EYELID SURGERY

If you’re considering eyelid surgery…

Eyelid surgery (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 an ethnic or racial heritage.  Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.

If you’re considering eyelid surgery, this information will give you a basic understanding of the procedure – when it can help, how it’s performed, and what results you can expect.

Click here for Before and After Patient images

THE BEST CANDIDATES FOR EYELID SURGERY

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations.  Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

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 are also reasons for caution. Check with your ophthalmologist before you have surgery.

ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK

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; and a slight asymmetry in healing or scarring. If tiny whiteheads 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.  Artificial tears or ointments can help with any irritation at bedtime.

PLANNING YOUR SURGERY

The initial consultation with your surgeon is very important.  The surgeon will need your complete medical history, so check your own records ahead of time and be ready to provide this information.  Be sure to inform your surgeon if you: have any allergies; if you’re taking any vitamins, medications (prescription or over the counter) or other drugs; and if you smoke.

You should carefully discuss your goals and expectations for this surgery.  You and your surgeon need to discuss: whether to do all four eyelids or just the upper or just the lower ones; whether skin as well as fat will be removed; and whether any additional procedures are appropriate.

Note:  Most insurance policies don’t cover eyelid surgery, unless you can prove that drooping upper eyelids interfere with your vision, usually with a visual field study performed and interpreted by an ophthalmologist.  Check with your insurer.

PREPARING FOR YOUR SURGERY

You will be given specific instructions on how to prepare for surgery, including: guidelines on eating and drinking; avoiding smoking; and taking or avoiding certain vitamins and medications.  Carefully following these instructions will help your surgery go more smoothly.

While you’re making preparations, be sure to arrange for someone to drive you home after surgery, and to help you out for a few days if needed.

WHERE YOUR SURGERY WILL BE PERFORMED

Eyelid surgery may be performed in a surgeon’s office or an outpatient surgery center on an outpatient basis, rarely requiring an inpatient stay.

TYPES OF ANESTHESIA

Eyelid surgery is usually performed under general anesthesia – which means you will sleep through the operation.

THE SURGERY

Blepharoplasty typically takes one to three hours, depending on the extent of the surgery.

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 any excess saggy skin and muscle.  The incisions are closed with very fine sutures.

If your problem is pockets of fat beneath your lower eyelids but you don’t need to have any skin removed, you may need a transconjunctival blepharoplasty.  In this procedure the incision is made inside your lower eyelid, leaving no visible scar.  It is primarily performed on younger patients with thicker, more elastic skin.

AFTER YOUR SURGERY

After surgery, your eyelids may feel tight and sore as the anesthesia wears off.  You can control any discomfort with ice compresses and the pain medication prescribed.  If you feel any severe pain, call your surgeon immediately.

Your surgeon will instruct you to keep your head elevated and rest your eyes for several days, and to use cold compresses to reduce swelling and bruising.  Bruising varies from person to person and reaches its peak during the first 48 hours and can last from two weeks to a month.  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.

The stitches will be removed in about 5 days 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 need to be very cautious about your eyelids. For example, do not let the shower water hit your face.

GETTING BACK TO NORMAL

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, you’ll be able to wear makeup to hide any bruising that may remain.  You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses when you go out.

Keep your activities to a minimum for three to five days, and 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.

YOUR NEW LOOK

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery.  Eventually, most scars will fade to a thin, nearly invisible white line.

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

As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing “bags” above and below.
The surgeon closes the incisions with fine sutures, which will leave nearly invisible scars.
Before surgery, the surgeon marks the incision sites, following the natural lines and creases of the upper and lower eyelids.
Underlying fat, along with excess skin and muscle, can be removed during the operation.
In a transconjunctival blepharoplasty, a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed, and the incision is closed with dissolving sutures.
After surgery, the upper eyelids no longer droop and the skin under the eyes is smooth and firm.