Blepharopasty or eyelid lifting is the most common procedure I perform. We see people from their early 20s into their 90s, who complain of excess upper or lower eyelid skin or lower eyelid bags that either block their vision or just look cosmetic unacceptable. This can be related to age or just something that runs your family. When evaluating a patient for eyelid surgery, I assess the amount of skin present, the height of the eyelids, and the position of the brows.
A youthful female face generally has higher, arched eyebrows with smooth, full upper eyelids and a distinct upper eyelid crease. Male eyebrows are slightly lower and flatter. The eyelids are open such that the very top of the cornea or iris are covered by the upper eyelid and the lower eyelid also rests at the bottom of the cornea. When the brows or eyelids are droopy or asymmetric, this can get the face a tired or unhappy appearance. And many patients comment that they are tired of people asking why they are mad.
Your appearance shouldn’t send the wrong signal about how you feel, but droopy eyelids can do just that. To determine your best treatment we’ll perform a careful evaluation in our office, which includes examination of the eyes, looking for any eye disease or dry eye problems. We also make measurements of the eyelids, perform a visual field test, which determines how your eyelids are affecting your vision, and take photos that will be sent your insurance company as part of the preauthorization. Depending on what I see, I may recommend only a blepharoplasty, where eyelid skin and fat are removed or I may recommend raising the eyebrows as well. Very often, the lower eyelids are also droopy and have developed bags.
These are often due to excess skin or fat coming forward in the eye socket. Correcting the appearance of the upper and lower eyelids at the same time will give you the best cosmetic result. At the time of eyelid surgery, you’ll be given medication to relax you and you’ll be made comfortable on an operating table. Before surgery, I’ll mark your eyelids, making careful measurements to ensure I leave enough skin to allow your eyes to close properly. You’ll then be given numbing medicine under the skin. If you would like to have an anaesthesia provider present, they’ll give you medicine to fall asleep briefly during the injection. I generally use electric caudery to remove skin and fat and simultaneously stop any bleeding.
We do occasionally use laser for our incisions if we think it is better for the patient. For lower eyelid surgery, I remove or reposition fat through an incision on the inside of the eyelid, then remove any excess skin from the front of the eyelid. This technique greatly reduces the chance of scarring, causing the eyelids to pull down or out. During surgery, you’ll be awake but comfortable, and may not remember much of what goes on due to the medicine. You’ll be able to tell us you have any discomfort and we’ll give additional numbing medicine. Once the surgery is complete, all the incisions are closed with absorbable sutures and covered in antibiotic ointment. You’ll begin using ice as soon as possible to reduce the swelling.
We recommend you ice for 48 hours after surgery, 20 minutes on and off while you’re awake. Gel packs work well. But frozen peas or corn in sealed bags hold the cold very well and mold easily to your eyes. You’ll apply the ointment to your incisions three to four times a day after surgery, then nightly until you’re completely healed. If at any time after surgery you have some bleeding from your incisions, you can hold direct pressure on them for three to four minutes. This will stop most bleeding. If the bleeding doesn’t stop after 10 to 15 minutes, call our office. This would be unusual and we may ask you to come into the office to be seen. For other concerns after your surgery, just call our office. After hours, there’s an answering service that can reach us any time.
Complications after blepharoplasty are rare. It’s normal to have significant swelling and bruising. And if your swelling becomes worse after three to four days or you develop new pain or discharge from the incisions, let us now. Some people react to the ointment and occasionally we have to recommend other medications. Following our post-op instructions closely will help you to recover faster and have fewer complications. Thanks for choosing Utah Oculopastic Consultants for your surgery. We look forward to helping you feel and look your best.