EYELID SURGERY (BLEPHAROPLASTY)
Eyelid surgery can be done to correct excessive upper eyelid skin, puffy fat pads in the upper or lower eyelids and wrinkled lower eyelid skin. Technically known as blepharoplasty (blef-r-o-plas-tee), this procedure involves removal of fat and excess skin and muscle from the upper and lower eyelids. In some cases, the lower lid itself is tightened at the outer corner of the eye socket (canthopexy) to correct weakness of the tone of the lower eyelid. In younger patients, fat can be removed from the lower eyelids using an incision on the inside of the lower eyelid (transconjunctival approach), if the skin elasticity allows. Eyelid surgery does not address crow’s feet lines, dark pigmentation of the lower eyelids, drooping eyebrow skin, or loss of volume along the lower eye socket (tear trough), but other procedures or treatments are available to address these concerns. Specialized surgery is done to add a crease to the upper eyelid in Asian patients, but will not erase other ethnic features which define racial heritage. Eyelid surgery is frequently done at the same time as other procedures, such as a facelift or browlift.
Dr. Creasman will take a medical history, with particular emphasis on conditions that may impact your candidacy for eyelid surgery. Underlying medical conditions, such as high blood pressure, bleeding disorders, heart disease, diabetes, thyroid disorders, or a history of dryness of your eyes are important issues that can increase the risks of eyelid surgery. We need to know about any prior eyelid surgery, eye muscle surgery, or laser vision correction. The medications you take may need to be altered prior to surgery, so be prepared to provide specific dosing information at the time of the consultation. Please inform us if you have any history of allergies to medications. Let us know also if you wear any corrective lenses.
The doctor will do a thorough eyelid examination, and will assess other related issues that impact the perception of eyelid aging, such as the effect of the eyebrows and the skin itself. A vision exam and sometimes a test of tear function will be done. He will discuss the relevance of all of these issues as they relate to your overall appearance. If he thinks it will add to your understanding of your situation, he might suggest we carry out computer imaging to demonstrate the impact that eyelid surgery might have on improving your appearance, and perhaps show you how this relates to your brow position. It is important that you understand not only the positive effect of eyelid surgery, but also the limitations of what surgery can do for you.
Dr. Creasman will answer all of your questions to the best of his ability, and you will be given the opportunity to look at examples of his work with other patients. On occasion, the doctor may feel that there are indications for you to seek consultation with a board-certified Ophthalmologist; he will make this referral if necessary.
Risks of Blepharoplasty
When eyelid surgery is performed by an experienced plastic surgeon such as Dr. Creasman, complications are infrequent and usually minor. Nevertheless, complications can occur including bleeding, infection, reactions to the anesthetic medications, temporary problems with excessive tearing, prominence or firmness of the scars, asymmetry in healing or scarring, and milia or whiteheads where the sutures emanate from the skin. After the procedure, some patients may have temporary difficulty closing their eyes completely while they sleep. Another rare condition is ectropion, or a pulling down of the lower lids. Further surgery may be required to correct some of these complications.
Before Your Procedure
It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which may interfere with the safety of their surgery. Specifically, any infections which arise prior to operation, however seemingly trivial, should be reported to our office.
Homeopathic preparations such as Arnica Montana, may reduce swelling and bruising. A prescription for pain medication is written ahead of time so that you have your pain pills when you return home from the operation. You may also be written a prescription for eye drops, depending on the exact nature of your procedure. Cooling the eyelids after surgery reduces swelling and bruising and is also soothing.
Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs 3 months after your procedure.
You will be asked to sign a surgical consent that enumerates the risks of the procedure in detail. These risks have been described herein and are also discussed at the consultation.
You will be asked to pay your surgical fee at your pre-operative visit. The fee for upper or lower blepharoplasty can be obtained by calling our office. There may an additional cost to you for you prescription medications, depending on your health insurance coverage. The procedure is not typically covered under any insurance plan because of its cosmetic nature.
You will need to arrange for an escort to drive you to and from our office operating suite. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transport in the event you cannot find an escort. It is a good idea to have someone stay with you for at least 24 hours after surgery, for your comfort and safety. You will also need transportation on your first follow up visit at 4-5 days.
Prior to giving you any sedation, Dr. Creasman will carefully mark the skin incisions with a marking pen, following your natural skin creases, so as to minimize visibility of the scars after surgery. After this, an intravenous line is placed and sedative medication is administered gradually, under continuous monitoring of your vital signs. Local anesthetic is injected while you are unconscious, and you will be unaware of any pain during this part of the procedure. You will probably remember very little of the operation, but you will be able to breath for yourself and be able to follow commands. Occasionally, patients have eyelid surgery under a general anesthetic, such as when other procedures (e.g. facelift) are being done on the same day.
The excess skin, muscle, and fat are removed once the area is completely numb. Much of the operation is done with a very fine electrocautery, which controls any bleeding. The skin is then closed with very fine sutures. If you do not require removal of any skin from the lower eyelids, then Dr. Creasman will remove the bulging fat pads through a small incision inside the lower eyelid (transconjunctival blepharoplasty), leaving no visible scar. This is usually the case in patients with younger, more elastic skin, and may be combined with a chemical skin resurfacing procedure.
Occasionally, the lower eyelid is very lax, and removal of any amount of skin could result in a pulling down of the lid. In this circumstance, the doctor may elect to perform what is called a lateral canthopexy. In this procedure, the actual lid structure is tightened up to the bone of the eye socket near the outer corner. This may result in a change in the shape of your eyelid which is temporary, and this additional procedure will lengthen your recovery. There is an additional fee for this procedure as well.
In Asian patients seeking a more open appearing upper eyelid, a special procedure is done to define a crease where one does not exist, or is indistinct. This special surgical procedure can be discussed in greater detail by Dr. Creasman at the time of your consultation. The indication for this procedure is not to create an “Occidental” eyelid out of an “Oriental” one, but rather to enhance an excessively hooded eyelid to create a more open appearance.
Following your procedure, you will be monitored briefly in our recovery room, and will then be discharged into the company of an adult escort. Post-operative instructions will be given to that person and to you in writing.
The Recovery Period
Dr. Creasman will place a lubricating ointment in your eyes, which may blur your vision temporarily. You may have tapes placed on your skin, and we will want you to continuously apply light weight ice cold compresses to your eyes for the first three days. As mentioned, frozen peas placed into an inexpensive “Ziplock” type baggie works very well as a compress. You should avoid anything heavier than one ounce. Dr. Creasman recommends that you avoid using your eyes, and try to get as much rest as possible during the first week after surgery. Stay propped up on a couple of extra pillows in bed, or better yet, sleep in a recliner if you have one; this reduces swelling. Blood pressure needs to be kept under tight control, as this can lead to bleeding complications that can affect your vision. Take the homeopathic pills to reduce swelling and bruising.
It is important to avoid reading, watching television, or using a computer for the first week. Blinking leads to increased swelling. Staring at a monitor is frequently accompanied by drying out of the eyes, which increases irritation and prolongs recovery. Take this opportunity to catch up on your sleep and avoid any interruptions which may cause you stress. To occupy your mind, we suggest listening to podcasts or audiobooks. DO NOT BEND OVER FOR AT LEAST 3 WEEKS.
Sutures are removed on the fourth or fifth day. Swelling and bruising usually lasts for ten to fourteen days, but makeup can be applied as a camouflage after the first week or so. When you go outside, use sunglasses, as you may be very sensitive to light for a while. Avoidance of contact lenses for a week or so is necessary. You should not drive until you have normal vision, and are off any narcotic medications. The eyes may fatigue easily for several weeks after surgery, due to any residual swelling in the tissues; frequent naps are helpful.
You should avoid strenuous activities such as bending, lifting, and sports for about six weeks. Drinking alcohol can lead to fluid retention, and delays recovery. Healing is a gradual process and it usually takes six weeks to three months for you to look completely natural, or no longer “surgical”. This may be more apparent to you than to others, and most people return to work in a week while still maintaining their confidentiality.
Scars may remain slightly pink for six months or so, but can easily be concealed with makeup. Eventually, they fade to a thin, nearly invisible white line. The more alert, youthful look that eyelid surgery gives one is very long lasting. For most people, the results are permanent.