Lower Eyelid Surgery

Important note: Lower eyelid blepharoplasty will not eliminate dark circles, fine lines or wrinkles around the eyes, or alter sagging eyebrows. To enhance the results of your eyelid procedure, your doctor may also recommend: 1.) a brow lift to correct a drooping brow and smooth the forehead, 2.) a facelift for saggy jowls, and/or 3.) skin resurfacing to eliminate fine lines.

Your surgeon will begin with a complete medical history and 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. You should also tell you’re your surgeon if you have 1.) thyroid problems such as hypothyroidism, 2.) elevated blood pressure or other circulatory disorders, 3.) cardiovascular disease, 4.) diabetes, or 5.) any other serious medical condition(s).

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.

1. An incision is made along the lash line, smile creases
2. Excess fat, muscle and skin are removed
3. Fine sutures are used to close the incision
4. Permanent stitches will be removed 3-5 days after the procedure

If you have a pocket of fat beneath your lower eyelids, but do not need to have any loose skin removed, your surgeon may recommend a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with fatty lower eyelids. Transconjunctival blepharoplasty does not tighten the skin, reduces the puffiness in the lower eyelid region.

1. Incision is made on the inside of the lower eyelid
2. Excess fat and muscle are removed (no tightening or removing of skin)

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.

Your vision may 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.

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.

• 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

Other potential complications include:

• Retrobulbar hematoma - (bleeding behind the eye) - rare, but can be serious. Symptoms include loss of vision
• temporary problems with excessive tearing
• decreased sensation in the eyelid
• dry eyes - dryness, burning, stinging, gritty sensation in your eye(s)
• prominence or firmness of the scars
• blurred vision
• asymmetry in healing or scarring
• milia or whiteheads where the sutures emanate from the skin.
• difficulty closing eyes completely; in rare cases, this condition may be permanent.
• ectropion, or a pulling down of the lower lids.

Further surgery is uncommon but often may be quite straightforward. 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. They include thyroid problems such as hypothyroidism, insufficient tear production or dryness of the eye, elevated blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. Caution should be exercised if you have ophthalmic problems, or other serious medical condition(s). In this case, your surgeon may require a clearance from your general practitioner or other physician.

1. Are the desired results I described realistic?
2. Where is the surgery performed? How long will the procedure take?
3. Am I good candidate for tranconjunctival blepharoplasty (inside lower eyelid surgery)? Why or why not?
4. What kind of anesthesia is used?
5. How much does it cost?
6. 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?)
7. What percentage of patients have had significant complications? (The physician should disclose this information to you.)
8. 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.)
9. May I see "before and after" photos of recent patients? The physician should provide many photos of recent patients.
10. 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.)
11. Could I observe the exact procedure I am considering before I decide to have the surgery? (Either What should I expect post-operatively, in terms of soreness, what to watch for, medication, bathing, and level of activity?
12. Who will be assisting during the surgery? What are their qualifications? (Does the plastic surgeon perform the entire surgery?)
13. Have you ever had your malpractice insurance coverage denied, revoked, suspended?
14. Do you offer patient financing?

• Tell your doctor about any allergies you have (to foods, drugs, environmental elements)
• 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)
• Tell your doctor about all medications, herbal supplements or natural supplements you are taking (both prescription and non-prescription).
• Be sure to tell your doctor if you smoke. Smoking can lead to complications and poor healing.
• Carefully follow any instructions your surgeon gives you regarding eating and drinking.
• Avoid aspirin and aspirin-containing medicines for two weeks prior to surgery.
• Arrange for someone to drive you home after surgery and help you for a few days afterward, if needed.

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