Blepharoplasty (Eyelid Lift)

Blepharoplasty

Eyelid surgery (technically called blepharoplasty) is a procedure to remove excess skin and fat  from the upper and/or 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. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift.

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.

QUICK FACTS

INDICATIONS

  • Tired, Aging eyelids
  • Excess or drooping skin of the upper eyelids
  • Bags and puffiness of lower eyelids

EYELID LIFT ADVANTAGES

  • Removes excess skin of upper eyelids
  • Removes excess skin of lower eyelids
  • Repositions, reduces, or removes bulging fat
  • Refreshes and rejuvenates eyelid area

EYELID LIFT TECHNIQUES

  • Upper Eyelid Lift (Upper Lid Blepharoplasty)
  • Lower Eyelid Lift (Lower Lid Blepharoplasty)
  • Transconjunctival Blepharoplasty
  • Blepharoplasty with Fat Grafts
  • Blepharoplasty with Laser Resurfacing

EYELID LIFT STATISTICS

  • Length: 1 to 3 hours
  • Back to Work:
    Upper and Lower Blepharoplasty – 4 to 7 days,
    Blepharoplasty with Fat Grafts and/or Laser – 10 to 14 days
  • Return to Exercise: 4 to 5 days (light cardio), 2 to 3 weeks (more strenuous exercise)

The best candidates for eyelid surgery are men and women who are physically healthy 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.

Any one or combination of the following conditions may indicate that you may be considered a good candidate for eyelid surgery:

  • Excess skin obscuring the natural fold of the upper eyelids
  • Loose skin hanging down from the upper eyelids, perhaps impairing vision
  • A puffy appearance to the upper eyelids, making the eyes look tired
  • Excess skin and fine, “crepe paper type” wrinkles of the lower eyelids
  • Bags and dark circles under the eyes
  • Lower eyelid droopiness

Aesthetic eyelid surgery can usually correct these problems, though other treatments may also need to be considered. If the upper eyelid condition is accompanied by sagging of the eyebrows, then Botox brow lifting may be recommended. Smoothing of crow’s feet may be accomplished chemical peeling or laser resurfacing procedures. Circles beneath the eyes caused by dark pigmentation may be treated with fillers such as Hyaluronic Acid or fat as well as bleaching solution or a chemical peel.

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. Don’t hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can realistically be achieved. You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems, diabetes, etc. should be reviewed as these medical conditions may increase some risks associated with eyelid surgery. Your plastic surgeon will want to know if you have allergies, especially if they affect your eyes. He or she may ask whether you have ever tried and were unable to wear contact lenses. It will be necessary for your surgeon to know if you were ever told by an ophthalmologist that you have a condition called “dry eye” or if you have any other problems with your eyes.

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. One of several surgical techniques may be suggested to improve the appearance of your eyelids. The particular technique that your plastic surgeon recommends will depend on many factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids. Because of individual factors, not everyone will achieve the same results from eyelid surgery. Your plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you.

UPPER LIDS

For upper eyelid surgery, generally an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed. Because the incision follows the natural contour of the upper eyelid, it usually is inconspicuous.

Blepharoplasty

LOWER LIDS

Transcutaneous technique (through eyelash skin incision):
For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be redistributed to eliminate puffiness or bulges. As in upper eyelid surgery, placement of the incision in natural crease lines allows for the scar to usually heal in an inconspicuous fashion.

Blepharoplasty

Transconjuctival lower eyelid fat excision and/or transposition:
In many cases, your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid in order to avoid injury to the lower eyelid muscle. This technique is called the transconjuctival technique and requires no external incision, although direct skin excision is frequently used in conjunction in order to tighten the lower eyelid skin. This approach is very frequently used by our surgeons as it significantly decreases the risk for lower eyelid malposition (ectropion or pulled-down eyelid).

Blepharoplasty

Fat transposition Lower Blepharoplasty
In many women simply removing fat bags from under the eyes will create a hollowed out look that may give the “operated look”. In these cases we may need to not only reduce a small amount of fat, but also reposition the rest of the fat into the tear trough or other hollowed out area. Refilling the areas under the eyes makes the eyes appear youthful and rested.

Lower eyelid Canthopexy
We will often incorporate a canthopexy, a procedure to tighten the lateral canthal tendon of the lower eyelid to support it as it weakens with age. This helps prevent lower eyelid shape change after lower blepharoplasty and may recreate the almond shaped eyes people had in youth.

canthopexy

Before surgery

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible. If you are a smoker, it is highly recommended to stop smoking well in advance of surgery. Smoking can impair your ability to heal. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. Aesthetic eyelid surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for the next 24 hours.

The Day of Eyelid Surgery

Your eyelid surgery is usually performed at one of our JCI-accredited hospitals. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing eyelid surgery, as general anesthesia is rarely needed. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. 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 a normal aftermath of eyelid procedures. There should be surprisingly little discomfort, however, from the surgery. You probably will be permitted to go home after a short period of observation, although in some occasions patients may stay overnight in the hospital.

Eyelid Surgery Recovery

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 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.

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.

Results of Your Eyelid Surgery

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. Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months usually becoming barely visible. The results of aesthetic eyelid surgery are usually long-lasting, but they may be affected by heredity and lifestyle factors. Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along with the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure. Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time.

Understanding Risks

Fortunately, significant complications from aesthetic eyelid surgery are rare. The subject of risks and potential complications of surgery is discussed on a personal basis between you and your surgeon. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection, changes in sensation, scarring, allergic reactions, damage to underlying structures, need for revisions, unsatisfactory results possibly necessitating additional procedures and medical risks. Following the surgery, there can be a feeling of dryness or irritation in the eye that requires treatment. There is a possibility of impaired eyelid function that sometimes may need to be corrected by additional surgery. You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your eyelid surgery. 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. 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 very 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.

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.

BLEPHAROPLASTY COMBINED WITH OTHER PROCEDURES

Eyelid lift or blepharoplasty surgery is frequently combined with other facial rejuvenative procedures. Blepharoplasty is often performed along with fat transfer (autologous fat grafts), laser resurfacing procedures, or chemical peels. For those individuals who desire additional plastic surgery enhancements, particularly geared toward achieving and maintaining a youthful balance of all parts of the face, your blepharoplasty may also be combined with a facelift. Eyelid lift or blepharoplasty can also be combined with breast and body contouring procedures such as liposuction, tummy tuck, breast augmentation, and breast liposuction, tummy tuck, breast augmentation, and breast lift.