Eyelid Surgery (Blepharoplasty)
Illustration 1: As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing "bags" above and below.
Illustration 2: Before surgery, Dr. Jensen marks the incision sites, following the natural lines and creases of the upper and lower eyelids.
Illustration 3: Underlying fat along with excess skin and muscle, is removed during the operation
Illustration 4: Dr. Jensen closes the incision with fine absorbable sutures, which will leave nearly invisible scars.
Illustration 5: 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.
Illustration 6: After surgery the upper eyelids no longer droop and the skin under the eyes is smooth and firm
Eyelid surgery (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. However, it won't remove crow's feet or other wrinkles (see laser surgery), eliminate dark circles under your eyes, or lift sagging eyebrows. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a laser skin resurfacing, facelift or browlift.
If you're considering eyelid surgery, this information will give you a basic understanding of the procedure-when it can help, how it's performed, and what results you can expect. It won't answer all of your questions, since a lot depends on the individual patient. Please ask Dr. Jensen about anything you don't understand.
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The best candidates for eyelid surgery
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. Before you decide to have surgery, think carefully about your expectations your reasons for wanting surgery and discuss them with Dr. Jensen.
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.
A few medical conditions can 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 rare and usually correctable. 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. Jensen'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; Dr. Jensen 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.
Planning your surgery
The initial consultation with Dr. Jensen is very important. We 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. Jensen if you have any allergies; if you're taking any vitamins, aspirin, ibuprofen, medications (prescription or over-the-counter), or other drugs; and if you smoke.
During your consultation, a nurse 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 at the time of your initial consultation.
You should carefully discuss your goals and expectations for this surgery with Dr. Jensen. 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.
Dr. Jensen will explain the techniques and anesthesia he will use, 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.) Don't hesitate to ask Dr. Jensen any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for your surgery
Dr. Jensen will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, 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 few days if needed. Assistance with transportation can be provided by our complimentary van.
Where your surgery will be performed
Eyelid surgery is usually performed in our office-based facility, on an outpatient basis; rarely does it require an inpatient stay.
Types of anesthesia
Eyelid surgery is usually performed under local anesthesia-which numbs the area around your eyes-along with intravenous sedation. You'll be sleepy during the surgery, relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
Blepharoplasty usually takes one to two hours, depending on the extent of the surgery. If you're having all four eyelids done, Dr. Jensen will work on the upper lids first, then the lower ones. In a typical procedure, Dr. Jensen 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. Jensen will separate the skin from underlying fatty tissue and muscle, remove excess fat, and then trim sagging skin and muscle. The incisions are then closed with very fine, absorbable sutures. If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, Dr. Jensen may recommend 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. Often this procedure is accompanied with laser skin resurfacing of the eyelid skin.
After your surgery
After surgery, the nurse will 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 by Dr. Jensen. If you feel any severe pain, call the office 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 care for your eyes, which may be gummy for a week or so. Frequently we recommend eyedrops, since your eyelids may feel dry at first and your eyes may burn or itch. 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.
Dr. Jensen will follow your progress very closely for the first week or two. The stitches will dissolve 5-7 days after surgery. Once they're gone, 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 soon after surgery. 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 ten days. By then you'll probably be able to wear makeup to hide the bruising that remains. We recommend Physicians Formula cover makeup sold at Walmart). Your eyes 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.
Dr. Jensen will instruct you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, heavy lifting, and rigorous sports. You will also be asked to avoid alcohol, since it causes fluid retention.
Your new look
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.
The positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.