A Discussion about Blepharoplasty (Eyelid Surgery)

With time, the eyes show some of the following changes: a puffiness may develop beneath the eyes which actually consists of fatty tissue, there may be excessive skin in both the lower and upper lids, the eyebrows can develop some droop with time, and crinkles can develop at the corners of the eyes, otherwise known as “crow’s feet.”  In addition to this, you may have dark circles underneath your eyes.  A blepharoplasty can remove extra skin from the upper and lower lids, and it can help to remove the fatty tissue or puffiness beneath the lower lids and in the upper lids as well.  It will not help dark circles under the eyes, and it will have a minimal to no effect on crow’s feet.  These problems, as well as the crepey skin of the lids, are best treated with a laser procedure, surgery or Botox.  If eyebrow droop is one of your main factors, then this might best be treated by a forehead lift (not discussed here) with or without blepharoplasty.  Also, we may choose an injectable (such as Restylane Silk or Perlane) as a filler for the under-eye hollows instead of surgery, or at 3-6 months after surgery to give a more attractive contour.

The procedure is usually performed in the office in my accredited out-patient ambulatory surgical suite or as an out-patient procedure in the hospital if the procedure is covered by insurance.  It involves an incision in the crease of the upper lid where it is well hidden and just below the eyelid margin.  These scars are usually almost imperceptible.  Through this incision, extra skin is removed as well as the extra fatty tissue of the upper and lower lids.  It should be noted that excision of the lower lid skin always has to be conservative to avoid excess pull on the lower lid skin.  The procedure is usually done in the office with intravenous sedation.  For the first two days, you will be staying at home with cool, moist compresses on your eyes, keeping your head elevated.  Some of the sutures will be removed between 3-5 days, and all the sutures will be out within the first week.  During the initial healing period, you will be swollen, bruised and your vision may be slightly blurred from the ointment you will be placing in your eyes to protect them.  After a few weeks, the swelling is much improved.  You can wear makeup over your incisions at about 7-10 days.  You should be able to return to work by about 1-2 weeks, depending on how much you bruise.

The risks of the surgery include bleeding, which may be as mild as a bruise, or in its most severe case, if you were to develop significant bleeding behind the eye, this could lead to swelling and a change in vision.  It would be very obvious if you have this problem because it would be extremely painful, and I would see you immediately in the emergency room.  The risk of this significant bleeding is less than 1 in 1000, and I have never seen it in my practice so far.

Other risks include infection, which would simply necessitate antibiotics and might delay the healing of your incisions, some pulling down of the lower lid skin which is very unusual but would get better on its own over time in 90% of the cases, and minor asymmetry which usually resolves spontaneously but which could be corrected at a later date, usually in the office.

Some patients who have poor lower lid tone or were very puffy before surgery or who have a lot of lower lid dissection for complicated lower lids may have an unusual duration of lower lid swelling.  If you have a tendency toward dry eyes, this can be worsened by the surgery because your eyes will be more open and more of the globe is exposed to air on a daily basis.  We can arrange for you to have an ophthalmolgic consultation for “punctal plugs” to create more tear film if this does not resolve with specialty drops and other conservative measures. Laser (LASIK) eye correction surgery may predispose a patient to dry eyes after a blepharoplasty.  A blepharoplasty should not be performed within 6 months of laser eye surgery.  Please advise Dr. Blanchet if you have had any eye surgery.  If your eyes are not irritated, you can return to wearing contacts in 1-2 weeks.

Smokers heal poorly in terms of infection and wound breakdown, and you are advised not to smoke for at least 1 month before and after the surgery.  Nicotine screening may be necessary the day of your surgery.  

Prior to having a blepharoplasty, it is helpful to be checked out by an ophthalmologist to make sure your vision is good, to be sure you don’t have dry eyes, and to make sure there are no medical reasons why you should not have a blepharoplasty.  Also, if you have enough extra upper lid skin to obstruct your vision, and an ophthalmologist documents this with visual fields, the upper blepharoplasty is often covered by insurance.  We can arrange for you to have the visual field test performed.

I hope this detailed information has not been overwhelming.  The vast majority of patients have smooth, uncomplicated courses and are quite pleased with their results.  It will be a pleasure to discuss blepharoplasty with you in my office.  Please do not hesitate to contact me if I can be of further assistance (804-320-8545).