Blepharoplasty (Upper Eyelid Surgery) Information and Procedure

Procedures

Upper Eyelid Surgery (Blepharoplasty)

One of the most frequently performed surgical procedures, upper eyelid blepharoplasty is used to remove the fat deposits, loose skin and drooping on that may form around the upper eyelids with age. Heredity and sun damage can accelerate these changes. Younger people also elect to have this procedure done to eliminate puffiness of the eyes from congenital excess fatty tissue.

Upper lid blepharoplasty can improve two common problem areas: 1.) excess skin on the upper eyelid itself, often called “hooding of the upper lid, and 2.) puffiness in the inner corner and middle of the upper eyelid caused by herniation (pushing forward) of fat.

This procedure is frequently done at the same time as other procedures, such as a lower eyelid blepharoplasty, facelift or forehead lift, and can be combined with laser or chemical resurfacing to smooth skin wrinkles. When drooping of the upper lids interferes with vision (a condition known as ptosis), the procedure may be partially or fully covered by insurance.

If you're considering upper eyelid blepharoplasty, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you consult a plastic surgeon who has completed a residency program that includes instruction in this procedure.

What are some of the most common benefits of this surgery?

What will happen at the initial consultation?

How is upper eyelid blepharoplasty performed?

How long does the surgery take?

Will I need to stay in a hospital?

How much pain is there?

What can I expect after surgery?

What is the recovery period like?

What is the long-term outcome like for most people?

Ideal candidate:

Alternatives:

Risks:

Other potential complications include:

Costs:

Questions to ask your doctor:

Be sure to:

How do I finance this procedure?

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What are some of the most common benefits of this surgery?

Upper eyelid blepharoplasty can make a remarkable difference in the appearance of the face, alleviating the appearance of tiredness and old age. The eyes appear fresher and more youthful, and these results may last for many years. The degree of improvement varies from patient to patient.

What will happen at the initial consultation?

During the consultation, you and your surgeon will discuss the changes that you would like to make in your appearance. He/she will explain the different options available to you, the procedure itself, and its risks and limitations. He/she will also explain the kind of anesthesia required, surgical facility, and costs.

Your surgeon will begin by asking for a complete medical history, and then examine the skin and fat around your eyes. He/she may also examine your eyesight, peripheral vision, and tear ducts. You should tell him/her about any related symptoms you may have, including any dryness of the eyes, changes in vision or eye pain.

Be sure to as all the questions you have about the surgery, and ask to see photos of the doctor's recent patients, before and after surgery. Also ask for, and follow up on, patient references. Learning everything you can about your options, risks and benefits is the key to making an informed decision. See Questions to ask your doctor below.

How is upper eyelid blepharoplasty performed?

The upper eyelid incision is made in the natural skin fold. Excess skin and fatty tissue is removed, the muscles and orbital septum (a thin connective tissue membrane) may be tightened, and the incisions are carefully closed. The external incisions are hidden within the natural fold of the upper eyelids. Much of the operation is done with a very fine electrocautery, which controls any bleeding. The skin is then closed with very fine sutures.

How long does the surgery take?

Upper eyelid blepharoplasty generally takes about one to three hours to complete, depending on the technique used and the extent of the repair.

Will I need to stay in a hospital?

This depends on your preferences as well as your surgeon's. Upper eyelid blepharoplasty can be performed on an out patient basis, in the hospital, or in an ambulatory surgical suite under either general or local anesthesia.

How much pain is there?

Initially, you may feel a tight sensation around the eyes, with minor discomfort that lasts for a day or two. A mild pain reliever can be taken as needed. People who have had the procedure are often surprised at how painless eyelid surgery can be. Many times, isolated eyelid surgery can be performed under local anesthesia with a total recovery time as short as 7 to 10 days. Recovery time and privacy needs varies from person to person. If you are not too concerned if people are aware that you have recently had surgery, you may be able to return to light activities earlier.

What can I expect after surgery?

After surgery, the physician will lubricate your eyes with ointment to reduce dryness in this area. (Your vision may be blurred temporarily from the ointment.) The first evening after surgery, you should rest quietly with your head elevated. It will help to apply cold compresses to your eyelids. (Avoid any compress heavier than one ounce. A Ziploc bag with a few frozen peas works well.) Your blood pressure should be monitored to avoid bleeding complications that can affect vision. And, although you can be up almost immediately, you should limit your activities.

What is the recovery period like?

At first the incisions will probably be red and somewhat bumpy. Eventually, the resulting scar should become flat and inconspicuous. Your sutures (stitches) will be removed sometime within the first week.

The swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel better each day. Swelling and bruising varies considerably from person to person. Bruising typically disappears within seven to ten days. Within the first week you will be permitted to use makeup, if desired, to conceal any discoloration.

Your vision may continue to be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. You may receive eyedrops to help relieve any burning or itching.

For the first week, you'll need to avoid activities that dry the eyes, including reading, watching television, wearing contacts, and using a computer. Also avoid excessive blinking, which leads to increased swelling. You should also wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation. The eyes may tire easily for several weeks; frequent naps are helpful.

For the first three or four weeks, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and sports. Your surgeon will let you know when you are ready for exercise. Also avoid drinking alcohol, which can lead to fluid retention and delay recovery.

What is the long-term outcome like for most people?

The more alert, youthful look that this surgery provides is usually long lasting. Thin scars may remain slightly pink for six months or so, but can easily be concealed with makeup. They eventually fade to a thin, nearly invisible white line. The removal of fat is permanent, but the looseness of the skin and fine wrinkling of the eyelid area may return in the future.

Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time. If continued loss of skin tone in the forehead later causes sagging of the eyebrows, a forehead lift or second eyelid procedure may be performed.

Ideal candidate:

In general, the best candidates for upper eyelid blepharoplasty are people:

18 years of age or older
In good physical health
Psychologically stable
Understanding the procedure's outcome
Desiring correction of droopy, baggy eyelids
With no known ophthalmic conditions such as glaucoma or detached retina
With no known medical conditions such as high blood pressure, circulatory problems, hypothyroidism or other thyroid related conditions.
Having realistic expectations for the outcome

The above is only a partial list of the criteria that your surgeon will consider in determining whether or not this procedure is appropriate for you. Be sure to ask your surgeon if he / she considers you an ideal candidate for upper eyelid blepharoplasty.

Alternatives:

Upper eyelid blepharoplasty is frequently combined lower eyelid blepharoplasty, or with a face lift or forehead lift as part of an overall facial rejuvenation procedure. It can also be combined with laser resurfacing or chemical resurfacing to further enhance the results. Usually, a cosmetic surgeon will recommend the resurfacing as a separate procedure, although it can be combined in certain situations.

Risks:

Significant complications from upper eyelid blepharoplasty are infrequent. As with any surgical procedure, however, there is always a possibility of infection, or reaction to the anesthesia.

Other potential complications include:

Retrobulbar hematoma - (bleeding behind the eye) - rare, but can cause loss of vision
Temporary problems with excessive tearing
Decreased sensation in the eyelid
Dryness, burning, stinging, gritty sensation in your eye(s)
Prominence or firmness of the scars
Asymmetry in healing or scarring
Milia or whiteheads where the sutures emanate from the skin.
Difficulty closing their eyes completely; in rare cases, this condition may be permanent. Further surgery may correct this problem.

You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your eyelid surgery. Pre-existing conditions can also put you at risk, including thyroid problems, insufficient tear production or dryness of the eye, elevated blood pressure, circulatory disorders, cardiovascular disease, and diabetes. If you have any of these conditions, discuss this with your surgeon before proceeding with this procedure. ). In this case, your surgeon may require a clearance from your general practitioner or other physician.

Costs:

The national average of 1999 surgeon fees for blepharoplasty was $2,395. Regional averages: New England states: $3,063; middle Atlantic states: $2,254; north central states: $2,199; south central states: $2,143; and mountain/Pacific states: $2,378. These fees do not include anesthesia, operating room facility, hospital stay and other related expenses. If your surgeon or opthamologist decides that this surgery is medically indicated (usually because your eyelids are obstructing your peripheral vision), the procedure may be covered by medical insurance.

Use our payment calculator to see what your monthly payments might be if you financed this procedure.

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Questions to ask your doctor:

Are the desired results I described realistic?
Where is the surgery performed? How long will the procedure take?
What kind of anesthesia is used?
How much does it cost?
What is your experience in performing this procedure? (How long has he/she performed this procedure, and how many he/she has performed in the past year?)
What percentage of patients have had significant complications? (The physician should disclose this information to you.)
Will you repeat or correct procedures if it does not meet agreed upon goals? And if the procedure must be repeated / corrected, will I be charged again? (The physician should provide you with his/her policy on this issue.)
May I see "before and after" photos of recent patients? The physician should provide many photos of recent patients.
May I have the names and contact information for several recent blepharoplasty patients? (Follow up to get first-hand information on the procedure and the surgeon.)
Could I observe the exact procedure I am considering before I decide to have the surgery? (Either on videotape or ask to view one in real life.)
What should I expect post-operatively, in terms of soreness, what to watch for, medication, bathing, and level of activity?
Who will be assisting during the surgery? What are their qualifications? (Does the plastic surgeon perform the entire surgery?)
Have you ever had your malpractice insurance coverage denied, revoked, suspended?
Do you offer patient financing?

Be sure to:

Tell your doctor about any allergies you have (to foods, drugs, environmental elements)
Tell your doctor about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
Carefully follow any instructions your surgeon gives you regarding eating and drinking, smoking, and vitamins.
Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
Arrange for someone to drive you home after surgery.

Tell your doctor if you have any of the following pre-existing conditions:

thyroid problems such as hypothyroidism
insufficient tear production or dryness of the eye
elevated blood pressure or other circulatory disorders
cardiovascular disease
diabetes
ophthalmic problems
any other serious medical condition(s)

The information on this web site is only intended as an introduction to this procedure and should not be used to determine whether you will have the procedure performed nor as a guarantee of the result. The best method of determining your options is to consult qualified surgeons who are able to answer specific questions related to your situation.

How do I finance this procedure?

Did you know that 29% of all Americans have considered having an elective procedure? Of those, 60% would schedule a procedure immediately if financing was available. With iEnchance's patient financing options, money no longer has to be the barrier between you and your new image. By filling out our on-line application you can qualify for a loan in as little as 30 seconds.

Please review the following articles for more information on this procedure.

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