The best candidates for eyelid surgery

Blepharoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations your reasons for wanting surgery and discuss them with Dr. Jensen.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations.

Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

A few medical conditions can make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves’ disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery. All surgery carries some uncertainty and risk.

When eyelid surgery is performed by a qualified plastic surgeon, complications are rare and usually correctable. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following Dr. Jensen’s instructions both before and after surgery. The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; Dr. Jensen can remove them easily with a very fine needle. Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.

Planning your surgery

The initial consultation with Dr. Jensen is very important. We will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform Dr. Jensen if you have any allergies; if you’re taking any vitamins, aspirin, ibuprofen, medications (prescription or over-the-counter), or other drugs; and if you smoke.

During your consultation, a nurse will test your vision and assess your tear production. You should also provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them along at the time of your initial consultation.

You should carefully discuss your goals and expectations for this surgery with Dr. Jensen. You’ll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate.

Dr. Jensen will explain the techniques and anesthesia he will use, where the surgery will be performed, and the risks and costs involved. (Note: Most insurance policies don’t cover eyelid surgery, unless you can prove that drooping upper lids interfere with your vision. Check with your insurer.) Don’t hesitate to ask Dr. Jensen any questions you may have, especially those regarding your expectations and concerns about the results

Preparing for your surgery

Dr. Jensen will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. While you’re making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed. Assistance with transportation can be provided by our complimentary van.

Where your surgery will be performed

Eyelid surgery is usually performed in our office-based facility, on an outpatient basis; rarely does it require an inpatient stay.

Types of anesthesia

Eyelid surgery is usually performed under local anesthesia-which numbs the area around your eyes-along with intravenous sedation. You’ll be sleepy during the surgery, relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)

The surgery

What are my options?

Dr. Jensen will choose the right procedure for you based on your physical characteristics and aesthetic concerns.

Upper eyelids

Dr. Jensen will place the incision line at the natural eyelid crease through which he will remove the excess skin and sometimes fat. Lasers may be used to remove this excess tissue to reduce swelling and bruising. If there is a hollowness of the upper orbit Dr. Jensen may suggest fat transfer.

Lower eyelids

There are a number of options for performing lower eyelid surgery:

• The traditional approach places the incision just below the eyelashes, trimming and/or repositioning excess skin and fat, and tightening the lower eyelid muscle.
• The transconjunctival approach, is effective in improving lower eyelid bags and puffiness, Dr. Jensen places the incision inside the eyelid. Dr. Jensen can remove excess fat through a transconjunctival incision, but not excess skin.
• Illustration 5: In a transconjunctival blepharoplasty a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed and the incision is closed with dissolving sutures.
• The ‘skin pinch’ blepharoplasty removes only a bit of skin. This is effective if you have strong lower eyelid support and only a little extra skin. In some patients laser resurfacing can both tighten excess skin and remove wrinkles.
• The use of Juvederm™ or fat transfer is a nonsurgical alternative for the lower eyelids. Restylane, Juvéderm, and other soft tissue fillers can be injected into the tear trough (crescent-shaped under-eye area) to rejuvenate the appearance of the under-eye area. Results are varied and last approximately six months with the Juvederm™ and typically much longer with the fat transfer.

What will my eyelid surgery incisions and scars be like?

Upper eyelid surgery: Dr. Jensen will mark the natural lines and creases of your lids and keep your scars as hidden as possible along these natural folds. Fine sutures will be used to close the incisions, thereby minimizing scar visibility.

Lower eyelid surgery: In traditional blepharoplasty, Dr. Jensen will make the incision in an inconspicuous site along the lash line and smile line of the lower lid. In a transconjunctival approach,

Dr. Jensen corrects eyelid puffiness caused by excess fat by making an incision inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin.

Blepharoplasty usually takes one to two hours, depending on the extent of the surgery. If you’re having all four eyelids done, Dr. Jensen will work on the upper lids first, then the lower ones.

After your surgery

Dr. Jensen will discuss how long it will be before you can return to your normal level of activity and work. After surgery, you and your caregiver will receive detailed written instructions about your postsurgical care, including information about:

• Normal symptoms you should expect
• Potential signs of complications

For the easiest recovery period, have the following items readily accessible at home:

• Ice cubes, ice pack, or freezer bags filled with ice, frozen corn, or peas (based on your surgeon’s recommendation for cold application to the eyelids)
• Small gauze pads
• Eye drops or artificial tears
• Clean washcloths and towels
• Over-the-counter painkillers, which Dr. Jensen can recommend, but avoid Advil, Motrin, Naproxen, Aleve, and aspirin due to the increased risk of bleeding
• Plan to stay home from work and limit your activities for the prescribed time after surgery to give your eyelids a chance to heal.

Immediately after eyelid surgery

• You may experience excessive tearing, light sensitivity, and double vision immediately after the surgery.
• Your incisions will be red and visible at first, and your eyelids may be puffy and feel numb for several days.
• Swelling and bruising, similar to having “black eyes,” will likely last a week or more.
• You should apply ice packs or cold compresses for the first 72 hours to your eyes to help reduce swelling.
• Pain is usually minimal. You may be given a pain reliever such as Vicoden, acetaminophen (Tylenol or others) for mild discomfort, but remember to avoid aspirin, ibuprofen (Advil, Motrin, or others), naproxen (Aleve), and any other medications or herbal supplements that may increase bleeding.
• If stitches used are dissolving and usually fall out in about a week.

If you experience extreme or long-lasting pain or redness and swelling after the surgery, contact your surgeon to find out if these symptoms are normal or a sign of a problem.

Recovery time frame after eyelid surgery

It is vitally important that you follow all postoperative instructions provided by your surgeon. This will include information about bandages, drains, taking an antibiotic if prescribed, and the level and type of activity that is safe. Your surgeon will also provide detailed instructions about the normal symptoms you will experience and any potential signs of complications. It is important to realize that the amount of time it takes for recovery varies greatly among individuals.

The first two weeks

Although you will not have to rest in bed following surgery, you should plan to relax, stay home, and use cold compresses on your eyes on the day of surgery as well as the day after. The amount of time it takes for recovery varies. Here are some helpful guidelines:

• Follow your surgeon’s instructions for care. For the first couple of days following surgery, expect to treat the incisions with ointment to keep them lubricated and place cold compresses on the eyes to reduce swelling. You will be advised to use eye drops to keep the eyes from drying. If you have dry eyes lasting more than two weeks, contact your doctor.
• Sleep with your head raised higher than your chest. You can use regular pillows, wedge pillows, or sleep on a recliner. Minimize swelling and bruising by keeping your head elevated as much as possible during the first few days of recovery.
• After upper and lower blepharoplasty surgery your eyelids will typically feel tight. You can treat soreness with acetaminophen. Significant bruising typically occurs, but will resolve within two weeks.
• Avoid straining, heavy lifting, swimming, and strenuous activities, such as aerobics and jogging, for ten to fourteen days. Specifically, you should avoid activities in which you must move your head abruptly or that increase the blood pressure in your head. This restriction includes, but is not limited to, bending over, which causes your head to be lower than your heart, and lifting objects heavy enough to cause you to strain. This restriction may apply for three to four weeks.
• You may notice that your eyes tire easily for the first several weeks of the recovery period. Take frequent naps. Avoid activities that may dry the eyes, including reading, watching television, wearing contacts, and using a computer.
• For the first two weeks after your surgery, wear dark sunglasses to protect the eyes from irritation caused by sun and wind.
• Your plastic surgeon will remove the stitches between two and seven days after your eyelid surgery.
• You may feel well enough to resume normal activities around the tenth day of recovery.
• Seek medical attention immediately if you experience shortness of breath, chest pains, an unusual heart rate, new pain, bleeding, or visual disturbance.

After surgery, the nurse will lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by Dr. Jensen. If you feel any severe pain, call the office immediately.

You will be instructed to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person; it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.)

You’ll be shown how to care for your eyes, which may be gummy for a week or so. Frequently we recommend eye drops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

Dr. Jensen will follow your progress very closely for the first week or two. The stitches will dissolve 5-7 days after surgery. Once they’re gone, the swelling and discoloration around your eyes will gradually subside, and you’ll start to look and feel much better.

Getting back to normal

You should be able to read or watch television soon after surgery. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while. Most people feel ready to go out in public (and back to work) in a week to ten days. By then you’ll probably be able to wear makeup to hide the bruising that remains. We recommend Physicians Formula cover makeup sold at Wal-Mart). Your eyes may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

Dr. Jensen will instruct you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including bending, heavy lifting, and rigorous sports. You will also be asked to avoid alcohol, since it causes fluid retention.
Your new look

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line.

The positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.

Illustration 5: After surgery the upper eyelids no longer droop and the skin under the eyes is smooth and firm