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BLEPHAROPLASTY

"The gaze is the mirror of our interior, the

tiredness or vitality are reflected in it."

General description

Blepharoplasty is a type of surgery that is performed to repair drooping eyelids and may involve the removal of excess skin, muscle, and fat. As you age, the eyelids stretch and the muscles that support them weaken. As a result, excess fat can accumulate above and below the eyelids, resulting in sagging eyebrows, drooping upper lids, and bags under the eyes.

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Aside from looking older, significant sagging of the skin around the eyes can reduce side vision (peripheral vision), especially in the upper and outer parts of the visual field. Blepharoplasty can reduce or eliminate vision problems and make the eyes appear younger and more alert.

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To help you decide if you should have blepharoplasty, find out what your realistic expectations are, as well as the risks and benefits of this procedure.

Why it is performed 

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You may be considering blepharoplasty if your eyelids are sagging or drooping and you can't open them all the way or if they push the lower eyelids down. Removing excess tissue from the upper eyelids can improve vision. Blepharoplasty of the upper and lower eyelids can give the eyes a more youthful and alert appearance.

 

Blepharoplasty may be an option if you have the following features:

 

  • Bags or flaccidity in the upper eyelids

  • Excess skin on the upper eyelids that interferes with peripheral vision

  • Excess skin on lower eyelids

  • Bags under the eyes

 

You can have your blepharoplasty done at the same time you have another procedure, such as a brow lift, facelift, or skin rejuvenation.

Insurance coverage may depend on whether the surgery repairs a condition that affects vision. If you have surgery only to improve your appearance, insurance probably won't cover the cost. Blepharoplasty of the lower eyelids is almost always performed for cosmetic reasons alone.

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Risks

Possible risks of eyelid surgery include:

 

  • Infection and bleeding

  • Dry, irritated eyes

  • Difficulty closing the eyes or other problems with the eyelids

  • Obvious scars

  • Injury to the eye muscles

  • Skin color changes

  • The need for follow-up surgery

  • Temporarily blurred vision or, in rare cases, vision loss

  • Risks associated with surgery in general, including reactions to anesthesia and the formation of blood clots

 

Talk to your doctor about how surgical risks may affect you. Understanding what blepharoplasty involves and considering the benefits and risks can help you decide if this procedure is a good option.

How to prepare yourself

Before scheduling a blepharoplasty, you will meet with a aesthetic surgeon and an eye specialist (ophthalmologist) or a surgeon who specializes in eye surgery (oculoplastic surgeon) to discuss the following:

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  • Your medical history. The surgeon will ask questions about past surgeries and previous or current conditions, such as dry eyes, glaucoma, allergies, circulatory problems, thyroid problems, and diabetes. The doctor will also ask about the use of medications, vitamins, herbal supplements, alcohol, tobacco, and drugs.

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  • Your expectations. An honest discussion about your expectations and motivations for surgery will help set the stage for a satisfying outcome. Your surgeon will talk with you about whether or not the procedure might work for you.

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Before eyelid surgery, you must perform:

 

  • A physical examination. The surgeon will perform a physical exam, which may include an analysis of tear production and measuring parts of the eyelids.

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  • An eye exam. The ophthalmologist will examine your eyes and test your vision, including peripheral vision. This is necessary to support an insurance claim.

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  • Photographs of the eyelids. Photographs of the eyes will be taken from different angles. These photos help schedule surgery, evaluate immediate and long-term effects, and support an insurance claim.

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They'll also ask you for the following:

 

  • Stop taking warfarin (Coumadin, Jantoven), aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), naproxen (Naprosyn), and any other medications or herbal supplements related to increased bleeding. Ask your doctor how long before surgery to stop using these medications. Take only medications approved by your surgeon.

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  • Quit smoking several weeks before surgery. Smoking may reduce healing after surgery.

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  • Ask someone else to drive you and bring you to the surgery site, if it is an outpatient surgery. Arrange for someone to stay with you the first night after you return from surgery.

What to expect

Before the procedure

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Blepharoplasty is usually performed on an outpatient basis. Your surgeon will inject medication to numb your eyelids and give you intravenous medications to help you relax.

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During the procedure

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If you have both upper and lower eyelid surgery, your surgeon will usually begin working with your upper eyelids. He or she will make a cut along the eyelid crease, remove some of the excess skin, muscle, and possibly fat, and then close the cut.

 

On the lower eyelid, the surgeon will make a cut just below the lashes in the natural crease of the eye or inside the lower eyelid. He or she will remove or redistribute excess fat, muscle, and sagging skin, and close the cut.

 

If the upper eyelid drops near the pupil, the surgeon may perform a blepharoplasty with a procedure called "palpebral ptosis" that provides additional support to the eyebrow muscle.

 

 

After the procedure

After surgery, you will spend some time in the recovery room, where you will be checked for complications. You will be discharged later the same day so that you can recover at home.

 

After surgery, you may feel temporarily:

 

  • Blurred vision due to lubricating ointment applied to your eyes

  • Watery eyes

  • Sensitivity to light

  • Double vision

  • Numb, swollen eyelids

  • Swelling and bruising similar to having a black eye

  • Pain or discomfort

 

Your doctor may suggest that you take the following steps after surgery:

 

  • Use ice packs on your eyes for 10 minutes every hour the night after surgery. The day after surgery, use ice packs on your eyes four to five times during the day.

  • Carefully clean the eyelids and use prescription eye drops or ointments.

  • Avoid straining, heavy lifting, and swimming for a week.

  • Avoid strenuous activities, such as aerobic exercise and jogging, for a week.

  • Avoid smoking.

  • Avoid rubbing your eyes.

  • If you wear contact lenses, do not wear them for at least two weeks after surgery.

  • Wear dark sunglasses to protect the eyelid skin from the sun and wind.

  • Sleep with your head elevated above chest level for a few days.

  • Apply cold compresses to reduce swelling.

  • If necessary, after a few days return to the doctor's office to have the stitches removed.

  • For about a week, avoid taking aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), naproxen (Naprosyn), and any other medications or herbal supplements that may increase bleeding. If necessary, take acetaminophen (Tylenol, others) to reduce pain.

 

Seek immediate medical attention if you have any of the following symptoms:

  • Difficulty breathing

  • Chest pain

  • Unusual heart rate

  • Severe eye pain

  • Bleeding

  • Vision problems

 

Results

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Many people report being satisfied with the results of blepharoplasty, such as enjoying a more youthful, rested appearance and increased self-esteem. For some people, the results of surgery can last a lifetime. For others, the eyelids may fall back.

Bruising and swelling usually diminish in 10 to 14 days, which may be when you feel comfortable in public again. Scars from surgical cuts may take months to fade. Try to protect the delicate skin of the eyelids against excessive sun exposure.

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