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General Information: Eyelid Surgery

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Eyelid surgery (technically called 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, eliminate dark circles under your eyes, or lift sagging eyebrows. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a 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 can't answer all of your questions, since a lot depends on the individual patient and the surgeon. Please ask Dr. Concannon about anything you don't understand.

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 and discuss them with Dr Concannon.

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 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 infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon'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; your surgeon can remove them easily with a very fine needle.

Planning your surgery

The initial consultation with Dr. Concannon is very important. He 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 him if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

You and Dr. Concannon should carefully discuss your goals and expectations for this surgery. 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. Concannon will explain the techniques and anesthesia he will use, the type of facility where the surgery will be performed, and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery).

Don't hesitate to ask any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for your surgery

Dr. Concannon 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.

Where Your Surgery Will Be Performed

The surgery is usually performed in our fully accredited office surgical suite, using IV sedation and local anesthesia.

Types of anesthesia

Eyelid surgery is usually performed under local anesthesia - which numbs the area around your eyes - along with oral or intravenous sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)

The procedure

Blepharoplasty usually takes one to two hours, depending on the extent of the surgery. If you're having all four eyelids done, Dr. Concannon will probably work on the upper lids first, then the lower ones.

In a typical procedure, Dr. Concannon 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, he separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

It is quite common for the lower lids to need to restore some of your youthful volume-- this volume loss is typically manifest as a "tear trough deformity". This is usually addressed by adding some fat graft (taken from your hip) to replace this lost volume. Severe hollowing of the upper eyelid can also be helped by the addition of fat graft--Dr. Concannon will be able to tell you if you are a candidate for these techniques.

 

Aftercare

After surgery, Dr. Concannon will probably 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 your surgeon. If you feel any severe pain, call Dr. Concannon 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 usually resolves within 2 weeks). You'll be shown how to clean your eyes, which may be gummy for a week or so. You may want to use 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. Concannon will follow your progress very closely for the first week or two. The stitches will be removed three days after surgery. Once they're out, 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 after two or three days. 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 10 days. By then, depending on your rate of healing and Dr. Concannon's instructions, you'll probably be able to wear makeup to hide the bruising that remains. You 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. Concannon will tell 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, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.

Your new look

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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.

On the other hand, the positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.

Questions and Answers about Blepharoplasty

Q. What Is Blepharoplasty?

A. Blepharoplasty refers to eyelid surgery and is designed to remove the excess fat, along with skin and muscle, from the upper and lower eyelids. It is the second most common aesthetic procedure performed by plastic surgeons. Newer techniques now add fat to these areas to restore a more youthful look. Not every person needs the same operation, Dr. Concannon will be able to advise you after evaluating your situation and your goals.

Q. Are there scars from the blepharoplasty procedure?

A. Scars are a result of any surgical procedure. The incisions made to accomplish the goals of the procedure are barely visible after several months as they are placed within the normal creases and folds of the upper and lower eyelids. In patients who only need removal or addition of fat at the eyelids, the incisions or injection points are quite small, and will therefore result in an invisible scar.

Q. Will the fine wrinkles around my eyes go away after blepharoplasty? What about my sagging eyebrows and dark circles rnder my eyes?

A. The blepharoplasty procedure will not eradicate the wrinkles around the eyes (crow's feet) nor will it elevate droopy eyebrow. There are other procedures designed for these purposes. Dark circles under the eyes may improve a bit if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.

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