Face Procedures

Eyelid Surgery (Blepharoplasty)

For that youthful and more alert look

Blepharoplasty is a procedure during which skin from the eyelid is removed, along with either the removal or addition of fat. 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 that may even interfere with your vision.

Details

While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage.

Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a facelift or browlift.

Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently.

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 if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

(Upper-eyelid surgery may be covered by insurance if used to correct visual field defects).

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Procedure

In a typical procedure, Dr. Patterson 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, he 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.

Underlying fat, along with excess skin and muscle, can be removed during the operation. If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, Dr. Patterson 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.

In a transconjunctival blepharoplasty, a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed and the incision is closed with dissolving sutures.

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

Anesthesia: Eyelid surgery is usually 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.)

In/Outpatient: Eyelid surgery is usually done on an outpatient basis; rarely does it require an inpatient stay.

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Side Effects & Risks

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.

All surgery carries some uncertainty and risk. 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. You can reduce your risks by closely following Dr. Patterson’s instructions both before and after surgery.

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; the surgeon can remove them easily with a very fine needle. Following surgery, some patients may have difficulty closing their eyes when they sleep; in 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.

SAGGING OR “ATONICITY” OF THE LOWER LIDS: Temporary or long-term loss of the nerve supply to the muscle that supports the lower eyelid can allow sagging of the margin of the eyelid. The muscle usually regains its innervations within several days to weeks*. Support of the eyelid with tape and upward massage usually helps. Few patients require further surgery.

MILIA (MICROCYSTS ALONG THE INCISION LINES): Tiny cysts often form along the incision line during the healing phase. These will either clear up with time or Dr. Patterson can “pick them out” with a needle tip during a postoperative visit.

RETRACTION AND ECTROPIN (EVERSION) OF THE LOWER EYELIDS: Rarely, scarring within the eyelid or excessive skin excision can cause eversion of the margin of the eyelid or a downward pull of the eyelid. Taping with adhesive strips (steri-strips) and upward massage usually solve the problem, but some patients require further surgery.

INABILITY TO CLOSE THE UPPER EYELIDS: This occurs because of the excessive skin excision or postoperative muscle weakness. Although we want to remove as much skin as possible in order to obtain the “best result,” we will operate conservatively and use our best judgment and experience to avoid such problems. In an extremely rare case, you may require a replacement of skin with a graft.

SAGGING OR “PTOSIS” OF THE UPPER EYELIDS: Surgery may damage the mechanism that supports and lifts the upper eyelid. Should this unlikely event occur, you may need further surgery.

DRY EYES: After eyelid surgery, your eyes will probably feel drier than usual. We suggest using artificial tears. If you have a problem with dry eyes before surgery, you must discuss this with your surgeon before the operation.

ASYMMETRY: One eyelid can heal slightly different than the other. Very minor differences are common in normal people and are common after surgery as well. Following surgery, patients examine themselves much more critically and have more concerns. Almost all minor differences disappear with the completion of healing.

INTERAL EYE DAMAGE: Eye muscles and nerves are rarely injured during blepharoplasty. Should such injury occur, secondary surgery could be required (usually by an Opthalmologist) and permanent damage could remain.

UNSATISFACTORY RESULT: If the results of your blepharoplasty surgery is unsatisfactory, either time and healing or a secondary surgical procedure will usually correct the problem.

BLINDNESS: This is an extremely rare complication. Bleeding deep within the orbit, around the eye appears to be the underlying reason. Avoiding deep orbital injections and employing meticulous hemostasis (control of small bleeders) during the procedure avoids the potential for this horrible complication. Most plastic surgeons do not even know another surgeon who has seen this problem.

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Recovery

After surgery, Dr. Patterson 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. If you feel any severe pain, call the doctor immediately.

You will be instructed 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*.
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 progress will be followed 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.
Getting back to normal: 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 the 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.

You should 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 and rigorous sports. You should also avoid alcohol, since it causes fluid retention.

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Results

After surgery, the upper eyelids no longer droop and the skin under the eyes is smooth and firm.
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 - that more alert and youthful look - will last for years*. For many people, these results are permanent*.

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FAQs

Q. Can I wear my contact lenses right away?

A. You won't be able to wear contact lenses for about two weeks* and even then, they may feel uncomfortable for a while.

Q. What are the bags under my eyes caused from?

A. As people age, the eyelid skin stretches, muscles weaken and fat accumulates around the eyes, causing "bags" above and below.

Q. What should I do if I feel extreme pain following the surgery?

A. If you feel any severe pain, call Dr. Patterson immediately!

Q. I'm under 35 but droopy eyelids run in my family. Can I have eyelid surgery at my age?

A. Most surgical candidates are 35 or older but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

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"*Dr. Patterson is excellent, put me at ease during each visit and took the time to answer all of my questions."

Recapture the Beauty of Self-Confidence

Should you have any questions not answered here, or if you would like more information before booking your consultation, contact us today! We'd always love to hear from you!