any of us consider our eyes our best feature, so when our eyes begin to show
signs of aging, it can acutely alter our self perception or lower our self
esteem. As we get older, our eyelids stretch and the muscles supporting our
eyes begin to weaken. Consequently, excess fat can gather both above and below
the eyelids, creating a sagging effect in the eyebrows, droopiness in the upper
lids and chronic bags under the eyes. In addition to making us look older, if
the skin around the eyes sags severely, then our vision may be impaired.
Blepharoplasty Defined
A solution to this problem, which may be both cosmetic and functional, is eyelid
surgery or blepharoplasty, which improves the appearance of the upper eyelids,
lower eyelids or both, and rejuvenates the appearance of the area surrounding
the eyes, making the patient look more rested and alert. Excess skin, muscle
and fat are removed, usually on an outpatient basis. When an advanced amount of
upper eyelid skin is present, the skin may hang over the eyelashes and cause a
loss of peripheral vision. This may cause problems with activities such as
driving or reading. In this case, the eyelid surgery would be considered
functional. Patients with a less severe amount of excess skin may have a
similar procedure performed for cosmetic reasons. Lower eyelid blepharoplasty
is almost always done for cosmetic reasons
—to remove bags under the eyes and reduce the wrinkling of skin.
Is This Procedure Right for Me?
Blepharoplasty is usually performed on adults with healthy facial tissue and
muscles and realistic goals for improvement. A good candidate is a healthy
individual who does not have a life threatening illness or medical condition
that may impair normal healing. Non-smokers are the best candidates for any
plastic surgery, due to the fact that smoking can inhibit the healing process.
More than likely, a qualified surgeon will not perform the surgery if you have
any serious eye conditions.
If you are considering eyelid surgery, make sure to tell your doctor if you have any eye disease such as glaucoma, dry eye or a
detached retina. Even thyroid disorders such as Graves
’ disease and under- or over-active thyroid can prevent you from being a
candidate. Additionally, cardiovascular disease, high blood pressure and other
circulatory disorders or diabetes should be reported to your surgeon prior to
scheduling surgery.
The Risks
As with any surgery, risks and complications are present, such as infection or
reaction to anesthesia. The decision to have this surgery is extremely personal
and each patient must decide if the benefits outweigh the risks associated with
the procedure. According to the Mayo Clinic, other possible risks specific to
blepharoplasty include:
•Temporary numbness of the eyelid skin
•Dry, irritated eyes
•Impaired eyelid function
•Scarring
•A very small risk of blindness due to bleeding behind the eye
Another complication that may result after surgery and that can greatly affect
your appearance is lid lag or ectropion, which occurs when the lower eyelid
pulls away from the eyeball and seems to droop downward. This condition is
typically temporary, but, if not, more surgery may be required.
Definitely talk to your doctor about how these risks apply to you. Understanding
blepharoplasty and weighing your doctor
’s responses to your concerns will enable you to make the best decision about
moving forward.
The Consultation
Any qualified surgeon will want to meet with you to discuss your medical history
and give you a physical examination. This exam will include a vision test and a
test to measure tear production. Additionally, you can expect your eyes to be
photographed from different angles to assist the surgeon in planning your
surgery and in assessing the immediate and long-term effects of the surgery.
You should also be prepared, as with any surgery, to ask questions of your
surgeon. The following questions may be helpful to use as a checklist:
•Are you certified by the American Board of Plastic Surgery?
•Are you a member of the American Society of Plastic Surgeons?
•Were you specifically trained in the field of plastic surgery?
•How many years of plastic surgery training have you had?
•Have you performed blepharoplasty previously? How many procedures have you done?
•Do you have hospital privileges to perform this procedure? If so, at which
hospitals?
•Is the office-based surgical facility accredited by a nationally- or
state-recognized accrediting agency, or is it state-licensed or
Medicare-certified?
•Am I a good candidate for this procedure?
•What will be expected of me to get the best results?
•Where and how will you perform my procedure?
•What surgical technique is recommended for me?
•How long of a recovery period can I expect, and what kind of help will I need
during my recovery?
•What are the risks and complications associated with my procedure?
•How are complications handled?
•How can I expect my eyes to look over time?
•What are my options if I am dissatisfied with the cosmetic outcome of my eyelid
surgery?
•Do you have before-and-after photos I can look at for this procedure and what
results are reasonable for me?
The Cost
Since blepharoplasty is usually an elective surgery, be prepared to pay a steep
fee. Your surgeon
’s level of experience may factor into the cost, along with the geographic
location of the office and hospital where your surgery will be performed. In
most surgeon
’s offices, patient financing plans are available, so be sure to ask.
Your cost may include the following:
•Surgeon’s fee
•Hospital or surgical facility costs
•Anesthesia fees
•Prescriptions for medication
•Medical tests
Most health insurance plans do not cover cosmetic surgery or any complications
resulting from it; however, when blepharoplasty is performed to correct or
improve vision, it may be covered by insurance, so carefully review your
policy.
The Surgery
Eyelid surgery is usually an outpatient procedure performed under local
anesthesia. A numbing medication is injected into your lids and an IV is
administered to relax you. You will most likely be very groggy, but not fully
asleep.
Expect the surgery to last between one and three hours, depending on the amount
of tissue removed and the location of the tissue. Afterward, you may spend time
in a recovery room where you
’ll be monitored for a while for complications, then allowed to go home to fully
recuperate.
If you are having both lids operated on, your upper lid surgery will be
performed first. The surgeon will make an incision along the natural fold of
the upper eyelid, and the excess skin is removed along with some muscle and fat
beneath the skin. The incision is closed with tiny stitches that leave an
almost invisible scar.
The lower lid is done last. The incision is made just below the lash line in the
eye
’s natural crease or just inside the lower lid. Again, the surgeon will remove
excess fat, sagging skin and muscle. Stitches will be placed in the natural
crease or just inside the lid, depending on where the incision is made.
The Results
After blepharoplasty, expect your vision to be a bit blurred due to the ointment
used to lubricate and protect the eyes and also due to the stitches and
swelling. You may have some excessive tearing, sensitivity to light and even
double vision for a few days after surgery. Expect puffiness and numbness, as
well as swelling and bruising reminiscent of
“black eyes,” for at least a week or two—maybe more. You should also be prepared to see visible, red incisions
immediately following your procedure.
For at least a week afterward, don’t lift anything over 20 pounds and don’t bend forward from your waist without also bending your knees. Don’t swim or do any strenuous activities, such as working out at the gym or
jogging. Avoid moving your neck in extreme ways and do your best to sleep with
your head higher than your chest.
Remember, scars take time to fade. In this case, it may be three to six months
before you don
’t see visible scarring. Protect your delicate eye skin from the sun initially
and forever to maintain your beautiful long-lasting results.
