Eyelid Surgery

Open your eyes to a more youthful, energetic you.”

Eyelid surgery (or 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. Eyelid surgery will not remove all crow’s feet or wrinkles, eliminate all 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. Eyelid surgery can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift.

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 family traits or other circumstances compel some 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 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.

Dr. Guy often performs upper eyelid blepharoplasty in her office with just local anesthesia and some sedative medicine taken by mouth.

Blepharoplasty Basics

Procedure:
Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle.

Length:
1 to 3 hours.

Anesthesia:
Usually local with sedation or general.

In/Outpatient:
Usually outpatient.

Side Effects:
Temporary discomfort, tightness of lids, swelling, bruising. Temporary dryness, burning, itching of eyes. Excessive tearing, sensitivity to light for first few weeks.

Risks:
Temporary blurred or double vision. Infection, bleeding. Swelling at the corners of the eyelids. Dry eyes. Formation of whiteheads, known as milia. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids, known as ectropion (may require further surgery). Blindness (extremely rare).

Recovery:

Reading:
Several days; may need to increase use of moisturizing eye drops temporarily.

Back to work:
7 to 14 days.

Contact lenses:
Two weeks or more.

Strenuous activities, alcohol:
About 3 weeks.

Bruising and swelling gone:
Most in 2 weeks, more subtle swelling gone in several weeks

Duration of Results:
Several years. Sometimes permanent.

Consultation & Preparation

The initial consultation with Dr. Guy is very important. Dr. Guy 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 Dr. Guy 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, Dr. Guy 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 Dr. Guy 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, such as tightening the lower lid cartilage to prevent ectropion.

Dr. Guy will explain the techniques and anesthesia 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 and your ophthalmologist).  Dr. Guy no longer participates in insurance billing.
Dr. Guy will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, quitting 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 day or two.  Dr. Guy will want to see you in her office a day or two after surgery and you will need a ride for that appointment..

The Plastic Surgery

Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you’re having all four eyelids done, Dr. Guy will probably work on the upper lids first, then the lower ones.

Eyelid surgery is sometimes 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. For surgery on both upper and lower eyelids, Dr. Guy prefers general anesthesia.

In a typical procedure, Dr. Guy 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, Dr. Guy 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.

If you have a pocket of fat beneath your lower eyelids but don’t need to have any skin removed, Dr. Guy 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. The transconjunctival approach is becoming more common for all patients, however, along with a modified method for excess skin removal or with laser resurfacing of the eyelid wrinkles.

Recovery & Results

After surgery, Dr. Guy will probably lubricate your eyes with ointment and may apply cool compresses. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by Dr. Guy.

Keep your head elevated for several days and 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 less than two weeks.) You’ll be shown how to clean your eyes, which may be gummy for a week or so. For the first few weeks you may also experience excessive tearing, sensitivity to light and drafts, and temporary changes in your eyesight, such as blurring or double vision.

Dr. Guy will follow your progress very closely for the first week or two. The stitches will be removed five 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 soon after. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while. Scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line.

Most people feel ready to go out in public (and back to work) in a week or two. By then, depending on your rate of healing and Dr. Guy’s instructions, you’ll probably be able to wear makeup to hide any 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. Keep your activities to a minimum for three to five days, and avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including bending, lifting, staining and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention and dilation of the blood vessels, which can cause more bruising and swelling.
You may see examples of before and after blepharoplasty results on our website photo gallery.