Background On Blepharoplasty
Eyelid surgery can be done to correct drooping upper eyelids, puffy fat pads in the upper and lower eyelids and sagging lower eyelid skin. Technically known as blepharoplasty (blef-r-o-plas-tee), this procedure involves removal of fat and excess skin and muscle from the upper and lower eyelids. In some cases, the lower lid itself is tightened at the outer corner of the eye socket to correct laxity of the tone of the lower eyelid (canthoplasty or canthpexy). Eyelid surgery does not address crow’s feet lines, dark pigmentation of the lower eyelids or drooping eyebrow skin.
Eyelid surgery is frequently done at the same time as other procedures, such as a facelift or browlift, and can be combined with laser or chemical resurfacing to smooth skin wrinkles.
Dr. Capella 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. 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. Let us know also if you wear any corrective lenses, or if you have had prior eyelid surgery or eye muscle surgery. The doctor will do a thorough eyelid examination, and will assess other related issues that impact the perception of eyelid aging, such as the effect of the eyebrows and the skin itself. A vision exam and sometimes a test of tear function will be done. He will discuss the relevance of all of these issues as they relate to your overall appearance. On occasion, the doctor may feel that there are indications for you to seek consultation with a board-certified ophthalmologist; he will make this referral if necessary.
Blepharoplasty Pre-Operative Period
You will visit with Dr. Capella again several weeks prior to the procedure. It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to operation. Prophylactic antibiotics are prescribed for 24 hours after surgery to reduce the risk of surgical wound infection. A prescription for pain medication is also provided, so that you have pain pills when you return home from the operation. Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 3 months after your procedure. You will be asked to sign a surgical consent, which enumerates the risks of the procedure in detail. These risks are also discussed at the consultation.
You will be asked to pay your surgical fee at the pre-operative visit. You will need to arrange for an escort to drive you to and from the operating suite. Patients cannot operate motor vehicles after surgery and recently sedated patients will not be placed into taxis for transport home. We can arrange for medical transport in the event you cannot find an escort. It is a good idea to have someone stay with you for at least 24 hours after surgery for your comfort.
Day of Blepharoplasty Surgery
Prior to giving you any sedation, Dr. Capella will carefully mark the skin incisions with a marking pen, 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 with continuous monitoring of your blood pressure and other vital signs. Local anesthetic is injected while you are unconscious. The excess skin, muscle, and fat are removed. Much of the operation is done with a very fine electrocautery, which controls any bleeding. The skin is then closed with very fine sutures. Occasionally, the lower eyelid is very lax, and removal of any amount of skin could result in a pulling down of the lid, or ectropion. In this circumstance, the doctor may elect to perform what is called a lateral canthoplasty or canthopexy. In this procedure, the actual lid structure is tightened up to the bone of the eye socket near the outer corner.
Following your procedure, you will be monitored briefly in the recovery room and will then be discharged into the company of an adult escort. Post-operative instructions will be given to that person and to you in writing.
Blepharoplasty Post-Operative Period
Dr. Capella will place lubricating ointment in your eyes, which may blur your vision temporarily. You should continuously apply lightweight ice-cold compresses to your eyes for the first 24 hours. Frozen peas placed into an inexpensive “Ziplock” type bag works very well as a compress. You should avoid anything heavier than one ounce. Prop yourself up on a couple of extra pillows in bed, or, better yet, sleep in a recliner if you have one, as this reduces swelling. Blood pressure needs 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 several days following surgery. Blinking leads to an increase in 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. Some sutures may need to be removed one week following surgery. Swelling and bruising usually last for 10-14 days, but makeup can be applied as a camouflage after the first week or so. When you go outside, use sunglasses, as you may be very sensitive to light for a while. Avoidance of contact lenses for a week or so is necessary. You should not drive until you have normal vision, and are off of any narcotic medications. The eyes may fatigue easily for several weeks after surgery because of residual swelling in the tissues; frequent naps are helpful.
You should avoid strenuous activities such as bending, lifting, and sports for about three weeks. Drinking alcohol can lead to fluid retention and delay recovery. Healing is a gradual process and it usually takes six weeks to three months for you to look completely natural, 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 maintaining their confidentiality. Scars may remain slightly pink for six months or so, but can easily be concealed with makeup. Eventually, they fade to a thin, nearly invisible white line. The more alert, youthful look that eyelid surgery gives one is very long lasting. For many people, the results are permanent.
Risks Associated With Blepharoplasty
When eyelid surgery is performed by a qualified plastic surgeon such as Dr. Capella, complications are infrequent and usually minor. Nevertheless, complications can occur including bleeding, infection, reactions to the anesthetic medications, temporary problems with excessive tearing, prominence or firmness of the scars, asymmetry in healing or scarring, and milia or whiteheads where the sutures emanate from the skin. After the procedure, some patients may have difficulty closing their eyes completely while they sleep; in rare cases, this condition may be permanent. Another rare condition is ectropion, or a pulling down of the lower lids. Further surgery may be required to correct many of these complications.