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 brow
lift.
If
you're considering eyelid surgery, the information
presented here 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.
A
few medical conditions make blepharoplasty more risky.
They include thyroid problems such as hypothyroidism
and Graves' disease, dry eyes 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.
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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 white-heads
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.
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As
people age, the eyelid skin stretches, muscles
weaken, and fat accumulates around the eyes,
causing "bags" above and below.
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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.
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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.
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| Before
surgery, the surgeon marks the incision sites,
following the natural lines and creases of
the upper and lower eyelids. |
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Underlying
fat, along with excess skin and muscle, can
be removed during the operation. |
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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The
surgeon closes the incisions with fine sutures,
which will leave nearly invisible scars |
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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. |
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.
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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 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.
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After
surgery, the upper eyelids no longer droop
and the skin under the eyes is smooth and
firm. |
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 ten 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 sun block 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.
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.
Before
& After Eyelid Surgery Patients
For
more information on facial rejuvenation procedures,
please click on a procedure below.
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