BLEPHAROPLASTY (EYELID SURGERY)
With time the eyes often show some of the following changes: a puffiness may develop beneath the eyes which actually consists of fatty tissue, there may be excessive skin in both the lower and upper lids, the eyebrows can develop some droop with time, and crinkles can develop at the corners of the eyes, otherwise known as “crow’s feet”. In addition to this, you may have dark circles underneath your eyes. A blepharoplasty can remove extra skin from the upper and lower lids and it can help to remove the fatty tissue or puffiness beneath the lower lids and in the upper lids as well. It will not help dark circles under the eyes and it will have a minimal to no effect on crow’s feet. These problems as well as the crepey skin of the lids are best treated with a laser procedure surgery or Botox. If eyebrow droop is one of your main factors, then this might best be treated by a forehead lift (not discussed here) with or without blepharoplasty. Also, we may choose an injectable (such as Juvaderm or Evolence) as a filler for the under eye hollows instead of surgery or 3-6 months after surgery to give a more attractive contour.
The procedure is usually performed in the office in my accredited out patient ambulatory surgical suite or as an out-patient procedure in the hospital if the procedure is covered by insurance. It involves an incision in the crease of the upper lid where it is well hidden and just below the eyelid margin. These scars are usually almost imperceptible. Through this incision extra skin is removed as well as removing the extra fatty tissue of the upper and lower lids. It should be noted that excision of the lower lid skin always has to be conservative to avoid excess pull on the lower lid skin. The procedure is usually done in the office with intravenous sedation. For the first two days you will be staying at home with cool, moist compresses on your eyes, keeping your head elevated. Some of the sutures will be removed between 3-5 days, and all the sutures will be out within the first week. During the initial healing period you will be swollen, bruised and your vision may be slightly blurred from the ointment you will be placing in your eyes to protect them. After a few weeks the swelling is much improved. You can wear makeup over your incisions at about 7-10 days. You should be able to return to work by about 1-2 weeks, depending on how much you bruise.
The risks of the surgery include bleeding, which may be as mild as a bruise, or in its most severe case if you were to develop significant bleeding behind the eye this could lead to swelling and a change in vision. It would be very obvious if you have this problem because it would be extremely painful and I would see you immediately in the emergency room. The risk of this significant bleeding is less than 1 in 1000, and I have never seen it in my practice so far.
Other risks include infection, which would simply necessitate antibiotics and might delay the healing of your incisions, some pulling down of the lower lid skin which is very unusual but would get better on its own over time in 90% of the cases, and minor asymmetry which usually resolves spontaneously but which could be corrected at a later date usually in the office.
Some patients who have poor lower lid tone or who have a lot of lower lid dissection for complicated lower lids may have an unusual duration of lower lid swelling.
If you have a tendency toward dry-eyes this can be worsened by the surgery because your eyes will be more open and more of the globe exposed to air on a daily basis. We can arrange for you to have “punctal plugs” to create more tear film if this is a bothersome problem for you. Laser (Lasik) eye correction surgery may predispose a patient to dry eyes after a blepharoplasty. A blepharoplasty should not be performed within 6 months of eye surgery. Please notify Dr. Blanchet if you have had eye surgery. If your eyes are not irritated, you can return to wearing contacts in one to two weeks.
Smokers heal poorly in terms of infection and wound breakdown and you are advised not to smoke for at least 14 days before and after the surgery.
Please take Vitamin K (100 micrograms) for 3 days before and 3 days after your procedure to minimize bruising unless you have a tendency to form clots in your legs or are on hormonal replacement. This can be found at most health food stores or South River Compounding Pharmacy.
Prior to having a blepharoplasty it is helpful to be checked out by an ophthalmologist to make sure that your vision is good, to make sure that you do not have dry eyes, and to make sure there are no medical reasons why you should not have a blepharoplasty. Also, if you have enough extra upper lid skin to obstruct your vision and an ophthalmologist documents this with visual fields, the upper blepharoplasty is occasionally covered by insurance.
I hope this detailed information has not been overwhelming. The vast majority of patients have smooth, uncomplicated courses and are quite pleased with their results.
It will be a pleasure to discuss blepharoplasty with you in my office. Please do not hesitate to contact me if I can be of further assistance.
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