EYELID SURGERY (BLEPHAROPLASTY)

The saying goes “our eyes are the gateway to the soul” which may be why the signs of aging around the eyes can be so disheartening. There are several reasons why the lines, excess skin and “bags” occur. As our skin ages, the collagen in the skin becomes damaged and this leads to the wrinkles and the excess skin. We lose fat underneath the skin around our eyes and this leads to the hollowing around the eyes and also to the excess skin. The brow also can affect the skin excess and fullness of the upper eyelid. As the brow descends, it folds the skin of the upper lid. If you look in the mirror as you raise your eyebrows with your hand, you can see how raising the brow smoothes the upper eyelid skin. In the lower lid, the “bags” or bulge that forms is due to the weakening of the lower eyelid and the bulging of the fat behind the eyelid.

Upper Eyelid

A common complaint is the excess skin of the upper eyelid. This is due to some loss of elasticity of the skin of the eyelid and also to a loss of fat under the skin in the brow region above the eyelid. The combination of events creates a loose fold of upper eyelid skin. Often, this excess skin can make it difficult to place eye makeup.

Removal of the excess skin and sculpting the upper lid region is often necessary to rejuvenate the upper eyelid. The incision is placed in the eyelid fold so it is not seen. I also will sometimes recommend a very small amount of fat grafting to plump up the skin area above the eyelid and give you back your fullness you had in youth. The removal of upper eyelid skin is often combined with a lifting of the brow using a forehead lift. Together a browlift and upper blepharoplasty can make for a great rejuvenation effect for your eyes.

Lower Eyelid

The lower eyelid will show some bulging of the fat with aging which produces the “bags” under the eyes. We also get a loss of the elasticity of the skin of the lower eyelid which produces the fine lines on the eyelid. A loss of some fat where the eyelid joins the cheek as we age gives the effect of a hollowness of the area around the eye.

I can improve the look of the lower eyelid “bags” by removing or redraping the fat which is bulging. I generally do this using an incision on the inside of the lower eyelid so the scar does not show. Again, a small amount of fat grafting can plump up the hollowness around the eye. A small amount of skin removal may also be beneficial if you have some skin folds.

What to Expect with Blepharoplasty

I usually like for you to have a general anesthetic to do eyelid surgery so you will not remember anything about the procedure and so you remain comfortable. Generally, the procedure lasts 1 – 1.5 hours. You will go home after your blepharoplasty. The recovery is about 10 – 14 days until the bruising and swelling subsides. I use dissolving sutures (stitches) so you will not need to have them removed. Sunglasses are always in fashion after blepharoplasty.

Blepharoplasty 1st week instructions

Normal Things: Expect that your eyelids will be swollen after the surgery. The swelling may be increased the following morning. To keep swelling at a minimum, keep crushed ice packs over your eyelids as much as possible the first night. By the next morning the ice will have less effect and is not necessary. It is also helpful to sleep with “the head higher than the heart”. This is best accomplished by sleeping with your back and head elevated on several pillows or to sleep in a recliner chair for a couple nights. You may have some bloody drainage from the eye. This is also normal. You will most likely have some bruising around the eyes. Often, it takes several days for the bruising to fully show up.

Medications: Take the Vicodin for pain every 4 hours if you need it for discomfort. Take it less often if your discomfort is controlled. If you get nausea from the Vicodin try taking a half a pill at a time. Take the antibiotics (Cipro) and Arnica as directed. The Maxitrol (antibiotic) ointment should be put on the eyelid skin incisions (if you have them) and in the eye at bedtime (if you have the incision there) as directed. The artificial tears are for use if your eyes get dry during the day. The ointment is for bedtime so that your eyes do not dry when you are sleeping.

My eyes feel scratchy or burn: This sensation is common after eyelid surgery. It is from the surgery and usually resolves in the first week. The eye drops and ointment usually help.

I have more tears than usual or my eyes are more dry than usual: Extra tearing or unusual dryness is common after eyelid surgery. It is because the normal tear production is altered temporarily by the surgery and swelling. Crusting on your lashes is also common in the morning for the same reason. Use the drops and ointment for dry eyes.

My vision is blurry: This is common after eyelid surgery for a couple of days. It is usually caused by the altered tear production. The ointment can also cause your vision to be blurred.

Makeup: It is best to avoid makeup directly where an incision is on the eyelids in the first week. Cover-up makeup can be used away from the incisions to conceal bruising.

Glasses and contact lenses: Glasses are fine to wear after our surgery. You should not wear contacts for 2 weeks after eyelid surgery.

Activity: You should take it easy after your surgery even if you feel fine. Vigorous physical activity can cause bleeding or break sutures. Wait for several weeks to begin vigorous activity.

Showering: Getting your face (and eyelids) wet is fine 48 hours after your surgery. Try to avoid direct shower spray on your eyes. Pat your face dry and try not to rub the sutures.