Blackledge Face Center - Procedure: Blepharoplasty

Blepharoplasty Procedure (before & after). To see more results photos, click here.

The eyes are considered the focal point and most expressive area of the face. Because of the repetitive movements of the upper and lower eyelids, they are also frequently the first to show the signs of aging. To address these changes, eyelid surgery, or blepharoplasty, is considered

Depending on the problem to be addressed, eyelid surgery may be performed on only the upper or lower eyelids, or it may be performed on both at the same time. The common misconception is that it is too much surgery to be done at one time. In the consultation, we examine your eyelids, show you the conditions that already exist and discuss with you which procedures would best address the problems.


Upper Eyelid Surgery

Upper eyelid surgery addresses both aspects of the eyelid that cause you to look tired: excess skin that hangs over the eye and the puffiness in the corner and middle of the upper eyelid. With time, the upper eyelids develop wrinkles, excess skin and puffiness that can cause a change in expression creating a tired and aged look. In fact, the upper eyelid excess skin can sometimes be so redundant that it hangs over the eyelashes and blocks part of the patient’s vision. This is a condition called hooding.   There is no magical age when this develops, but we do know that it is frequently an inherited condition. Patients complain that their mother or father developed heavy upper eyelids at a younger age. It may also be linked to excessive sun exposure and fluctuations in weight gain. Regardless of the cause, it may be corrected with upper eyelid surgery and give you a more youthful look.

In upper eyelid surgery, the excess skin is trimmed and the fat bulges are sculpted to enhance the appearance of the eyelid. The incision is placed in the natural crease of the upper eyelid. The incision is typically extended out into the laugh lines at the corners of the eye. Because of the placement of the incision, when the scar matures, it appears to be the preexisting natural upper eyelid crease and is easy to camouflage. A single suture is tunneled under the skin across the incision site and left in place for five to seven days before being removed. By placing the suture under the skin, the incision and resulting scar has a better final result. Bruising with upper eyelid surgery is variable but typically minimal and the majority of the swelling is unnoticeable within a week.


Lower Eyelid Surgery

The lower eyelids usually develop pouches initially and then wrinkles and loose skin. Frequently, we may see these pouches in patients as young as thirty years of age. As with the upper eyelids, the lower eyelid aging pattern can be a hereditary condition. The pouch that develops is a pocket of fat that at one time is located behind a membrane close to the eye socket. With time, this fat pad actually herniates through the membrane like any other hernia in the body. The fat pad weighs down on the skin and causes loose skin to accumulate creating a “tired” appearance. This is the process that creates the “bags” under the eyes that commonly prompts patients in for a consultation. Lower eyelid surgery removes the lower lid excess skin, reduces the wrinkles and takes care of the bagginess under the eyes. There are two different techniques to address the lower eyelids.


Traditional Lower Eyelid Surgery

The traditional approach to lower eyelid surgery involves removing excess skin and fat by making an incision immediately below the lower eyelashes. The redundant skin is excised, the fat is sculpted and the incision is closed with a single suture tunneling the entire length of the incision underneath the skin. Occasionally additional absorbable stitches will be placed on the surface of the skin for additional support. This technique is used when patients have fat bulges and loose skin.


No-Scar Lower Eyelid Surgery (Transconjunctival)

A second technique, called transconjunctival blepharoplasty, is for patients who only have fat bulges without loose skin. This alternative allows for the fat to be removed by entering the fat from inside the inner lining of the lower eyelid. The advantage is that no incisions are made under the eyelid. In some occasions, patients may not have enough loose skin under the eyelid to warrant making an incision on the outside of the eyelid. Instead of loose skin, the skin is thin with fine lines. Makeup does not cover this condition and actually accentuates the fine wrinkles. For this condition, a resurfacing procedure is the best treatment. Resurfacing removes the old skin allowing for a newer, fresher skin that has no memory of the fine lines. This can be done at the same time as the transconjunctival blepharoplasty.   With lower eyelid surgery, bruising and swelling are variable and usually depend upon the amount of skin and fat to be removed. When sutures are placed under the eyelid, these are removed in five days and makeup may be applied at this point.

There is some confusion over which areas around the eyelid that blepharoplasty rejuvenates and which areas blepharoplasty does not address. Blepharoplasty will get rid of the sags and pouches as well as the excess skin in the upper and lower eyelids. It will not rid one of the wrinkles around the lateral eye area. Specifically, the “crow’s feet” area is not fully addressed with blepharoplasty. These fine lines are improved with other alternatives. The common temporary solution is Botox to the crow’s feet area. A permanent solution is some type of resurfacing procedure, which may be either laser or chemical peel. Often, we will discuss resurfacing with you after eyelid surgery or in conjunction with eyelid surgery for some of the finer lines around the eyes that are not addressed with eyelid surgery.   Another site that is not addressed with blepharoplasty is the eyebrow. If the brows are falling down and causing heavy eyelids, then eyebrow surgery may be the best way to rejuvenate the eye area. All of these options are discussed in the consultation.

We recommend that you get an eye exam prior to your surgery. We will send with you the tests that we need from your eye doctor and will review the results prior to surgery.   We can also help you get an appointment if necessary.


Before Surgery

We will schedule an appointment for you approximately 10 days prior to surgery. At your preoperative appointment, our patient coordinator and nurse will review all the instructions for you both prior to surgery and after surgery. You will receive prescriptions for your necessary medicines at this time, and we will review any of your current medicines that you are taking. This is also an excellent opportunity to ask our physicians any questions you may have thought about since the consultation. At the conclusion of your preoperative visit, we want you to feel totally comfortable with your upcoming experience.   Remember, we are here to answer your questions and make the preop and recovery process as easy as possible for you. For many of our long-distance patients, the preoperative appointment may be done over the telephone, via e-mail or even on the morning before surgery if possible.


The Morning of…

Upon your arrival, you will be greeted by one of our nurses, and allowed to change into a more comfortable gown. Wear something that is comfortable and slides easily over your head or zips/buttons up the front. You will then be seen by your physician and will discuss any “last minute” questions. We will also draw on you while you are awake and sitting up – as everything tends to change once you lie down. Once you feel comfortable and all questions are answered, we will give you a cup of pills that should start to drift you off into a relaxed state.


Anesthesia

We encourage you to review the section on anesthesia. The type of anesthesia that is used is determined during the initial consultation. It is at this time that some patients will express a preference of anesthesia, and we will make certain recommendations based on these preferences. Most patients have eyelid surgery performed under what is called “twilight” sleep. However, some patients opt for general anesthesia. All factors are considered including your general health, past anesthesia experiences, and patient preference.


The Recovery Period

Even though the recovery period technically starts immediately after surgery, there are several things that you can do before your surgery day to make the recovery period smoother. During your consultation, we will talk to you about the importance of being physically and mentally prepared for surgery to ensure that we get the best results possible.   Now back to the recovery period. Immediately after surgery, ice packs are placed on your eyes to minimize bruising and swelling.   These are worn as often as possible for the first twenty-four hours.   Most patients go home the day of surgery if eyelid surgery is the only procedure performed. You will be shown how to keep the incisions on your eyelids clean with peroxide swabs and then moist with ointments. All of these measurers allow for a more pleasing scar.   The first day after surgery is strictly a “bed rest” day. Most patients feel better than expected, so the temptation is to “over do” it on this first day. However, patients have less bruising and swelling if they rest with their head elevated on the first day. Swelling is typically mild to moderate reaching its maximum on the third postoperative day, and then it starts to decline. Typically with camouflage makeup and sunglasses, there is little “down-time” involved and you may resume normal activities after a few days. Pain is rarely significant after eyelid surgery. However, it is not uncommon to feel fatigued for a couple of days after surgery.

The scars following eyelid surgery only get better with time. Because the eyelid skin is thicker at the outside corners of the eyelids, these scars tend to heal and mature slower than the scars directly above and below the eyelashes. These scars will continue to mature to the point that they are easily camouflaged and blend in with the adjacent skin. Occasionally, we have to inject cortisone in these scars to improve their appearance.


Post-op Eyelid Surgery Instructions

Each day during your recovery period, you will probably have a new and different question.

You will be given specific instructions regarding your postoperative care of the eyelid areas. These instructions are meant to help make your recovery period easier and also to ensure that the results of your surgery are as pleasing as possible.

Bruising

Bruising is expected after any kind of surgery. The amount that you bruise is extremely individualized – some people will bruise more than others. However, with every patient, we can expect a reduction in the amount that you bruise by taking Bromelain during the preoperative and postoperative period. We encourage you to drink at least 8 glasses of water each day during your recovery period to flush the bruising out of your system. Our experience with eyelift surgery is that the combination of Bromelain and water intake will reduce the amount of bruising that you normally would have had.

During the recovery period, you will notice that your bruising changes colors. All bruises initially appear red and change to a purplish hue. By day five, the majority of your bruises will have changed to a green and then yellow color. Once you have reached the yellow stage, you are almost “bruise free.”


Swelling

Just like bruising, expect swelling. The day after surgery, swelling will actually increase over the day. Typically, swelling begins to decrease on the third day after surgery. We often get the question, “what can I do to reduce swelling?” You will be given ice compresses to place over your eyes for the first two to three days to reduce swelling.


Sleeping

It is best to sleep in an upright position with your head at least above the level of your heart for the first week after surgery. This helps to reduced swelling and also bruising.   The best beds are usually either a recliner or an incline pillow. Both of these keep the head and shoulders in a natural position. If you try to sleep with your head elevated with pillows, you wind up sleeping in an unnatural position and develop muscle spasms in your shoulders.


Exercise
You may begin light walking on the fourth day after surgery. In fact, we usually encourage this because it helps to improve your circulation, which in turn gets rid of bruising and swelling quicker. You can gradually increase the intensity of your walking over the next few days as your body tolerates it. Your body will tell you how much exercise is enough. We usually recommend that you refrain from any competitive sports such as tennis or golf for at least two weeks.


Pain

A popular question is “how much pain will I have after an eyelift?” Most patients will tell you that they had little to no pain after surgery. The common response is that everything felt “tight.” This is usually due to swelling and the tight sensation begins to subside after about 2 – 3 weeks. Patients are given prescriptions prior to surgery for pain medicine and are encouraged to take theme as directed for discomfort. However, most patients switch to Tylenol soon after surgery.


When Will I Look Presentable?

Obviously, this is a very individualized answer. The average patient is able to go back in public without being obviously swollen or bruised by about 5 – 7 days.