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Blepharoplasty (Eyelid Surgery)
San Francisco - Oakland - Santa Rosa
Blepharoplasty Cosmetic eyelid surgery (blepharoplasty) is a surgical procedure in which the excess skin and fat are removed from the upper and lower eyelid. Eyelid surgery can correct droopy upper lids and remove puffy bags from below your eyes. These are features that make you look older and more tired than you feel, and may interfere with your vision. However, it will not correct crow’s feet or other wrinkles, eliminate dark circles under your eyes, or lift saggy eyebrows. The current state-of-the-art is to remove less fat in the eyelids and to reposition and reinforce the anatomy. The goal is to prevent the hollowed looking eyelid over the long term. Blepharoplasty can be done alone or in conjunction with other facial procedures, such as a face lift or brow lift.
Who is a candidate for blepharoplasty? Many people in their early to mid-thirties begin to notice a tired appearance around their eyes. This is a commonly caused by a fullness or puffiness of their eyelids, caused by the accumulation of excess skin and fat. This fat is often independent of weight gain or loss and often does not fluctuate. The fat acts as “shock absorbers” around the eyes and protects the globe, and over time migrates forward with aging of the eyelid tissue. The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. In my practice, blepharoplasty is the most requested procedure by both men and women.
Before Surgery In the initial consultation, Dr. Delgado will ask you to express your concerns about your appearance. You and Dr. Delgado will carefully discuss your goals and expectations. Then, he will use digital photography to put your image on the computer. Computer imaging will aid in evaluating your appearance and the proposed changes that can result. Your medical history will be reviewed and a physical examination will be conducted. He will determine if there is looseness of the lower eyelids that would require tightening and any other specific procedures. Dr. Delgado will determine if the upper lid sagging is due only to upper eyelid skin or eyebrow looseness or a combination or both. Usually as one ages, there is also eyebrow ptosis (droopiness).
Dr. Delgado will advise you if cosmetic eyelid surgery is the best procedure for you. He will help you decide whether you require both the upper and lower lids corrected, and whether a brow lift is important. At times other suggestions are made. For example, if one would like eyelid rejuvenation and this would make the face look significantly younger. He may suggest a face-lift as well, to balance the face and to create harmony.
Dr. Delgado will give a precise preoperative instruction pamphlet that will explain your medications and any preparation that you need to make at your home. This preoperative pamphlet will also give a concise list of all aspirin and aspirin containing compounds, including anti-inflammatory products that must be stopped two weeks before and two weeks after surgery. Tylenol may be taken during this time. You will also be given a list of vitamins and homeopathic drugs to take prior to and after surgery.
Anesthesia Cosmetic eyelid surgery can be done in the office with local anesthesia and IV sedation. It may be performed in conjunction with other procedures like a facelift and/or brow lift. If multiple procedures are performed, often general anesthesia is used. Dr. Delgado and the anesthesiologist will determine with you the best choice.
Operative Procedure Before the anesthesia is given, the upper eyelids are marked very precisely to outline the surgical plan. Dr. Delgado spends a significant amount of time creating the most natural and balanced shape.
The procedure involves excising an elipse of skin from the upper eyelid. The incision is made in the upper eyelid’s natural crease. A section of muscle underneath (to develop a clean upper lid crease) is excised and the redundant fat is removed. In addition, a fat layer underneath the lateral eyebrow can be removed to reduce the heavy-looking or hooding lateral eyelid. The lower eyelid blepharoplasty is performed either through an incision, inside of the eyelid (transconjunctival blepharoplasty) or on the outside of the eyelid. The transconjunctival blepharoplasty is more commonly performed because in many cases it requires excess fat removal or repositioning. If it is necessary to tighten the skin below the eyelid, then an incision is made on the exterior of the eyelid, below the eyelash line. A portion of skin is excised and the skin is tightened. Laser resurfacing of the lower eyelid can also tighten the skin and reduce wrinkles. We now realize that lower eyelid muscle (like the skin) become laxed over time, and also requires tightening.
Post Operative Period The first few hours after surgery is spent in the recovery room and cold compresses are placed on the eyes and the head and back is elevated to reduce swelling. When the patient is fully alert, they will be able to return home. We strongly advise care from a friend for twenty-four to forty-eight hours. Eyelid surgery is not painful, but the swelling and sometimes tightness is uncomfortable. During the first 48-hours ice compresses to the eyelids will help significantly with reduction of swelling. Some patients experience tearing and irritation for the first several days after surgery. An ointment or solution may be prescribed until the symptoms resolve. Blurred vision is experienced by some patients for several days after surgery, and some patient’s eyes feel quite tired for a period of time.
I recommend that my patients take about five to seven days off work, so that they can properly take care of their eyes. The sutures are removed five days after surgery. The bruising is reduced within seven to ten days. You may then resume wearing makeup and using contact lenses. The incisions remain pink for approximately four to six weeks after surgery, gradually blends in and will fade to eventually be inconspicuous in approximately four to six weeks. Most patients return to work and activity after one week. Strenuous exercise should be avoided for the first four to six weeks following eyelid surgery.
What are my results? The results of cosmetic surgery are more youthful and well-rested appearance without a change or shape or expression of the eye. The results will look natural and well balanced without the “surgical” look. You can expect the results to last for many years. You will continue to age and over time a small amount of excess skin may be noted. It can easily be removed. It is uncommon for excess fat to reappear after many years. If this does occur, the fat can easily and safely be removed. As stated earlier, we are excising less fat and preserving more fat to avoid a “hollowing” of the eyelid area.