Eyelid surgery (Upper and lower)

Procedure: Correct drooping upper eyelids and puffy bags below the eyes by removing excess fat, skin, and muscle. (Upper-eyelid surgery may be covered by insurance if used to correct visual field defects.)

Duration: 1 to 3 hours.

Anaesthesia: Usually locally 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 white-heads. Slight asymmetry in healing or scarring. Difficulty in closing eyes completely (rarely permanent). Pulling down of the lower lids (may require further surgery). Blindness (extremely rare).

Recuperation: Reading: 2 or 3 days. Back to work: 7 to 10 days. Contact lenses: two weeks or more. Strenuous activities, alcohol: about 3 weeks. Bruising and swelling gone: several weeks.

Duration of Results: Several years. Sometimes permanent.

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If You’re Considering Eyelid Surgery...
Eyelid surgery, or blepharoplasty, is a procedure to reshape the upper or lower eyelid – usually by the removal of excess skin, muscle and fat. Eyelid surgery can correct upper lids hanging over the eyelashes and puffy bags under the eyes. Such features make a person look older and more tired than he or she really is, and may even trouble your vision. However, eyelid surgery won’t eliminate other marks of aging such as crow’s feet, dark circles below your eyes, or sagging eyebrows. Eyelid surgery can be performed alone, or may be combined with other facial procedures, as for example facelift or browlift.
If you’re thinking of undergoing blepharoplasty, this information will give you general understanding of the procedure – when it can improve your health and appearance, how it’s done, and what outcomes can be expected. However, it can’t cover all questions you may have because many answers depend on the individual patient and the surgeon.

The Best Candidates For Eyelid Surgery
Blepharoplasty can improve your looks and enhance your self-esteem, but it won’t necessarily alter your appearance to equal your ideal, or make other people treat you in a different way. Before you make your mind up to undergo the surgery, think about your expectations and discuss them with your surgeon.
If you are in a good physical and emotional state, and have realistic expectations, you may be a good candidate for the surgery. Most eyelid surgery candidates are 35 or older, but in case droopy eyelids run in your family, you may have eyelid operation earlier.
Some medical conditions make eyelid surgery more dangerous. These conditions include thyroid problems such as hypothyroidism and Graves’ disease, dry eye or lack of tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also a reason for caution; visit your eye doctor before you have surgery.

All Surgeries Carry Some Uncertainty and Risk
When blepharoplasty is done by a qualified plastic surgery specialist, complications are rare and usually insignificant. Yet, the possibility of complications remains, including infection or negative reaction to the anaesthesia. You can lessen the risks by carefully following your surgeon’s instructions both before and after the surgery.
Minor complications that may follow eyelid surgery are: double or blurred vision for several days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. After removing the stitches, small white-heads may appear; they may be simply taken out by the surgeon with a special needle.
After the surgery, some patients may feel difficulty closing their eyes when they sleep; in exceptional instances this problem may be permanent. An extremely rare complication is ectropion, a rolling outward of the lower lids. Then, an additional surgery may be required.

Planning Your Surgery
The first visit to the plastic surgeon is very important. He or she will need to know your full medical history, so be prepared to give this information. Tell your surgeon if you suffer from any allergies; if you smoke; and if you’re taking any vitamins, medications or other drugs.
During this meeting, your surgeon or a nurse will check your vision and evaluate your tear production. You should also give any important information from your eye doctor or the record of your latest eye examination. Patients who wear glasses or contact lenses should bring them along.
You should carefully discuss your goals and expectations for the surgery with your surgeon. You’ll need to discuss whether to choose a surgery of all four eyelids or just the upper or lower ones, whether the skin and fat will be removed, and whether any other procedures are needed and can be done.
Your surgeon will tell what techniques and anaesthesia he or she will use, where the operation will be done, what risks and costs are involved. (Eyelid surgery is not covered by most insurance policies, except when you can prove that sagging upper lids trouble your vision. Check with your insurer.)
If you have any questions regarding your expectations and concerns about the results, don’t hesitate to ask.

Preparing For Your Surgery
You will be given detailed instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, taking or avoiding certain vitamins and medications, and washing your face. Closely following these instructions you can expect a more smoothly going surgery.
While preparing for the surgery, make sure that someone will be able to drive you home after your surgery and be near for a few days if any help will be needed.

Types of Anaesthesia
Eyelid surgery is typically carried out under local anaesthesia, with oral or intravenous sedation. You’ll remain conscious but relaxed and pain-free. (However, you may have a sensation of some tugging or occasional discomfort.) Some surgeons may prefer a general anaesthesia. Then you’ll be “put to sleep” for the duration of the procedure.

The Surgery
Eyelid surgery normally lasts one to three hours: it depends on the scope of the operation. If a surgery of all four eyelids is chosen, the surgeon will work on the upper lids first, then the lower ones.
A usual procedure involves incisions along the natural lines of the patient’s eyelids; in the folds of the upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow’s feet at the outer corners of the eyes. Having made these incisions, the surgeon frees the skin from the fatty tissue and muscle beneath, removes redundant fat, and trims the drooping skin and muscle. Afterwards, the cuts are closed with very fine sutures.
If you have a bag of fat collected beneath your lower eyelids but there is no need to have any skin trimmed, your surgeon may do a transconjunctival blepharoplasty, in which the incision is made inside the lower eyelid. The procedure is typically performed on younger patients, whose skin is thicker and more elastic.

After Your Surgery
Following the surgery, the surgeon may lubricate your eyes with ointment and apply a bandage. You may feel tightness and sore as the anaesthesia wears off, but you can lessen any irritation or ache with the pain medication prescribed by your surgeon. If you feel any harsh pain, report to your surgeon right away.
You will be advised to keep your head upright for a few days, and to apply cold compresses to minimise swelling and bruising. You’ll be instructed how to clean your eyes, which may be gummy for about seven days. The surgeon may recommend eye-drops, since your eyelids may feel dry at first, and your eyes may burn or itch. During the first several weeks, you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.
Your surgeon will watch your progress attentively for the first week or two. The stitches will be removed in five days after surgery. Then, the swelling and discoloration around your eyes will settle, and your appearance will begin improving.

Getting Back to Normal
Reading or watching television is generally allowed after two or three days. However, you won’t be able to wear contact lenses for two weeks or so.
Most patients go out in public (and back to work) in 7 to 10 days. By then, depending on the pace of healing and your surgeon’s directions, you’ll possibly be able to wear makeup to mask the remaining bruising. Your eyes may be sensitive to sunlight, wind, and other irritants for a few weeks, so wearing sunglasses and a special sunblock made for eyelids when you go out are recommended.
You are likely to be told to minimise your activities for 3 to 5 days, and restrain from more strenuous activities for about three weeks. The surgeon may also advise you to avoid alcohol, as it causes fluid retention.

Your New Look
Since healing is a gradual progression, your scars may look somewhat pink for six months or more after the surgery. Finally they’ll form into a thin, almost invisible white line.
On the other hand, the youthful look as the result of plastic surgery will last for years and in most cases permanently.

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