Eyelid Surgery

What Is Blepharoplasty (EyeLid Surgery)?

Blepharoplasty, or eyelid surgery, is a surgical procedure that removes excess folds of skin in the upper lids and pouches under the eyes (lower lids). Whether to improve your appearance, your vision, or both, reconstructive surgery usually produces a very pleasing effect and gives you a more rested, youthful look. Sometimes, blepharoplasty is accompanied by a procedure known as a brow lift. Blepharoplasty can be performed on one eyelid or on both. These procedures are generally performed by a plastic surgeon.

Your eyes are an expressive feature – one that people notice first – and your eyelids are part of that feature. The eyes are also the first of our features to show signs of age. As skin around the eye area ages, excess folds appear in the upper and lower lids.

Blepharoplasty can have a dramatic effect on your eyelids, restoring a brighter, more rested appearance. Blepharoplasty is one of the most satisfying facial cosmetic procedures because recovery is brief while results are long lasting.

And let’s face it; when we look better, we feel better.

Nice to know:

Eye Accessories

The eyes depend on accessory structures that support, move, lubricate, and protect them. These include the orbital bones of the eye socket, muscles of the eyeball, eyebrows, eyelids, and eyelashes, as well as lacrimal (tear) glands and ducts. If any of these structures ARE irritated, infected, or misshapen, vision may be impaired.

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Eyeballing the eyeball

The eyeball is cushioned by pads of fatty tissue and protected by the bony eye socket. Attached are six tiny muscles that give it a remarkable range of motion and allow it to follow an object’s movement smoothly.

Why Have A Blepharoplasty?

Over time, your eyelids may thin and lose elasticity, which causes them to sag. Often, fat from behind the eyeball migrates forward, giving the appearance of “baggy” eyes. If severe, it can interfere with vision or wearing glasses.

  • At first, bags or sagging eyelids may be noticeable mostly in the morning.
  • As the condition progresses, you may look tired throughout the day.
  • In addition to changing your appearance, sagging eyelids may interfere with your vision.

Nice to Know:

Your Special Shades

Think of your eyelids as shades for your eyes, playing both a protective and an aesthetic role. Their protective role is achieved by lubricating and washing away irritants each and every time you blink. They shield your eyes from bright lights, and they allow you to sleep at night by closing out the rest of the world. Aesthetically, your eyelids frame your eyes, providing a pleasing context in which others see your face. Of course, no two pairs of eyes are alike, so think of your eyes and eyelids as being custom-made for your individual face.

 


Are You A Good Candidate For Blepharoplasty?

As with any surgical procedure, there are certain factors that make you a suitable candidate:

  • good health
  • good muscle tone under your eyes (if considering lower-lid surgery)
  • healthy skin with no serious sun damage
  • an understanding that the procedure will not eliminate further signs of aging
  • an understanding that the procedure cannot correct crow’s feet, fine wrinkles under your eyes, or severely sagging brows

Nice to Know:

Interesting Eye Facts

The eye cannot be transplanted. It is connected to the brain by the optic nerve, which cannot be “reconnected” if severed. The cornea, which is the clear front part of the eye, can be transplanted. Surgeons often use plastic intraocular lens implants (IOLs) to replace natural lenses removed during cataract surgery.

  • Color exists only in our heads. Without the brain’s ability to interpret the intricate and individual way light is reflected off every object in nature, the world would be entirely colorless.

 


How Do You Choose A Good Cosmetic Surgeon?

Choosing a cosmetic surgeon is all about finding the right surgeon for the procedure. Having any kind of surgery is serious, including cosmetic surgery. You may feel a little overwhelmed at the amount of information available as you begin to research your options. A good place to start is with a physician who specializes full time in cosmetic surgery (some do ordinary injury and surgical care as well). The following list will help you make an informed decision about who will perform your blepharoplasty:

  • Research the doctor’s qualifications and his or her surgical experience. Ask about training and educational background.
  • Contact the physician’s office and speak with a nurse to obtain pertinent information about the practice and the physician.
  • Ask questions that are “procedure specific.” For example, ask the physician how many eyelid surgeries he or she has performed. You can even go one step further by asking how many eyelid surgeries he or she has performed on someone your age or skin coloring, etc.
  • Ask if the physician has completed residency in a specialty related to cosmetic surgery.
  • Ask about the physician’s hospital privileges, such as the hospital where he or she admits patients and the type of privileges. Hospitals also monitor physician qualifications, and your cosmetic surgeon should have privileges for eyelid surgery.
  • Contact your local medical society or your local hospitals for names of board certified or board eligible plastic surgeons. After obtaining these names, check each doctor’s credentials. You can do this by contacting the local or state medical society or The American Society of Plastic Surgeons at 1-800-766-4955.

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What Does It Mean To Be Board Certified?

The surgeon you choose should be board certified or board eligible in Plastic Surgery. The American Board of Plastic Surgery maintains standards by which this eligibility is granted. There is a nationally organized medical certifying system for each medical specialty. For plastic surgery, it requires completion of an accredited Plastic Surgery fellowship program and successful completion of stringent written and oral exams.

 


How Do You Plan For EyeLid Surgery?

Your surgeon probably will suggest an initial consultation. He or she will discuss your condition, expectations, and probable results. Your surgeon may require you to have your vision and tear production assessed by an eye doctor. You’ll need to discuss whether

  • to do all four eyelids or just the upper or lower ones,
  • skin as well as fat will be removed
  • any additional procedures, such as facelift or brow lift, are appropriate.

Be prepared to have your “before” pictures taken. Inform the surgeon of any allergies or any vitamins or medications (prescription or over-the-counter) you are taking.

After you and your surgeon decide on the type of eyelid surgery, you will discuss the technique indicated for your individual procedure. Together, you will discuss the type of anesthesia, surgical facility, any supportive surgery, and the risks and cost involved.

  • Ask any questions you may have, especially those regarding your expectations and concerns about the results.

(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.)


How Do You Prepare For Eyelid Surgery (Blepharoplasty)?

Blepharoplasty 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. 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 preoperative instructions will help your surgery go more smoothly.

  • Ask when you should eliminate aspirin and other similar medications before surgery. Aspirin inhibits blood clotting.
  • Don’t eat or drink anything (including water) after midnight the day before surgery.
  • Arrange for someone to drive you home after your surgery and help you out for a few days, if needed.

What Is Involved In The Surgical Procedure for EyeLid Surgery?

Blepharoplasty usually is performed in an outpatient facility under local anesthesia in a matter of one or two hours. If local anesthesia is used, you will be well sedated but partially awake during the surgery. You may be able to tell that the surgeon is working on your eyes, but you will not feel any pain. If general anesthesia is used, you will sleep through the procedure.

Blepharoplasty usually is performed on the upper lids first, then the lower lids. Whether you are having upper, lower, or both lids done, the procedure generally follows this format:

  • Making the incision. Incisions will be made following natural lines and creases, extending into fine lines or crow’s feet at the outer edges of your eyes.
  • Achieving a better shape. Excess skin, fat, and muscle are removed at the surgeon’s discretion.
  • Closing the incisions. The number of sutures (stitches) varies, depending on your surgeon’s judgment. These delicate sutures will be removed three to four days after your surgery. Hairline scars will fade, becoming barely visible within 6 to 8 weeks.
  • Protecting the eyes. Moist gauze will be applied to your eyes after sutures are in place.

Nice to Know:

Alternative Blepharoplasty

In a procedure called transconjunctival lower eyelid blepharoplasty, an incision is made on the inside of the lower eyelid with a laser. The excess fat is then removed. The settings on the laser are adjusted, and the external skin of the lower eyelid is “resurfaced.” When sutures are used to close this kind of incision, they are invisible to the eye. They are also self-dissolving and leave no visible scar. With this procedure, you will be sedated.

 


Will You Need A Brow Lift?

If eyebrows have dropped significantly, an upper-lid blepharoplasty may not be enough to remove all the loose skin. A brow lift can be done separately, or together with the blepharoplasty. During the procedure:

  • The skin of the forehead is peeled forward from an incision made across the top of the head from one ear to the other.
  • Muscles are removed and/or weakened.
  • Skin is tightened upwards, raising the eyebrows.
  • Excess skin is removed and the incision sutured.

Are There Risks And Complications From EyeLid Surgery?

As with any surgical procedure, there are possible risks and complications. For eyelid surgery, the following are possible:

  • Bleeding
  • Infection
  • Blood clots
  • Visible scars
  • Tightness in lids
  • Drooping lower lids
  • Dryness
  • Partial vision loss in one eye (extremely rare)
  • Blindness (extremely rare)

Usually, these conditions improve within weeks. Occasionally, however, these conditions are permanent, or further surgical procedures are necessary to correct them.


What About The Recovery Process After EyeLid Surgery?

You will find that your recovery process is fairly quick both immediately following surgery and in the weeks that follow.

  • You will stay in the recovery room for one or two hours and released once you are no longer groggy from the anesthesia and danger of abnormal bleeding, nausea, or swelling has passed.
  • Ice compresses will reduce swelling and bruising.
  • Pain medication will be prescribed for you, if needed.
  • Once home, your bruising and swelling will begin to subside. Healing will occur more quickly if you follow your surgeon’s instructions.
  • Avoid contact sports for one to two weeks.
  • Avoid activities that can increase your pulse or blood pressure for two or three days to decrease your risk of bleeding and swelling.
  • Call your surgeon immediately if you have any of the following symptoms:
    • Vision problems
    • Severe swelling or pain
    • Heavy bleeding or yellow or green drainage

How To Promote Healing

To minimize swelling:

  • Sleep on your back and elevate your head.
  • Apply ice compresses during waking hours for two days.
  • If eyes are dry, ask your surgeon to prescribe an ointment.
  • Wear sunglasses to protect your eyes.

Resume wearing contact lenses and eye make-up only with your surgeon’s permission.


Will You Need Follow-Up Visits?

To ensure that your eyes are healing properly, your surgeon will probably require a few office visits.

  • Sutures will be removed three to five days after surgery.
  • Adhesive tape may be used to reinforce your incisions after sutures are removed.

Nice to Know:

Spotting Eyelid Skin Cancer

Because the eyelid protects the eye, cancer of the eyelid poses special concerns. For example, drainage structures must remove lubricating fluids, or tears will overflow onto the cheeks.

  • Eyelid skin cancer occurs most often on the lower eyelid but also may occur in the corner of the eye, eyelid margins, or eyebrows. The cancer appears as painless nodules. The affected areas may be ulcerated and accompanied by bleeding and crusting. Eyelashes may be distorted or missing.
  • Eyelid skin cancers usually are treated with ophthalmic plastic by reconstructive surgeons specializing in diseases and conditions involving the eyelids, tear duct system, orbit (bone cavity around the eye) and adjacent facial structures.
  • Fellowship in the American Society of Ophthalmic Plastic andReconstructive Surgery (ASOPRS) indicates that the surgeon has special training in this subspecialty and is board certified by the American Board of Ophthalmology.

Nice to Know:

Banishing Wrinkles: Get Out of the Sun

Dermatologists agree that if it weren’t for exposure to sun, we would be wrinkle-free well into our eighties. Sun exposure damages skin both inside and out. The outermost tier of the skin – the epidermis – is damaged first, resulting in a layer of dead cells that give the skin a leathery look. Then the upper layers of dermis – the bulk of the skin – are damaged, resulting in thinner, less resilient skin, which becomes more likely to wrinkle. With time, the collagen and elastin fibers forming the dermis break down as well, and skin begins to droop and sag.

Nice to Know:

Hooray for Retin-A

Retin-A is a vitamin A compound, a star for eliminating wrinkles. Retin-A was originally developed as an acne medication but was found to work against wrinkles by stimulating new cells. Retin-A stimulates collagen production and blood flow into the dermis, yielding a more youthful appearance and preventing some wrinkles from occurring. Retin-A is available by prescription only.

Nice to Know:

The Eyes Have It

There are three types of vision or eye care specialists:

Ophthalmologists are physicians who specialize in diagnosing and treating eye diseases. They prescribe drugs, perform examinations and eye surgery, and also may provide eyeglasses and contact lenses.

Optometrists are not medical doctors but have doctor of optometry degrees in eye care. They examine eyes, diagnose vision problems, and provide eyeglasses and contact lenses. They also may detect eye diseases but will normally refer you to an ophthalmologist for definitive diagnosis and treatment.

Opticians take measurements and design, verify, and deliver contact lenses, eyeglass lenses, frames, and low-vision aids on prescriptions written by ophthalmologists and optometrists. They may not examine eyes or prescribe lenses.

 


Eyelid Surgery: Frequently Asked Questions

Here are some frequently asked questions related to eyelid surgery.

Q: Isn’t eyelid surgery part of a facelift procedure?

A: Eyelid surgery is a distinct procedure referred to as a blepharoplasty. It is the original “cosmetic” procedure and is still the most common, with about 50,000 persons having the procedure in the United States each year. People look older and more tired once aging skin creates baggy or puffy eyelids, and since this occurs much earlier than wrinkles in the face, it is common for people to elect eyelid surgery years before they need a facelift.

Q: I am in my late 60s. Can I still have eyelid surgery?

A: There are several factors such as age, condition of skin, and general health that are involved in the decision as to whether eyelid surgery is appropriate for you. Generally, in younger persons, blepharoplasty is performed to remove fatty tissue only. In older persons, loss of skin tone may require removing excess skin. If you are in good health without serious eye problems, your age alone should not keep you from having this procedure.

Q: I am of Asian descent. Is the procedure for eyelid surgery different?

A: You need to find a doctor who is familiar with the unique anatomy of the Asian eyelid. It is important to undergo an Asian and not a Western blepharoplasty to match your other features. Only 50 percent of Asians have eyelid creases, and a Western lid crease and Western removal of fat may look very unnatural on an Asian face. Some persons who do not have an eyelid crease may end up with one after surgery anyway, because the scar in the eyelid often causes an eyelid crease to form. If this does happen, the incision needs to be placed in the natural crease lines seen in Asian eyelids.

Q: Will the results of eyelid surgery last?

A: Generally speaking, the benefits of a blepharoplasty are long lasting, and few people need to have the procedure a second time. Fat that has been removed will not come back. However, the skin will have a tendency to stretch again, and the procedure cannot alter or retard the natural aging process.

Q: Can eyelid surgery eliminate the dark color on the lower lids?

A: No. Only makeup can hide the dark shadows often seen under the eyes.


Eyelid Surgery: Putting It All Together

Here is a summary of the important facts and information related to eyelid surgery.

  • Eyelid surgery can improve the overall appearance of excess skin around the eye that can make you look tired or older than your age.
  • This procedure is usually done on an outpatient basis using local anesthesia and sedation to help you relax.
  • This procedure can be done alone or at the same time as other procedures, including a facelift or a brow lift.
  • Eyelid surgery is the most common form of cosmetic surgery.

Eyelid Surgery – Glossary

Here are definitions of medical terms related to eyelid surgery.

Blepharoplasty: Eyelid surgery that involves removal of fat, skin, and muscle deposits and improves the function and/or appearance of the eyes. Can be performed on both top and bottom eyelids.

Cosmetic surgery: Surgery performed primarily to improve the appearance of a part of the body. Cosmetic surgery evolved from reconstructive surgery. Not all insurance policies cover cosmetic surgery.

Glaucoma: Eye disease characterized by an increase in pressure within the eye itself. The increased pressure causes damage to the eye, which can impair vision and lead to blindness if untreated.

Lacrimal : Anything having to do with tears. Lacrimal glands in the eye secrete tears.

Ophthalmologist: A doctor who specializes in treatment of eye diseases and who can perform eye surgery, prescribe medications, and prescribe glasses.

Optic nerve: A nerve that sends signals to the brain from the retina, located in the back of the eye, which allows sight.

Plastic surgeon: A doctor who specializes in cosmetic and/or reconstructive surgery with the goal of improving the function and/or appearance of a body part.

Reconstructive surgery: This type of surgery is done to repair or correct abnormalities caused by disease, injury, birth defects, other surgeries, or infections. The goal is to restore function and sometimes restore appearance.


Eyelid Surgery: Additional Sources Of Information

Here are some reliable sources that can provide more information on eyelid surgery.

Websites:

http://www.4cosmeticsurgery.com

http://www.cosmetic-surgery.net

Books:

Cosmetic Surgery Without Fear: How To Make Safe Choices and Informed Decisions-Patricia Burgess, Cosmetic Surgery Consultants-Patricia A. Burgess; Mass Market Paperback

BodySculputure: Plastic Surgery of the Body for Men & Women-Alan M. Engler MD-paperback

Associations:

The American Society of Plastic Surgeons 1 (800) 766-4955


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