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BLEPHAROPLASTY (EYELIDS)
If you're considering eyelid surgery...
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 your surgeon 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
your surgeon.
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.
Following surgery, some patients may have
difficulty closing their eyes when they sleep;
in rare cases this condition may be permanent.
Another very rare complication is ectropion, a
pulling down of the lower lids. In this case,
further surgery may be required.
PLANNING YOUR SURGERY
The initial consultation with your surgeon is
very important. The surgeon 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 your surgeon
if you have any allergies; if you're taking any
vitamins, medications (prescription or
over-the-counter), or other drugs; and if you
smoke.
In this consultation, your surgeon or a nurse
will test your vision and assess your tear
production. You should also provide any relevant
information from your ophthalmologist or the
record of your most recent eye exam. If you wear
glasses or contact lenses, be sure to bring them
along.
You and your surgeon 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.
Your surgeon will explain the techniques and
anesthesia he or she 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,
unless you can prove that drooping upper lids
interfere with your vision. Check with your
insurer.)
Don't hesitate to ask your doctor any questions
you may have, especially those regarding your
expectations and concerns about the results.
PREPARING FOR YOUR SURGERY
Your surgeon 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
Eyelid surgery may be performed in a surgeon's
office-based facility, an outpatient surgery
center, or a hospital. It's usually done on an
outpatient basis; rarely does it require an
inpatient stay.
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.) Some
surgeons prefer to use general anesthesia; in
that case, you'll sleep through the operation.
THE SURGERY
Blepharoplasty usually takes one to three hours,
depending on the extent of the surgery. If
you're having all four eyelids done, the surgeon
will probably work on the upper lids first, then
the lower ones.
In a typical procedure, the surgeon 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, the surgeon
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.
If you have a pocket of fat beneath your lower
eyelids but don't need to have any skin removed,
your surgeon may perform a transconjunctival
blepharoplasty. In this procedure the incision
is made inside your lower eyelid, leaving no
visible scar. It is usually performed on younger
patients with thicker, more elastic skin.
AFTER YOUR SURGERY
After surgery, the surgeon 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 your surgeon immediately.
Your surgeon will instruct you 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
generally lasts anywhere from two weeks to a
month.) You'll be shown how to clean your eyes,
which may be gummy for a week or so. Many
doctors recommend 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.
Your surgeon will follow your progress very
closely for the first week or two. The stitches
will be removed two days to a week 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 your
doctor'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.
Your surgeon will probably 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
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.
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