Blepharoplasty is performed to reduce the wrinkling and/or bulging of eyelid tissue. Not all patients need to have both excess skin and excess fat (bags under the eyes) removed. In many cases only one or the other procedure is needed. Every wrinkle and fold of skin around the eyes cannot be removed. Most recently, there have been innovations in eye surgery to preserve and redistribute fat around the eyes rather than just to remove it. This results in less of a hollow, “done” appearance.
As we grow older, the skin begins to lose some of its elasticity, and the area around the eyes often begins to sag. These wrinkles, pouches beneath the eyes, and sagging upper eyelids can be greatly improved with eyelid surgery (blepharoplasty). Renowned throughout Southern California, our surgeons have performed exceptional eyelid surgeries for many patients at Prime Plastic Surgery.
Upper blepharoplasty (sometimes called an upper eyelid lift) can correct overhanging upper lids, while lower blepharoplasty (sometimes called a lower eyelid lift) most often eliminates bags under the eyes. Upper and lower eyelid surgery can be performed separately or concurrently if you have signs of aging both above and below the eyes.
Eyelid surgery patients find that their eyes appear larger and more attractive, which brings a brighter, more youthful appearance to the face.
During your eyelid surgery consultation, your surgeon will ask about the areas that concern you and your desired outcome. He will take a detailed medical history and will examine and evaluate you. He will then explain the options that are available and the pros and cons of each alternative.
This explanation will include what treatment option or options he recommends, where the surgery will be performed, what type of anesthesia will be used, a step-by-step explanation of what the recovery will be like, what is expected of you as a patient, and potential problems that can occur. Your surgeon will also answer all of your questions during your consultation so that you can make an informed decision about your procedure(s).
As part of your initial consultation, our staff will review expectations for surgery. At that time, we will provide a realistic picture of what surgery can and cannot accomplish. Depending on which procedures you are interested in, we will provide you with a list of risks reported in the medical literature associated with all of the procedures you are considering. Although risks from cosmetic surgery are uncommon, every patient should be fully informed of any the risks associated with surgery.
Both younger and older healthy patients who have hooding of the upper eyelids or bags under the lower eyelids could benefit from blepharoplasty. Patients with “single eyelids” who wish “double eyelids” can also benefit from eyelid surgery.
Botox or Dysport non-surgical injectables are often used to further diminish crow’s feet and other fines lines around the eyes after eyelid surgery.
Our surgeons often performs eyelid surgery with a brow lift for optimal results. They may recommend a brow lift when there are deep forehead wrinkles, frown lines between the eyes, lines over the nose, or wrinkled, sagging upper eyelids that are caused by drooping eyebrows. Other surgical and non-surgical procedures that are frequently performed in combination with eyelid surgery include microfat grafts, Juvederm, facelift, and/or nose surgery.
During eyelid surgery, excess skin and fat are removed, and stretched muscles are tightened. Using the latest techniques in facial plastic surgery, your surgeon smooths and sculpts upper lid creases and eliminates wrinkles and pouches beneath your eyes.
All eyelid surgery incisions are carefully positioned beneath the lashes or along your natural eyelid creases so that they are scarcely visible. The results are smooth, sculpted creases on the upper lids and elimination of most of the wrinkles and pouches beneath the eyes.
The length of eyelid lift surgery depends on several factors, including the extent of tissue laxity and the anatomy of your eyelids, but it generally takes 1-2 hours. Many patients who have previously had a blepharoplasty are referred to Prime Plastic Surgery for revision eyelid lift surgery. Revision blepharoplasty can take a little longer because of corrections that need to be made as a result of the initial eyelid surgery. If concurrent surgeries are done, such as a facelift, the length of the procedure will also be longer.
Recovery from Blepharoplasty
Most patients who have eyelid surgery say they are surprised that the post-operative discomfort is so mild. Patients more typically complain of tightness from swelling or a pulling sensation.
Understandably, after any surgical procedure, some discomfort can be expected, and pain tolerance varies from patient to patient. You will be provided with prescriptions for pain medication, as well as eye drops and an antibiotic to prevent infection. Many patients use the pain medication 2-5 days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report extreme pain after surgery.
Post-operative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising and swelling may take 2-3 weeks. Most patients can camouflage bruises fairly easily at 7-10 days with a concealer. Our aestheticians at Prime Plastic Surgery are available to help you with this during your recovery period.
You can also expect some drainage or crusting of your eyelids. Simply draw it away with a Q-Tip dipped in tap water.
Restrictions from work are generally 1-2 weeks after eyelid surgery. Because some bruising and swelling may still be present, an occasional patient will take 3 weeks off.
Smoking adversely affects your recovery by diminishing the blood supply to the skin. Patients must stop smoking for a minimum of 2 weeks prior to surgery to decrease the risk of these complications and continue smoking cessation after the procedure for a period of weeks.
Do not drink alcohol for 5 days after surgery, and do not drive for 4 days. You may wash your hair 3 days after surgery or the day the dressings are removed during a follow-up visit. You may resume wearing makeup 10-14 days following your procedure, and you can wear contact lenses within 2-3 weeks.
Aerobic activities should be avoided for 3 weeks following surgery. Any activity that potentially increases blood pressure will extend the amount of time it takes for post-operative swelling to resolve. This includes brisk walking, sex, and hot tubs.
The results of eyelid surgery may be considered permanent in that you will continue to look younger years later than you would have without undergoing the eyelid improvement. You will, for example, always look younger and better than a twin if you undergo the correction and the twin does not. Most patients can expect their results to last between 8-12 years. However, eyelid surgery cannot stop the aging process.
It may take several months until you are happy with the results and up to 1 year to see the final result.
It’s not uncommon for patients who have previously had eyelid surgery to be referred to Prime Plastic Surgery for revision surgery. Although patients may want immediate adjustments to the original surgery, patients generally should wait 6 months to a full year before undergoing revision eyelid surgery. The final results of a blepharoplasty are not achieved until one full year postoperatively, since it takes that period of time for postoperative healing to be complete. Changes, however subtle, continue throughout the 12-month course following eyelid surgery. As time goes by, the eyes gradually improve and features refine as the swelling resolves. These refinements sometimes are enough for a result to be considered acceptable by a patient. A revision blepharoplasty can be more complex, may take longer than the initial eyelid lift surgery, and may take a slightly longer time to heal.
A thorough consultation is necessary to evaluate whether the areas that concern you can be realistically improved.
The results of eyelid surgery may be considered permanent in that you will continue to look younger years later than you would have without undergoing the eyelid improvement. However, eyelid or forehead surgery cannot stop the aging process and you will continue to age. You will, however, always look younger and better than a twin, if you undergo the correction and the twin does not.
The results will vary from person-to-person. Most patients can expect their results to last between eight and twelve years. The length of time that patients enjoy a satisfactory improvement after an eyelid surgery depends on many factors including the quality of their skin, which is influenced by the degree of sun damage or loss of elasticity. Smokers typically have poorer quality skin. Older patients will see an earlier return of laxity, while younger patients will see a more long-lasting improvement.
Heredity is important. If your parents aged slowly, you probably will, too. Your diet, general health, time spent in the sun, smoking, weight gains and losses, emotional traumas, and type of skin will all play a role in determining how long the improvement will last.
Eyelid Post-Op Instructions
You must have someone available to drive you home from the surgery center and remain with you for the first night following surgery. If you live further than 30 miles away from the surgery center, we ask that you stay locally for the first night. There are post-operative care facilities close by if interested. Please ask our office for numbers. The office will call you the evening of surgery.
Take the pain medication every three to four hours, if needed. Ideally, it should be taken with food to prevent nausea. Take the antibiotic every eight hours for 7 days.
It is also a good idea to record when medications are taken to avoid taking too much or not enough.
Upon leaving the surgery center, you may have small quantities of liquids as desired and tolerated. The following day you may progress to a soft diet. After the above, you may eat as desired. NO ALCOHOLIC BEVARAGES are allowed for one week after surgery and especially while taking the medications.
Return home and go directly to bed for 24 hours, with bathroom privileges only. Sleeping on your back at all times will be the most comfortable and will help to keep the swelling down.
Clean suture lines with hydrogen peroxide on cotton applicator sticks, 3-4 times daily. You will have some oozing from the incisions the first day. Cleaning with hydrogen peroxide will keep crusts from forming on the incisions. Such crusts slow the healing process and lengthen the recovery time. Apply Neosporin ophthalmic ointment to suture lines with Q-tips, after cleansing with hydrogen peroxide.
You may use artificial tears to relieve any irritation of your eyes. Apply ice on your eyes continuously for the first 24 hours. However, except for hydrogen peroxide usage, the incisions must remain dry, so please use ice cautiously. At bedtime, apply Lacrilube ointment inside your eye to moisten during the night.
Swelling and discoloration are expected. However, excessive or uneven swelling (more on one side than the other) or bleeding should be reported to the office.
AVOID STRENUOUS ACTIVITY, sunbathing and getting overheated for 2-3 weeks. NO BENDING, LIFTING OR STRAINING.
DO NOT shampoo your hair until instructed to do so — usually 3-5 days post-operatively.
If there are any complications, such as severe pain or excessive bleeding, please call the office day or night at 619 466-8851.
To schedule your cosmetic surgery consultation in our San Diego office, call (619) 466-8851.
The general comments from friends and associates after returning to normal activities “are:” Gee you look great. Did you change your hairstyle?” “New makeup? Or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes unless patients request dramatic changes. Eyelid or forehead surgery performed meticulously, in the hands of a skilled, experienced, board certified plastic surgeon should not result in an unnatural over-operated appearance. Most patients want to look natural and like themselves, yet refreshed. This is achieved by the artistic combination of repositioning and removing the lax excess tissue and adding micro fat grafts or fillers where the tissue is deficient.
Some of the characteristics of a good board certified aesthetic (cosmetic) plastic surgeon are: willingness to listen to patients, an ability to tell the difference between realistic and unrealistic expectations, being truthful about meeting each patient’s desires, and the ethics to tell a patient why something should not be done. Our biggest referral source is from satisfied patients – ones who have had realistic expectations and were satisfied with the results.
Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery, since the facial area usually heals with better scars. At the time of your consultation, it’s important to show your surgeon any previous scars that are of concern to you so he can give you a realistic assessment of your healing potential following facial plastic surgery. Healing is variable from patient to patient, and somewhat unpredictable, although most patients heal with scars that generally blend in extremely well with time. Scars continue to improve in appearance for up to 1 year. The eyelid area generally heals with excellent scars.
Nothing will remove all of the fine lines and crow’s feet. Botox or Dysport help diminish the crow’s feet. Skin care and light resurfacing with gentle peels or lasers can further improve the fine lines. It is natural to have lines when you smile.
Yes, it’s generally preferred to combine procedures. It is financially beneficial because you only undergo 1 anesthesia and minimize the cost of the operating room and surgical supplies. In addition you minimize downtime by having to go through the recovery process following surgery only once. Commonly combined procedures with face lift surgery include the following:
• Brow lift
• Microfat transfer
• Laser or dermabrasion
• BOTOX® Cosmetic or Dysport
• Face or neck lifts
• Chin implant
• Rhinoplasty (nasal surgery)
Most patients who have eyelid surgery say how surprised they are at how mild the discomfort is that they experience. Patients more typically complain of tightness from swelling or a pulling sensation. Understandably, after any surgical procedure, some discomfort can be expected and pain tolerance varies from patient to patient. All patients are provided with prescriptions for pain medication. Many patients use the prescription medication 2-5 days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report extreme pain after surgery.
The length of eyelid lift surgery depends on several factors including the extent of tissue laxity and the anatomy of each person’s eyelids, but generally takes 1-2 hours. Many patients who have previously had a blepharoplasty are referred to Prime Plastic Surgery for revision eyelid lift surgery. Revision blepharoplasty can take a little longer because of corrections that need to be made as a result of the initial eyelid surgery. If additional procedures like forehead surgery, micro fat injections, laser treatments or facial lifting are performed in conjunction with the eyelid surgery, it will naturally take longer.
Most eyelid or forehead surgeries are performed on an outpatient basis. Because you will be receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment the next day. Our patient coordinator can arrange for an experienced individual to help with your post-op care, if you do not have someone to take care of you after surgery. Patients having surgery must stay in the immediate La Jolla area overnight within 60 minutes of our facility.
Some patients who feel more comfortable in a hospital after surgery and those who would benefit from closer monitoring are admitted to Scripps Memorial Hospital – La Jolla for 1 to nights after surgery. Prime Plastic Surgery is on the campus of the hospital and immediately adjacent to the main hospital building.
It’s a good idea for patients to prearrange for post-surgery support from family members or friends before undergoing surgery. Our patient coordinator can arrange for an experienced individual to help with your post-op care at your home or a nearby hotel if you do not have someone to take care of you after surgery.
Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take 2-3 weeks. Bruising is variable and many patients can camouflage bruises fairly easily at seven to ten days with a concealer. Our aestheticians atPrime Plastic Surgery are available to help patients with this during their recovery period.
Healing depends on blood supply and smoking adversely affects your recovery by diminishing the blood supply to the skin. Smoking causes the blood vessels that supply oxygen and nutrients to the tissues to constrict and prevent the necessary healing of the operated areas. Patients who smoke have a greater chance of delayed or non-healing of incisions, which can result in additional scarring or pigment change of the skin, as well as lung problems with anesthesia. Patients must stop smoking for a minimum of two weeks prior to surgery to decrease the risk of these complications, and continue smoking cessation after the procedure.
Botox or Dysport, a filler like Restylane, light skin peels, and a supervised ongoing skin care program may be options for patients who want some improvement, but are not ready or unwilling to undergo eyelid surgery (blepharoplasty).These options may offer some benefit, depending on your individual anatomy and concerns, but in most patients are not a replacement for surgical correction.
This visit will be scheduled approximately two weeks before surgery. It will give you an opportunity to ask questions you might not have asked previously. We will review your medical history, give you a preoperative examination, arrange for laboratory tests, and discuss what to expect during surgery. If you are over forty years of age, or have a history of heart abnormalities, we may arrange for an electrocardiogram and chest x ray. We will also take preoperative photographs, which become a permanent part of your medical record, and remain strictly confidential. Your operative consent will be read and signed, preoperative instructions reviewed, and prescriptions for the medications that you will need will be given to you at this visit. Your fee will be due at this time.
Arrangements to facilitate admission will be made if you are scheduled for hospital surgery, or for an overnight hospital stay. Hospital and anesthesia charges are separate from those of our office.
A lower blepharoplasty (lower eyelid surgery) can get rid of the pockets of fat that can cause the puffiness.
Yes, upper eyelid surgery can alleviate the “heaviness” that people feel around their eyes when the excess skin of the eyelid weighs down on them.
The incision for upper eyelid surgery is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner. For the lower eyelid, the incision is also hidden but below the lower eyelashes.
It is suggested that you take off 3-5 days from work after eyelid surgery but refrain from strenuous activity for up to one month after the surgery.