Blepharoplasty (BLEF-uh-ro-plas-tee) is surgery that includes the repair of droopy eyelids by removing excess skin, muscle and fat. As you age, your eyelids stretch; and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, drooping upper lids and bags under your eyes. Besides making you look older, severely sagging skin around your eyes can impair your peripheral (side) vision. Blepharoplasty can reduce or eliminate such impaired vision.
Blepharoplasty is usually done on an outpatient basis. To help decide whether blepharoplasty is right for you, first find out what you can realistically expect; then take time to explore the benefits and risks of blepharoplasty.
Dr. Cherry will take a medical history with particular emphasis on conditions that may impact your candidacy for eyelid surgery. Underlying medical conditions, such as high blood pressure, bleeding disorders, heart disease, diabetes, thyroid disorders, or a history of dryness of your eyes are important issues that can increase the risks of eyelid surgery. We need to know about any prior eyelid surgery, eye muscle surgery or laser vision correction. The medications you take may need to be altered prior to surgery, so be prepared to provide specific dosing information at the time of the consultation. Please inform us if you have any history of allergies to medications. Also let Dr. Cherry know if you wear any corrective lenses.
The doctor will do a thorough eyelid examination and will assess other related issues that impact the perception of eyelid aging, such as the appearance of the eyebrows and the skin itself. Dr. Cherry will answer all of your questions to the best of his ability, and you will be given the opportunity to look at examples of his work with other patients. On occasion, the doctor may feel that consultation with a board-certified ophthalmologist is indicated for you. Dr. Cherry will make this referral if necessary.
Prior to giving you any sedation, Dr. Cherry carefully marks the skin with a marking pen to precisely plan the incisions – following your natural skin creases, so as to minimize visibility of the scars after surgery. After this, an intravenous line is placed; and sedative medication is administered gradually, under continuous monitoring of your vital signs. Local anesthetic is injected while you are unconscious, and you are unaware of any pain during this part of the procedure.
The excess skin, muscle and fat are removed once the area is completely numb. Much of the operation is done with a very fine electrocautery, which controls any bleeding. The skin is then closed with very fine sutures. If you do not require removal of any skin from the lower eyelids, then Dr. Cherry removes the bulging fat pads through a small incision inside the lower eyelid (transconjunctival blepharoplasty). He leaves no visible scar. This is usually the case in patients with younger, more elastic skin, and may be combined with a chemical skin-resurfacing procedure. Occasionally, the lower eyelid is very lax; and removal of any amount of skin could result in a pulling down of the lid. In this circumstance, the doctor may elect to perform what is called a lateral canthopexy. In this procedure, the actual lid structure is tightened up to the bone of the eye socket near the outer corner. This may result in a temporary change in the shape of your eyelid, and this additional procedure will lengthen your recovery.
Following your procedure, you will be monitored briefly in our recovery room and will then be discharged into the company of an adult escort. Postoperative instructions will be given to that person and to you in writing.
Dr. Cherry will place a lubricating ointment in your eyes, which may blur your vision temporarily. You may have tapes placed on your skin, and we will want you to continuously apply lightweight ice-cold compresses to your eyes for the first three days. Kernels of frozen corn placed into an inexpensive ziplock-type baggie work very well as a compress. Avoid anything heavier than one ounce. Dr. Cherry recommends that you avoid using your eyes and try to get as much rest as possible during the first week after surgery. Stay propped up on a couple of extra pillows in bed; or better yet, sleep in a recliner if you have one – this reduces swelling. Blood pressure will need to be kept under tight control, as this can lead to bleeding complications that can affect your vision.
It is important to avoid reading, watching television or using a computer for the first week. Blinking leads to increased swelling. Staring at a monitor is frequently accompanied by drying out of the eyes, which increases irritation and prolongs recovery. Take this opportunity to catch up on your sleep and avoid any interruptions which may cause you stress. To occupy your mind, we suggest listening to Books on Tape. DO NOT BEND OVER FOR AT LEAST THREE WEEKS.
Sutures will be removed on the fourth or fifth day. Swelling and bruising usually last for 10–14 days, but makeup can be applied as camouflage after the first week or so. When you go outside, wear sunglasses; as you may be very sensitive to light for a while. You must avoid contact lenses for a week or so. Do not drive until you have normal vision and are off any narcotic medications. Your eyes may fatigue easily for several weeks after surgery, due to residual swelling in the tissues; frequent naps help.
Avoid strenuous activities such as bending, lifting and engaging in sports for about six weeks. Drinking alcohol can lead to fluid retention and delays recovery. Healing will be a gradual process. It usually takes six weeks to three months for you to look completely natural again, or no longer “surgical.” This may be more apparent to you than to others; and most people return to work in a week, while still keeping their secret.
Scars may remain slightly pink for six months or so, but can easily be concealed with makeup. Eventually, they will fade to a thin, nearly invisible white line. Though those scars will be there, the more alert, youthful look that eyelid surgery gives one is very long lasting. For most people, the results are permanent.
Risks & Side Effects
In practice, the following side effects happen quite rarely.
Your physicians will examine you thoroughly to minimize the risks and avoid Blepharoplasty side effects:
- Swelling and discoloration to an excessive degree, permanent abnormal pigmentation
- Bleeding, hematoma
- Infection and/or abscess
- Dehiscence (separation of the incision)
- Bad scars: wide, thick, painful or contracting
- Pain (early, late, neuroma)
- Numbness, pruritus (itching), tingling, burning or other abnormal nerve sensation