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Blepharoplasty
If you're considering eyelid
surgery...
Eyelid surgery (technically called 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.
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. It can't answer all
of your questions, since a lot depends on the individual patient and the
surgeon. Please ask your surgeon about anything you don't understand.
The best candidates for eyelid surgery
Blepharoplasty can enhance your appearance and your self-confidence, but it
won't necessarily change your looks to match your ideal, or cause other people
to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with your surgeon.
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.
As people age, the eyelid skin stretches,
muscles weaken, and fat accumulates
around the eyes, causing "bags" above
and below.
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.
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. 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 permanent. Another very rare
complication is ectropion, a pulling down of the lower lids. In this case,
further surgery may be required.
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.
In this consultation, your surgeon or a nurse will test your vision and assess
your tear production. You should also provide any relevant information from your
ophthalmologist or the record of your most recent eye exam. If you wear glasses
or contact lenses, be sure to bring them along.
You and your surgeon should carefully discuss your goals and expectations for
this surgery. You'll need to discuss whether to do all four eyelids or just the
upper or lower ones, whether skin as well as fat will be removed, and whether
any additional procedures are appropriate.
Your surgeon will explain the techniques and anesthesia he or she will use, the
type of facility where the surgery will be performed, and the risks and costs
involved. (Note: Most insurance policies don't cover eyelid surgery, unless you
can prove that drooping upper lids interfere with your vision. Check with your
insurer.)
Don't hesitate to ask your doctor any questions you may have, especially those
regarding your expectations and concerns about the results.
The surgeon closes the incisions with
fine sutures, which will leave nearly
invisible scars.
Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for surgery,
including guidelines on eating and drinking, 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 your 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-based facility, an
outpatient surgery center, or a hospital. It's usually done on an outpatient
basis; rarely does it require an inpatient stay.
Types of anesthesia
Eyelid surgery is usually performed under local anesthesia--which numbs the area
around your eyes--along with oral or intravenous sedatives. You'll be awake
during the surgery, but relaxed and insensitive to pain. (However, you may feel
some tugging or occasional discomfort.) Some surgeons prefer to use general
anesthesia; in that case, you'll sleep through the operation.
The surgery
Blepharoplasty usually takes one to three hours, depending on the extent of the
surgery. If you're having all four eyelids done, the surgeon will probably work
on the upper lids first, then the lower ones.
Before surgery, the surgeon marks the
incision sites, following the natural
lines and creases of the upper and
lower eyelids.
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.
Underlying fat, along with excess skin
and muscle, can be removed during the
operation.
If you have a pocket of fat beneath your lower eyelids but don't need to have
any skin removed, your surgeon may perform a transconjunctival blepharoplasty.
In this procedure the incision is made inside your lower eyelid, leaving no
visible scar. It is usually performed on younger patients with thicker, more
elastic skin.
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 your surgery
After surgery, the surgeon will probably lubricate your eyes with ointment and
may apply a bandage. 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 forn
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 eyedrops, 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.
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 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.
Your new look
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.
After surgery, the upper eyelids no
longer droop and the skin under the
eyes is smooth and firm.
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
permanent.
The preceding information was provided by the ASPS
at www.plasticsurgery.org
I hope the preceding information was helpful to you. For
more information you can e-mail me at dek111@pol.net
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