelling.
  • Get your hair and nails done since it will be a while before you can do either.
  • Prepare Power of Attorney for Medical Care and Advance Directives, just in case. Give copies to your doctor and/or surgical center.
  • Breathe and relax! Stress can adversely affect your recovery. Try to remember that you will heal, the soreness will subside and you will look great.

During Your Procedure

Anesthesia: Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.

The incision: The incision lines for eyelid surgery are designed for scars to be well concealed within the natural structures of the eyelid region.

In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow’s feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

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Conditions of the lower eyelid may be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelids is removed.

A transconjunctival incision, one hidden inside the lower eyelid, is an alternate technique to correct lower eyelid conditions and redistribute or remove excess fat. This procedure is usually done on younger patients with younger, more elastic skin.

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Recovery

Recovery is an important part of any surgery, and you must take the doctor’s orders to heart if you want to heal as quickly as possible.

After your procedure is completed, lubricating ointment and cold compresses may be applied, and in some cases your eyes may be loosely covered with gauze. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by your surgeon. If you feel any severe pain, call your surgeon immediately.

Your surgeon will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month. You’ll be shown how to clean your eyes, which may be gummy for a week or so. Many doctors recommend eye drops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

Your surgeon will follow your progress very closely for the first week or two. The stitches will be removed two days to a week after surgery. Once they’re out, the swelling and discoloration around your eyes will gradually subside, and you’ll start to look and feel much better.

You should be able to read or watch television after two or three days. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing and your doctor’s instructions, you’ll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

Your surgeon will probably tell you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including bending, lifting and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.

You will be given specific instructions that may include: how to care for the surgical site, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in overall health, and when to follow up with your plastic surgeon.

Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery? When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

Results: Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line.

On the other hand, the positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are long-lasting.

Risks

The decision to have eyelid surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor.

Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

The minor complications that occasionally follow blepharoplasty include:

  • Double or blurred vision for a few days
  • Temporary swelling at the corner of the eyelids
  • Slight asymmetry in healing or scarring
  • Tiny whiteheads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle

Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be long-lasting. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.

Other risks include:

  • Bleeding (hematoma)
  • Poor wound healing
  • Infection
  • Fluid accumulation
  • Blood clots
  • Numbness and other changes in skin sensation
  • Anesthesia risks
  • Eyelid disorders that involve abnormal position of the upper eyelids (eyelid ptosis), loose eyelid skin, or abnormal laxness of the lower eyelid (ectropion) can coexist with sagging forehead and eyebrow structures; brow lift surgery will not correct these disorders; additional surgery may be required
  • Pain, which may persist
  • Skin discoloration and swelling
  • Sutures may spontaneously surface through the skin, become visible or produce irritation that require removal
  • Deep vein thrombosis, cardiac and pulmonary complications
  • Possibility of revisional surgery
  • Loss of eyesight

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