Eyelid Surgery (Blepharoplasty)

It is also known as eye lift, eyelid lift, or blepharoplasty.

When the surgery should be considered

Extra and sagging skin that covers normal folds of the upper eyelid
Loose sagging skin from the upper eyelid over the eyelashes
Swellingappearance of upper and lower eyelids that makes your eyes look exhausted and old
Having deep grooves under the eyes

Considerations

Positive aspects

By removing the swelling and bags under the lower eyelids and the encapsulated skin over the upper eyelids, you will make your appearance younger and healthier.
You won’t suffer from visual problems associated with sagging eyelids any more.
Any scar resulted from the eye lift is concealed within your natural folds and they would be almost undetectable.

Negative aspects

Observing the outcomes after the surgery is time taking.
You will most probably have bruises and swellings and you may experience dry and itchy eyes.
If you have droopy eyebrows or a wrinkled forehead, you may need a forehead lift.

These are three positive and negative aspects to decide on an eyelid surgery. If you would like to focus on your unique personal issues, do counsel with your plastic surgeon.

Are you a right candidate for eyelid surgery?

These are some of the common reasons for having an eyelid surgery:

Extra skin than covers the natural folds of the upper eyelids
Loose upper eyelid skin that impairs your sight
Swollen upper eyelids that make your eyes look tired and sad
Extra skin and tiny wrinkles in the form of “crepe paper” over the lower eyelids
Having turbid bags and circles under your eyes
Very small or unsmooth area over the eyes to wear make-up

If you are generally in good health and hold a positive attitude and realistic expectations, you are most probably a suitable candidate for this surgery.

Detailed information about the surgery procedure

How is the eyelid surgery performed?

Eyelid surgery (blepharoplasty) can be performed on upper eyelids, lower eyelids, or both. Based on evaluating some factors such as the structure of face muscles, skeletal structure, and eyebrows’ asymmetry before the operation, the surgeon decides on how much skin, muscle and/or fat to remove.

Your surgeon would determine the location of extra tissues in your upper and lower eyelids by exact marking.
Your surgeon would make a hidden incision in natural folds of your upper eyelid.
The incision will be concealed right under the eye lashes of the lower eyelid. This incision can be made alternatively when the extra fat inside the lower eyelid is removed (transconjunctival). Sometimes laser can be used along with this method to tighten the lower eyelid skin.
Making these incisions and applying surgical instruments such as surgical scissors, surgical knife, radio frequency incision instruments, and sometimes by making laser incisions, your surgeon will remove the tissue.
Sometimes fat might be re-distributed in lower eyelids to eliminate the swelling. Your surgeon might use other adjustments to modify specific problems like loose muscles.
Then he will make use of surgical sutures or topical tissue adhesives for leveling and re-configuration of the areas around the eyebrows and eyelids. Sutures are not visible and are normally absorbable. In most cases there is no obvious scar remained.
In patients with dry eyes, in order to avoid eyes’ exposure with air, that can deteriorate symptoms, less tissue is removed.
In addition, the surgeon may improve the operation by restoring the surface and leveling the wrinkles of the eyelids and eye brews by applying laser.

What are my options?

The board certified plastic surgeon will choose your suitable surgery type based on your physical characteristics and cosmetic consideration.

Upper eyelids

The surgeon will make the incision in the natural gap of the eyelid and remove the extra skin, muscle, and fat through it. Laser may be used to remove this extra tissue in order to reduce the swelling and bruising around the eyes.

Lower eyelids

There are several options for lower eyelid surgery:

The traditional method puts the incision right under the eyelashes, modifies or displaces extra skin and fat, and tightens the lower eyelid muscle.
In transconjunctivalmethod, which is useful in improving the lower lids’ bags and swelling, will make the incision inside the eyelid. The surgeon can remove the extra fat through transconjunctival method which is not feasible for extra skin.
Blepharoplasty “skin pinch” can remove only a small part of the skin. This surgery is only influential if it is strongly supported by the lower eyelid and there must be just a little extra skin. Surface reconstruction by laser can lead to extra skin tightening and wrinkles’ removal in some patients.
Making use of hyaluronic acid (HA) fillers is a non-surgical substitute for lower eyelids. Restylane and Juvederm and other soft tissue fillers can be injected to tear trough (the crescent area of the sub-eye) to rejuvenate the appearance of the sub-eye. The results are different and last almost for 6 months.

How would my incisions and wounds look like after the eyelid surgery?

Upper eyelid surgery: the surgeon would mark lines of your eyelids’ natural wrinkles and would keep your wounds hidden along the natural folds as much as possible. Delicate sutures are used to stich the incisions, therefore wounds’ visibility would be minimized.

Lower lid surgery:in traditional blepharoplasty the surgeon would make the incision in an invisible area of the eyelashes line and smile folds of the lower eyelid. In transconjunctival method, the surgeon would modify the swelling resulted from extra fat by making an incision inside the lower lid. This method does not need exterior incision, but cannot be used for extra skin removal.

Eyelid surgery modifies the wrinkled skin over the upper eyelid and the swollen bags under the eyes.
Incisions aremade along the natural separating lines of the upper and lower eyelids.
The incisions would be stitched and they would disappear in natural gaps of the eyelid.
After the surgery you would look brighter, calmer, and more conscious.

Electing the surgeon

Choose the reliable surgeon

It is important to choose your surgeon based on the followings:

Education, training, and license
Level of eyelid surgery experience
Friendliness

Your initial appointment

During your initial counseling you can discuss your cosmetic objectives. Surgeon will evaluate you as a candidate for the eyelid surgery and determine what blepharoplasty can do for you. After realizing your objectives, the surgeon may suggest other methods.

You have to be prepared to discuss about your medical history. The information includes:

Previous surgeries
Previous and present medical situation
Allergies and current medications

It is important to be honest throughout the counselling session. Moreover take your old photos with you, they can act as a suitable reference to discuss your surgery objectives. It is a good idea to be prepared to answer these questions:

Have you ever undergone non-invasive cosmetic surgeries?
What do you expect from your surgery? What is your main incentive to do the eyelid surgery?

In addition, the surgeon may:

Ask you to look in the mirror and tell him what exactly you want to improve.
Take a photo of you for medical registration, size your face, and use computerized imaging to display the expected advances.
Evaluate your health, such as your previous health situation or risk factors.
Evaluate your skin elasticity.
Discuss your options and recommend the treatment course.

Your therapeutic plan

Based on your objectives and physical features and the surgeon’s experience and training, he will share some recommendations and information with you:

A method for your surgery, including surgery type or a combination of methods
Expected results
Your financial investment in this surgery
Risks and complications
Anesthesia options and location of the surgery
The necessary items to get prepared for the surgery
The expected experiences after the surgery
The physician will share photos before and after the surgery of similar surgeries with you and will answer your questions.

Questions that you have to ask your surgeon

It is important to have an active role in your surgery, therefore use this list of questions as the starting point for your initial counselling.

Am I a suitable candidate for blepharoplasty?
Are my respective results logical and realistic?
Do you have before and after photos to look at?
Will my wounds be visible?
What kind of anesthesia is recommended for me?
What do you expect me in order to obtain the best results?
What type of recovery course can I expect? When can I resume my activities?
What are risks and complications associated with my surgery?
How are these complications resolved?
If the results of my eyelid surgery were not matched with the compromised objectives, what are my options?

Getting prepared for the surgery

How can I get ready for my eyelid surgery?

The surgeon will provide you with pre-surgery instructions, answer your probable questions, prepare your exact medical history, and physically examine you to determine your bodily preparation.

You can expect being asked complete questions about dry eyes, glaucoma, eye allergies, and other eye problems. If you have circulation difficulties, thyroid malfunction, diabetes, or other serious medical situations do inform your physician. You will be asked about your currently used medications, including over the counter (OTC) drugs. Make sure to inform your physician of any consumed herbal supplements, because some of them can cause bleeding.
The surgeon will physically examine you, this can include tear production test. Some specialized tolls may be used to measure parts of your eyelids.
Expect your eyes to be imaged from various angles. These images help the surgeon plan and evaluate instant and long-term effects.
The surgeon will discuss the expectationswith you. Honest discussion will help determine the satisfying result. Be prepared to talk about your motivation to undergo blepharoplasty and your expected outcomes. The surgeon will let you know if these expectations are along with usual results or not.

Before the surgery, the surgeon may ask you to:

Stop smoking at least six weeks prior to the surgery to facilitate recovery.
Avoid taking aspirin, nonsteroidal anti-inflammatory medicines (NASAID: Advil, Mortin, Aleve), vitamin diets/homeopathy which can increase hemorrhage.
Keep hydrated. Regardless of type of surgery, hydration is prominent. Hydration is vital before and after the surgery for secure recovery and ideal results.
Eyelid surgery is normally an outpatient surgery. Have someone take you home after the surgery and stay at least the first night after the surgery with you.

What can I expect on the day of my eyelid surgery?

Your surgery can be done in a well-known hospital, a free mobile facility, or an official surgery complex. Majority of eyelid surgeries take 1-2 hours.

Medicines are prescribed for your comfort during the surgery.
Local anesthesia along with tranquilizers is generally used in eyelid surgery. However, general anesthesia can be applied.
For your safety during the surgery, several monitors are used to check your heart, blood pressure, pulse, and blood circulating oxygen.
The surgeon will follow the plan which he had discussed with you prior to the surgery.
After the surgery you are transferred to the recovery and you will be still under surveillance.
After blepharoplasty a lubricating ointment will be used to protect your eyes and prevent their dryness which may lead to temporary blurred vision.

You can return home to continue your recovery. Someone should take you home and stay with you during the first night.

Care after the eyelid surgery

The surgeon will discuss about the necessary duration to let you return to your normal activities and carrier.

You and your nurse will be provided with meticulous instructions about post-surgical cares which include the followings:

Normal signs
Signs of potential complications

To have the easiest recovery, provide the followings:

Ice cubes, fill ice bags or freezer bags with ice, frozen corns, or peas (based on your surgeon recommendation to apply cold on your eyes)
Small gauze pads
Eye drops or artificial tears (ask your physician to recommend the right type to meet your particular needs)
Clean washcloths and towels
OTC analgesics which are recommended by your physician. However due to the increased risk of hemorrhage avoid taking Advil, Motrin, Naproxen, Aleve, and Aspirin.
Plan to have some days on leave and rest at home. Restrict your activities for some defined time after the surgery to let your eyelids recover.

Immediately after the eyelid surgery:

You may experience excessive tears, sensitivity to light, and diplopia after the surgery.
The incisions are first red-colored and visible, moreover, your eyelids may look swollen and you may feel numb for several days.
The swollen and bruised eye, known as “the black eye”, probably will take a week or more.
The surgeon may ask you to have cold compress or put ice bags on your eyes.
Usually you experience a slight pain. A pain killer such as acetaminophen (Tylenol or other medications) may be prescribed for your slight pain. However, keep in mind to avoid taking aspirin, ibuprofen (Advil or other medicines), naproxen (aleve) and other herbal medicines or supplements which can increase bleeding.
Sutures (if used) would be absorbed after three or four days.
If experiencing any severe or long-term pain, swelling, or redness after the surgery, contact with your surgeon to find out if these symptoms are normal or resulted from a specific problem.

The recovery timeline after the eyelid surgery

It is very important to follow all post-surgery instructions which include information related to dressing, antibiotics consumption (if prescribed), and the level and type of safe activities. The surgeon provides you with detailed instructions about normal signs and symptoms of potential complications you may experience.

The first two weeks

Although you don’t have to rest in bed after the surgery, but you should plan to rest, stay at home, and apply a cold compress on your eyes on the day of the surgery and after that. Recovery timing differs. Here are some useful points:

Carefully observe your surgeon’s care instructions. For the first couple of days after the surgery, the incisions should be treated with ointment to keep them lubricated. Cold compress can be placed on the eyes to reduce the swelling as well. Use eye drops to help keep the eyes from drying out. If your eyes remained dry for over two weeks, let your physician know.
Choose a sleeping position to keep your head above your chest. Use normal pillows or wedge pillows or sleep on a sofa. During the first days keep your head up as long as you can to help decrease the swelling and bruises.
Generally after the upper and lower blepharoplasty, you will experience a feeling of rigidity in your eyelids, you can alleviate the pain by taking acetaminophen. Usually there are considerable bruiseswhich are removed within two weeks.
For 10-14 days avoid straining, lifting heavy items, swimming, and severe sporting activities such as aerobics and jogging. Specifically you should keep away from activities entailing sudden movement of the head or activities that increase the blood pressure in head. This restriction includes (but is not limited to) the following cases: bending which puts your head lower than your heart and lifting heavy items which are heavy enough to strain you. This restriction can be continued for 3-4 weeks.
You may notice that your eyes tire easily for the first several days of the recovery period. Take frequent naps during the day. Avoid activities such as reading, watching TV, wearing contact lenses, and using the computer since they may cause eye dryness.
Dark sunglasses are recommended during the first couple of weeks following the surgery to protect your eyes from the irritation caused by the sun and wind.
The plastic surgeon will remove your sutures 2-7 days after the eyelid surgery.
Around the tenth day of recovery you may feel good enough to continue your normal activities.
In case you experience any of these symptoms immediately refer to your physician: dyspepsia, chest pain, abnormal heart beat, new pain, hemorrhage or visual difficulties.

How long does the results last?

The results of the surgery must be long-term. For most cases, the procedure to remove encapsulation and upper eyelid skin is performed only once. Aging may cause your forehead lower and produce extra skin on the upper eyelid and the solution is lifting the forehead not second-time blepharoplasty. Usually lower blepharoplastyis used to get rid of eye bags and swelling around the eyes and should be done just once.

Keeping in touch with your plastic surgeon

For your immunity and also to achieve the most gorgeous and healthy result it is highly recommended to refer to your plastic surgeon in determined intervals to evaluate the follow-up and this way you can ask any question about the eyelid surgery recovery procedure and its outcomes.

The respective costs

The cost of eyelid surgery differs according to your physician, geographical region and surgery method. See the physicians’ average national fees based on each method[1].

These figures merely reveal the physician/surgeon fees and do not cover the costs related to surgery, anesthesia, medical examination, prescriptions, surgery gowns, or other eyelid surgery-associated costs.

Since eyelid surgery is a type of optional cosmetic surgery, health insurance companies do not cover its costs. Many surgeons provide their patients with financial plans to economically perform this very surgery.

Select your surgeon based on quality and his training and experience not the costs!

Having observed various licenses, trainings, and ASAPS members’ licenses, observe the surgeons’ wide fame to support the highest standards of cosmetic plastic surgery.

Limitations and risks

Fortunately,serious complications of eyelid surgery are quite rare. Thousands of people are annually undergoing successful eyelid surgeries and they are generally satisfied with the results. Blepharoplasty is known as the golden standard of eyelids’ rejuvenation and is normally carried out without any serious problem.

All surgical operations entail some degrees of danger. Some of the probable complications of all surgeries are as follows:

Side reaction to anesthesia
Hematoma or seroma (subcutaneous blood or fluid aggregation)
Infection and hemorrhage
A change of senses
Wounds
Allergic reactions
Any damage to basic structures
Unfavorable results which may necessitate extra surgeries.

You can minimize surgery risks by following recommendations and instructions by board-certified plastic surgery before and after the surgery.