Cosmetic eyelid surgery — or blepharoplasty — can help restore a more youthful and rested appearance to the eyes. The procedure involves removing excess skin to correct drooping of the upper lids and excess fat to remove the “bags” below your eyes.
Many people in their early to mid-30s begin to notice a tired appearance around their eyes. This is most commonly attributed to a fullness or puffiness of their eyelids, caused by the accumulation of excess skin and/or fat. This fat is independent of body weight. It is originally under or behind the eye and migrates forward with the aging of the eyelid tissues. This condition can be remedied with cosmetic eyelid surgery. There are other conditions, however, such as allergy, fluid retention and thyroid disease which must be ruled out before surgery because blepharoplasty will not substantially improve these situations.
Those individuals with special ophthalmic problems such as dry eye syndrome, glaucoma or a detached retina may be surgical candidates but require additional evaluation by an eye doctor.
PRIOR TO SURGERY
At your initial consultation, Dr. Glassman will ask you to express your concerns about your appearance. You and he will carefully discuss your goals and expectations. Your medical history will be reviewed and a physical examination will be conducted. Dr. Glassman will determine if there are any eye conditions that might preclude surgery. He will check your vision and make sure that your tear production is normal. He will determine if there is excessive laxity of the lower eyelids which, if present, may warrant a different surgical technique.
Dr. Glassman will advise you if cosmetic eyelid surgery is best for you. He will help you decide whether to have surgery on all four eyelids or just the upper or lower ones. Furthermore, he will discuss whether any additional procedures are appropriate. At times, for example, a patient may request eyelid surgery when, in fact, another procedure such as a brow lift or laser resurfacing may be more appropriate.
Dr. Glassman may request that you visit your private medical doctor and/or your eye doctor for a check-up and for any necessary lab work and x-rays. Precise preoperative instructions are provided, and all necessary prescriptions are given to you in advance of the surgery. All aspirin, aspirin-containing products, and anti-inflammatory products must be stopped at least ten days before and for ten days after surgery. You will be provided with a complete list of which medications to avoid. Tylenol may be taken during this time. Also, you will be given a list of vitamins and homeopathic preparations to take prior to and after the surgery. This is done to promote healing and limit bruising.
In most eyelid surgeries, general anesthesia is used. However, in some cases, local anesthesia with intravenous sedation may be used. Dr. Glassman and our anesthesiologist will help you make the decision of which type of anesthesia is best for you.
Cosmetic eyelid surgery is generally performed as an outpatient in a private facility. It may be combined with other procedures, such as brow lift and/or a facelift.
Before anesthesia is given, a detailed “map” of the skin and/or fat to be removed is drawn on your skin using a special marking pen. The surgery is planned and marked while you are awake to preserve your natural expression and eye shape as well as the mechanical function of your eyelids.
After anesthesia is given, an incision is made in the curved eyelid crease of the upper eyelid. This placement assures that the scar will be well hidden when it heals. Dr. Glassman removes the previously determined amount of excess skin and fat, and the incision is then closed with small stitches.
In the lower eyelid, the fat is removed through a small incision on the inside of the eyelid (this is known as the transconjunctival approach). Great care is taken to remove the precise amount of fat. A portion of the fat may be repositioned into the groove below the lower eyelid (the nasojugal groove) to prevent the “hollow look” that some people develop with aging and others develop following eyelid surgery.
If after fat removal there is excess skin, it may then be trimmed by making an incision immediately below the eyelashes. When it heals, this incision is virtually imperceptible. The carbon dioxide laser may also be used to resurface the lower eyelid, causing a mild contraction or shrinkage of the excess skin. The operation takes one to two hours.
THE POSTOPERATIVE PERIOD
The first one to two hours after surgery are spent in the recovery room where cold compresses are applied to minimize swelling. When you are fully alert, you will be able to return home in the care of a friend or family member.
You will be encouraged to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. There is very little if any pain following eyelid surgery. Pain medication is prescribed, although it is usually not necessary.
Some patients experience tearing and irritation for the first several days after surgery. Eye ointment may be prescribed for use at night and eye drops for daytime use until the symptoms resolve. Blurred vision is experienced by some patients for several days after surgery, and the eyes may fatigue more easily during this time.
In most cases the bruising is minimal and resolves after the first week. The stitches are removed five to seven days following surgery. You may then resume wearing makeup and using contact lenses. The incisions may remain pink for a short period after surgery. They can be covered easily by makeup after the stitches are removed. They usually fade and become inconspicuous in four to six weeks.
Most patients return to work and social activities after one week. Strenuous physical exercise is avoided for two to three weeks following cosmetic eyelid surgery.
RISKS AND COMPLICATIONS
As with any operation, the eyelid surgery has minimal risks and potential complications. However, with highly trained doctors and nurses making up the surgical team, complications are extremely rare and usually minor.
Bleeding, infection, scarring and anesthesia problems are potential complications of all types of surgery, and eyelid surgery is no exception. Rarely, a patient experiences corneal irritation due to drying of the eye during surgery.This can be treated easily and usually resolves completely overnight. Excessive removal of skin can result in a pulling down of the lower lid or in the inability to completely close the eyes, which can result in dryness or irritation. This is avoided by careful measurements and execution of the surgical plan. A surgical revision can correct this problem. Visual disturbance is exceedingly rare.
You can reduce your risks by closely following our detailed instructions both before and after surgery.
The goal and the result of cosmetic eyelid surgery are a more youthful and well-rested appearance without a change in the shape or expression of the eyes. For many people, these results are permanent. At very least, you can expect the improvement to last many years. If, after the passage of time a small amount of excess skin is noted, it can easily be removed. It is uncommon for excess fat to reappear until many years later. If this occurs, the fat can be removed safely and easily as in the original procedure.
ADVANTAGES OF THE TRANSCONJUNCTIVAL APPROACH
The major advantage of making the lower eyelid incision on the inside of the lid is the avoidance of trauma to the muscle which supports the lower eyelid. This is important in preserving the natural shape of the eye after surgery and preventing a “surgical stare.”