Eyelid Surgery (Blepharoplasty)
Reviewed by Yael Halaas, MD
They say our eyes are the mirrors to our soul. If that's true, what are your eyes saying about you?
If your eyelids are drooping, and there are bags all around them, your eyes are probably falling under the radar. Who could possibly focus on your eyes with all that puffiness?
Eyelid surgery (blepharoplasty) can refresh and rejuvenate your eyes, correct sagging or drooping eyelids and remove excess fat, skin and atrophied muscle around your eyes. It can't, however, correct dark circles, fine lines or crow's feet.
Specialized eyelid surgery like Asian blepharoplasty has a different purpose that has little to do with facial rejuvenation. This cosmetic procedure is popular with some members of the Asian community who wish to create a natural crease or fold in their eyelid, creating a "double eyelid" from a "single eyelid."
Are You a Candidate for Blepharoplasty?
If you have loose, sagging eyelids, you may be a good candidate for eyelid surgery. You must also be in good overall health and have no uncontrolled preexisting diseases or medical conditions. You need to be emotionally stable and have realistic expectations of what the eyelid surgery can — and can't — do for your eyes. You may not be a good candidate for blepharoplasty if you have an overactive thyroid gland, which can cause swelling and other problems with and around your eyes.
During your initial consultation, your surgeon will take a thorough medical history. Be prepared to discuss your current health status, past illnesses and surgeries, and your medication regimen. Don't leave anything out when discussing your medications. Even herbal remedies that are billed as "all natural" can affect your eyelid surgery. Make sure to mention any past eye or vision problems, including the use of contact lenses or glasses and whether or not you have had LASIK surgery.
Your surgeon may ask you to look in the mirror and point out what you wish to change about your eyes and eyelids. He or she will also examine your facial anatomy before making a recommendation about what type of surgery can help improve the look of your eyelids. For example, he or she may suggest surgery on all four lids, or just the upper or lower eyelids.
You can look at before-and-after eyelid surgery photos of others who underwent the procedure with the same surgeon. This is no guarantee of your outcome, but it can help you get a better idea of the surgeon's skill, style and aesthetic vision. Remember that some of these photos may have been "touched-up."
The surgeon will also discuss the placement of incisions, eyelid surgery risks and other surgical details such as the type of anesthesia that will be used for your procedure. Most of the time, eyelid surgery is performed using a local anesthetic and intravenous sedation, but general anesthesia may be an option.
You should also discuss post-surgery downtime and eyelid surgery cost during this visit. If you do book a surgery, you will likely need to leave a deposit to hold the date. Some doctors charge for a consultation visit, but they may allow you to deduct this cost from the surgery if you decide to book. Find this out in advance so there are no surprises.
The next step is your preoperative appointment. This is your second opportunity to ask any questions you may have. You will also go over your preoperative instructions and be given an information packet on what you can and can't do in the days and weeks leading up to your eyelid surgery. The packet should list all the medications you should avoid taking for at least two weeks before your surgery. The most common products on this list will be anything containing aspirin or ibuprofen, which can increase your risk of bleeding. If something is not clear, ask for more information.
If you smoke, now is the time to quit. Besides being bad for your health in general, smoking can impede your healing, affect your circulation and accelerate the aging process. Ask your doctor about available smoking cessation tools. Remember nicotine replacement products also impede wound healing and circulation and cannot be used during the post-op period.
You will probably need to have routine blood work done before your eyelid surgery. Some surgeons ask that you have a complete pre-surgery physical exam, especially if you have any underlying health conditions. Your surgeon will also tell you what to expect during your recovery and in the months ahead. You will be instructed on how to clean your eyes after the surgery. You may be given (or asked to purchase) icepacks, gel masks, or other products to use directly after surgery. At this appointment, you will probably be given prescriptions for antibiotics and pain relievers so that you can fill them in advance.
Your Eyelid Surgery
Choosing a board-certified facial surgeon is important to your overall satisfaction with your eyelid surgery. Facial plastic surgeons should be certified by the American Board of Facial Plastic and Reconstructive Surgery. This ensures that they have had extensive training, are up to date on the latest developments in eyelid surgery and take appropriate safety precautions. Most facial plastic surgeons do their residency training in otolaryngology-head-and-neck surgery, which means they have extensive knowledge of your facial anatomy.
Blepharoplasty usually takes 30 to 90 minutes. If you are having both upper and lower blepharoplasty, your surgery will take longer to perform. Eyelid surgery is usually done on an outpatient basis in a hospital, a free-standing surgical clinic, or your surgeon's office.
Your anesthetist or anesthesiologist may meet with you briefly before your eyelid surgery. You may be given an oral sedative or Valium to reduce any pre-surgery jitters. Once you are on the operating table, your blood pressure, breathing, blood oxygen levels, and other vital signs will be carefully monitored. You will likely have an intravenous (IV) line started to administer fluids and medications. During the surgery, your eyeball is protected with a special guard that looks like a large contact lens.
The incisions for upper and lower blepharoplasty are placed within the natural folds of the eyelids. If you have bags beneath the eyes, but your skin has a lot of elasticity, a transconjunctival incision may be an option. This type of incision is made on the inside of your lower lid through the membrane called the conjunctiva. Most of the time eyelid surgery scars are undetectable.
After the incisions are made, the surgeon separates the skin from the underlying tissue and muscle and removes excess fat or muscle tissue, if needed. Muscle and fat can also be repositioned instead of removed. The surgeon then trims excess sagging skin and your incisions are closed with very fine sutures which may be left in for anywhere from two to five days. The surgeon will lubricate your eyes with an ointment and may apply a dressing. You are then awakened and brought into the recovery room.