Few would argue that the eyes are one of the most expressive features of the face. It stands to reason, therefore, that blepharoplasty (BLEF-AR-OH-PLASTY) can affect one's appearance as dramatically as any facial plastic surgery. Blepharoplasty is a safe, effective plastic surgery procedure accomplished to restore a more youthful appearance and less fatigued look while maintaining or improving function. Performed to remove excessive skin and fat around the eyelids, blepharoplasty is one of the most common facial plastic surgery procedures. Once thought a beauty procedure sought by only wealthy women, men in today's competitive corporate workplace are increasingly seeking eyelid surgery to restore a younger look that more typifies their energy level.

When patients come to our office seeking facial plastic surgery, it's not uncommon for them to focus on a single aspect of their appearance rather than the overall picture. Blepharoplasty alone is not always the answer to redundant skin about the eyes. Premature aging and drooping of the brow can cause a tired, angry look with frown lines and sagging skin. It is not uncommon for patients who come to the Quatela Center for Plastic Surgery for evaluation of the eyelid area to simultaneously discuss an eyebrow lift. Our Eyelid FAQs answer questions such as "How do I know if I need upper eyelid surgery or eyebrow surgery?"

Along with baggy eyelid skin, an additional source of concern is textural or surface changes (fine little lines) in the skin around the eyes. Although some improvement in facial wrinkles can be obtained from a blepharoplasty, it will not address all the superficial lines that come from premature aging, overexposure to weather and genetics. Blepharoplasty addresses "excess skin and fat; skin resurfacing such as chemical peels and laser surgery addresses textural wrinkles and imperfections.

A board certified facial plastic surgeon, trained to perform plastic surgery exclusively on faces and necks, knows that his responsibility is to evaluate not only the areas of concern but also the motivation behind the requests. It goes without saying that blepharoplasty won't save a failing marriage. Similarly some patients not ready for cosmetic surgery are better served with conservative measures, such as Botox for fine lines and wrinkles or Restylane for crows feet. Patients who educate themselves about facial plastic surgery know when and if the time is right to proceed.

When discussing plastic surgery procedures, the best place to start is by looking at before and after photos to see just what can be accomplished. As you will see in the photos, patients often ask to combine an eyelid lift with other cosmetic surgery. Facelifts, chin implants, cheek implants, rhinoplasty (nasal surgery), otoplasty (ear surgery) and lip surgery can also be performed in conjunction with blepharoplasty.

The illustration (left) shows the incision placement for upper and lower eyelid surgery. For traditional lower eyelid blepharoplasty, it is common that an incision is made in the lower eyelid skin with removal of excess skin and fat to achieve a refreshed look.

However, an advanced technique that has been performed successfully for the past ten years on lower eyelids is the transconjunctival blepharoplasty. (Wow! That's a big word! The conjunctiva (con junk tie vah) is the pink inner lining of the lower eyelid.) With this approach, the incision is made just inside the lower eyelid and no external incision is required. Ask your facial plastic surgeon if you are a candidate for this surgery.

Revision Eyelid Surgery
While we're on the subject of alternatives to traditional blepharoplasty, we would like to include a word about revision eyelid lift. It is not uncommon for patients to be referred to Lindsay House for revision cosmetic surgery. The following instructions for eyelid tuck apply to all patients undergoing blepharoplasty. However, revision eyelid patients have their own set of challenges.

In revision blepharoplasty, the facial plastic surgeon is working on an area that has previously undergone changes. Correcting previous surgery by another plastic surgeon can be a bit more complex and, therefore, may take longer than the initial eyelid lift surgery. Also, swelling can be more pronounced with revision surgery as well as a slightly longer healing time. Please don't hesitate to contact us if you have questions about previous cosmetic surgery.

At your initial consultation, we evaluate the bony and soft tissue architecture as well as the form and function of the eyes. Assessment of the upper and lower eyelids along with the eyes themselves provides the basis for what one may expect from blepharoplasty. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of eyelid lift surgery.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of plastic surgery procedures and routines is essential to a successful final result. Following your consultation, we continue our discussion at the preoperative appointment.

BEFORE EYELID LIFT SURGERY
At your preoperative appointment our nurse will provide all the instructions for you to follow before and after eyelid lift surgery. On the business day prior to the operation we ask you to call to confirm your arrival time for surgery. Upon arrival for your eyelid lift surgery, you will talk with a nurse (who will start an IV), discuss anesthesia (local anesthesia with IV sedation keeps you asleep and comfortable) and meet with your doctor before going to the operating room. An eyelid lift (either upper or lower eyelids) takes about an hour depending on the structure and amount of excess tissue prior to surgery. If you are having a combination of plastic surgery procedures your surgery will take longer. Recovery time from the anesthetic takes about an hour and you will be discharged about four hours from the time of admission.

PREOPERATIVE EYELID LIFT SURGERY INSTRUCTIONS

AFTER EYELID LIFT SURGERY
When you wake up from eyelid lift surgery you will notice iced saline eye pads on your eyes. These help to minimize swelling and bruising. Your vision will be blurry due to the eye ointment that was placed in your eyes after eyelid lift surgery. You may also notice that tears run down your cheeks, which is due to swelling and will subside during the first week following surgery.

Following blepharoplasty, the nurses will ask assist you to meet the discharge criteria: to drink liquids, walk with a steady gait, void, manage your discomfort, and to have your nasal drainage under control. The nurses will teach you how to change the eye pads, which you will need for about 24 hours.

You will be asked to come to our Lindsay House office (not the Surgery Center) three days after eyelid lift surgery for suture removal. Although most patients describe removal of eyelid sutures as discomfort rather than pain, you are encouraged to take your pain medication about an hour prior to suture removal.

POSTOPERATIVE EYELID LIFT SURGERY INSTRUCTIONS
Wound care
For 24 hours after surgery, keep ice water soaked pads on eyes, changing pads every 20-30 minutes. Pads should be soaking wet - do not wring out completely. It is the weight of the water as well as the temperature that helps minimize bruising. A small bag of frozen peas or corn may also be used on top of the eye pads. Make sure the bag is not placed directly on the skin. Use a washcloth or towel between the bag and your skin.

At bedtime clean any excess ointment off sutures with a Q-tip. Then apply the eye ointment (most commonly polysporin ophthalmic) on the eyelid sutures and inside the lower eyelid. Until the sutures are removed, you will apply the eye ointment two times a day (morning and evening) to the sutures. It is only necessary to apply the ointment inside the lower eyelid at bedtime. Ointment inside the lower eyelid will make vision blurry, so best to do this immediately prior to retiring for the evening. Sutures that have been kept lubricated with ointment are less painful to remove.

Medications
Most patients complain of discomfort more than pain. Use pain medication (Vicodin/hydrocodone) as directed/as needed. Vicodin contains Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin. Do not drive or drink alcohol while taking pain medication. Side effects of pain medications can include nausea and constipation. Taking pain medication with food helps minimize nausea. Over-the-counter laxatives are indicated if constipation persists.

Start your antibiotic (Keflex/cephalexin) when you get home and one at bedtime. Tomorrow take one tablet every six hours until gone. It is not uncommon to have a low-grade fever for 24 hours following eyelid lift surgery.

Start swelling medication (Medrol Dosepak/methyl prednisolone) when you arrive home. Take with food.

Take Vitamin C (ascorbic acid), which helps promote healing, for two weeks following surgery. Also take Arnica, a natural herb that significantly decreases bruising, for one week following eyelid lift surgery.

Diet
Advance diet from liquids to soft food to your regular diet as tolerated.

Activity
Sleep with head of the bed elevated or use two to three pillows for one week after eyelid lift surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. One week off work is recommended.

After 24 hours, keep incisions dry except for ointment. You are encouraged to shower and wash your hair before coming for suture removal. Steristrips, which must remain dry and in place for four days following suture removal, are applied. Bruising can be camouflaged at one week postoperatively with make-up. Avoid unprotected prolonged sun exposure for three months following blepharoplasty to prevent pigmentation of incision lines.

Please Remember!
Tearing, bruising, swelling, eye fatigue and disrupted sleep are very normal postoperative eyelid lift symptoms and will decrease as the healing process occurs. Since vision is temporarily compromised, assistance with daily activities is recommended.

Final Result
Following blepharoplasty, it takes time for the swelling to subside and for the skin to heal. Most patients return to work one to two weeks following eyelid lift surgery, depending on temporary bruising and swelling. At that time, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following blepharoplasty are not apparent for one full year following surgery. After three months, the changes are ever so subtle, although still important. Being perfectionists about our work, you may tell us you are pleased long before the one year anniversary. However, we request that you follow-up with us at that time for postoperative eyelid lift photographs and so that we can enjoy your final result.

Please notify the office 244-1000 and ask for our nurse for any concerns. For an emergency, please contact our office or professional answering service at 258-4851. Remember, we are all here to help in any way we can.