Our eyes contribute enormously to the overall aesthetics of our faces. As we age, the muscles around the eyes weaken and the skin becomes loose. This may produce drooping skin in the upper eyelids, and bulging fat of the lower eyelids, which creates a tired and sad appearance. Blepharoplasty involves the removal of excess skin from the upper eyelids, and bulging fat and excess skin from the lower eyelids. The goal is to achieve a refreshed appearance with smooth upper and lower eyelids. Upper and lower eyelid surgeries can be performed separately, together, or in combination with other procedures such as a facelift. If the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift or Ultherapy® may be recommended. Crows’ feet can be diminished with the use of Botox® or a light chemical peel. Dark circles beneath the eyes caused by dark pigmentation may be treated with fillers or fat, or in some cases with a chemical peel. The goal of aesthetic surgery on the eyelids is always to produce a more rested, refreshed and alert appearance.
During my initial consultation with a patient, I allow the patient to look into a mirror and tell me exactly what he or she likes, and does not like, about his or her eyes. As for any other surgical procedure, the patient’s history is very important. I need to know about any prior surgery, and medical problems, and all current medications and herbals. Certain medical problems, such as diabetes, high blood pressure, and thyroid disease, can increase the risk of complications associated with eyelid surgery. Any history of allergies, dry eyes, and contact lens use is also important.
Some of the potential complications of eyelid surgery which I always discuss include hematoma (an accumulation of blood under the skin that may require removal), infection, changes in sensation, scarring, allergic reactions, damage to underlying structures, and the need for revisions. Smokers are urged to stop smoking well in advance of surgery, as this can impair the ability to heal. Aspirin, anti-inflammatory drugs, and some herbal medications can cause increased bleeding, so patients are advised to stop these for at least two weeks prior to surgery.
Blepharoplasty, or eyelid surgery, can be performed through several different techniques. The particular technique I select depends on various factors including the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of the muscles around your eyelids. Because of these various factors, not every patient will achieve the same results from surgery.
For the upper eyelid, an incision is made within the natural fold of the eyelid and extended slightly beyond the outside corner into an existing crease. Through this incision, excess skin and fatty tissue are removed. Because the incision is made to follow the natural contour of the upper eyelid, it usually is inconspicuous.
For lower eyelid surgery, I generally place the incision just below the lower lashes. Excess skin, muscle and fat can be removed through this incision, or fat can be redistributed to eliminate bulges. Again, placement of the incision in natural crease lines allows the scar to usually heal inconspicuously. In some cases, I use an incision placed inside the lower eyelid. Although this requires no external incisions, it does not allow me to remove any excess skin.
The procedure takes 1 to 2 hours and is performed as an ambulatory procedure in the hospital or at an ambulatory surgery center. Depending upon the patient’s needs and anatomy, the surgery may be done under sedation with local anesthesia, or under general anesthesia. All patients need to have someone available to take them home after surgery and to stay with them for the next 24 hours.
After surgery, your vision will be blurry as a result of ointment used to soothe and protect the eye during surgery, as well as from the swelling that is typical following surgery. There should relatively little pain. For the next 3-5 days, patients should expect to rest at home with their heads elevated during sleep. Iced compresses applied to the eyelids are very helpful in reducing swelling and bruising around the eyes which is most pronounced for the first 48 hours after surgery. Bruising typically disappears within seven to ten days, and patients can wear concealer makeup during this period. Stitches are removed in the office 3-5 days after surgery.
Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. In some cases I will recommend eye drops to help relieve any burning or itching. Dark glasses should be worn for several weeks to protect your eyes from wind and sun irritation. Strenuous exercising, bending, and lifting should be avoided during the early postoperative period, but most patients are able to return to normal activities within one week.
Because the healing process takes time, and because everyone heals at a different rate, you should expect to wait at least several weeks to begin to see your final results. The incisions will continue to fade, and usually are minimally apparent after one year or less. Although the results of aesthetic eyelid surgery usually last a long a time, they may be affected by heredity and lifestyle factors. Removal of fat from your eyelids is permanent. Your skin will continue to age, so skin laxity along with the fine wrinkling of the eyelid area may return. Fortunately, most patients are extremely gratified with their results from surgery: a refreshed, natural appearance that contributes to the appearance of overall vitality.