Blepharoplasty (Cosmetic Eyelid Surgery) Topics

What symptoms are caused by droopy eyelid skin?

The combination of hanging loose skin and puffy bags causes eye fatigue, blocks vision, and gives on an older, tired appearance. It’s not surprising that loose skin around the eyelids gives the appearance of age and fatigue. Patients may complain they are looking more and more like their parents. Friends, relatives, and coworkers ask if they are tired or if they’ve had a poor night’s sleep. The discord between how a patient feels and how they look is by far the most common reason that patients have cosmetic eyelid surgery.

The extra hanging skin of the eyelids causes other symptoms such as blocked vision. Loose, saggy eyelids block vision by hanging over the eye and blocking the light rays coming into the eye. Typically, light rays coming into the eye from up above are the ones affected. Light rays coming from the sides of the eye can be blocked as well. When peripheral vision is constricted in this way it makes it harder to see. Patients complain of difficulty reading, problems driving, and trouble with most any task that requires vision.

When loose eyelids are hanging over the eyes a subconscious effort is made to open up vision. This is done by activating the muscle in the forehead and raising the forehead and brow. Opening the eyes in this way works well over the short run. Unfortunately, it also causes deep wrinkling in the forehead and makes the forehead very tired. Patients complain of very tired eyes and even headaches, unaware that their forehead muscles are undergoing the equivalent of a marathon.

A special problem that women have is that of wearing makeup. The space between the eyelashes and the natural fold of the eyelid is where many women place their eye shadow. This area is hidden for many women by the extra hanging skin above it. Some women give up wearing eye shadow altogether. One of the very nice affects of cosmetic eyelid surgery is that this space becomes visible again, allowing a women to wear eye shadow again if she chooses.

Blepharoplasty, or cosmetic eyelid surgery, directly addresses the hanging skin and bulgy bags around the eyes. It gives the eyelids a more youthful appearance, reduces eye fatigue, and can help with vision.

What to Expect during a Blepharoplasty Consultation

A consultation is mainly a time for communication between the patient and surgeon. The patient must be given time to express what is bothersome. For example, a patient may have hanging and excessive upper eyelids, bags under their eyes, and droopy eyebrows. From the patient’s perspective, it may only be the upper eyelids that are bothersome. Dr. Ebroon feels very strongly that a patient should only work to address what is bothersome to them.

After listening to the patient’s concerns it is time to review the medical history. What other medical conditions does the patient have? What surgeries has she had in the past? Does she have any particular eye conditions? Is she allergic to medications? What family history exists? Does the patient smoke? What else is going on medically?

Once these questions are answered, then Dr. Ebroon can perform a comprehensive examination of the eyes, eyelids, and face. This includes taking vision, taking ten separate measurements of the eyelids, assessing for dry eye with two different dry eye tests, looking at the eye with a microscope, assessing the position and strength of the eyelids, checking for droopy eyelids, measuring eyebrow position, looking for normal eye reflexes, testing the nerves around the eyes, and taking eyelid photographs.

Once the physical examination is completed, Dr. Ebroon can give his recommendations. He discusses what surgical technique he would advise, if any. He also discusses any special circumstances of the surgery given a patient’s unique medical history and physical examination. For example, a patient with dry eyes might be told that their surgery needs to be more conservative so as not to exacerbate the dryness.

Finally, Dr. Ebroon tries to answer any remaining questions. He tries to anticipate common questions that are asked during the consultation. Nevertheless, patients always have unique concerns that are best addressed at this point after a thorough history and physical examination. Dr. Ebroon recognizes that patients feel much more comfortable when they have been given enough time to ask questions.

Patients meet Dianne, Dr. Ebroon’s surgical coordinator, after the consultation is completed. Dianne is happy to review “before and after” pictures of other patients who have had surgery. (These pictures are all from patients who have given our office permission to show their pictures to others.) It can be quite helpful to see examples of others who have benefited from blepharoplasty.

Dianne can also go over possible surgical dates. Dr. Ebroon performs most of his surgery on Fridays so that patients can incorporate the weekend into the healing process. Dr. Ebroon’s surgical schedule is often booked for a at least a few weeks. Sometimes a cancellation will open up a sooner date.

What are the potential complications of Cosmetic Eyelid Surgery?

Although cosmetic eyelid surgery is a relatively safe procedure, it is important to review the potential risks. The most dangerous complication from surgery is excessive bleeding after the surgery. The nerve that is responsible for eyesight could be potentially squeezed by excess blood and cause permanent loss of vision. By stopping any blood thinning medications two weeks prior to surgery the chances of such a problem are greatly diminished. Other potential risks of surgery include double vision, dry eyes, infection, a retracted or pulled down eyelid, asymmetry, undercorrection, overcorrection, and the need for more surgery. A brow lift has its own unique set of complications. These include tenderness along the hairline and weakness of the facial nerve. Fortunately, with good surgical technique such problems are rare.

One effect of cosmetic eyelid surgery that is quite common is the formation of milia during the healing process. These are small cysts that can form along the incision line in the weeks after surgery. These cysts are hard to see with the naked eye but can be seen with a magnifying mirror. They are treated at first with simple observation since they usually resolve on there own and they are so difficult for anyone to see. If they don’t go away spontaneously after a few months, your physician can remove them in the office very easily.

Gathering Information on Cosmetic Eyelid Surgery

Once the desire is sparked to enhance the appearance of the eyelids, the information gathering stage begins. The internet is a good place to start since good general information can be found about blepharoplasty or cosmetic eyelid surgery on many websites, hopefully including this one. Websites are particularly useful for learning about the considerations for surgery, the risks and benefits of surgery, the recovery period after surgery, and the credentials of various surgeons.

Once the general information is gathered it’s time to find out how one’s unique personal characteristics fit into the picture. In other words, it’s time to set up a consultation so that the eyelid plastic surgeon can evaluate one’s specific medical history, anatomy, and expectations. In collaboration with the surgeon, it can be determined if there is a high chance for satisfying expectations.

A logical choice for considering surgery around the eyes is an ophthalmic plastic surgeon. An ophthalmic plastic surgeon (or cosmetic eyelid surgeon) is a surgeon who specializes in surgery of the eyelids. These are surgeons who first undergo training as an eye surgeon and then train specifically as plastic surgeons of the eyelids.

How long will the healing process take?

For cosmetic eyelid surgery the simple answer is about two weeks. The reality is that there are so many factors that go into the healing process that in an individual’s case the healing time can vary. What affects healing time? Some factors that affect healing are which procedures are performed, how easily the patient bruises, how well the eyelids are taken care of during the postoperative period, and how good of a healer the patient is.

Upper eyelid blepharoplasty causes bruising and swelling that starts soon after the surgery. The bruising and swelling will worsen the day after the surgery. Most patients will start improving on the third day after surgery and many patients feel comfortable driving on this day. Simple tasks around the house can be done as long as there is no heavy lifting.

Stitches will be removed by Dr. Ebroon between the fifth and seventh day after surgery. Patients who can work while still being bruised and swollen often choose to work after their stitches come out. There is no exact time when the healing stops. Rather it is a process that involves many stages. Most patients look very good after two weeks. Nevertheless, there is often a slight amount of swelling that can slowly resolve for even twelve months after surgery. Also, the hidden incision in the eyelid slowly loses its red color and becomes thinner. This process can take months to heal as well, but since the incision is hidden it is not an issue. Of course, if more surgery is performed then the healing process takes longer. A brow lift or surgery to remove the under eye bags will increase the healing time somewhat.