Premiere Plastic Surgery

Your Consultation

During the initial consultation, your surgeon will ask for a complete medical history and will conduct a careful examination to evaluate your overall health. After that, the doctor will ask you to describe your concerns with regards to your eyelids. A careful and thorough evaluation of your health will be done before the evaluation of your eyes to check for any other conditions that may bring complications to the upcoming procedure. Examples of these conditions are visual impairment or inadequate tear production, thyroid diseases, allergy and glaucoma. During the consultation, the doctor will also advise you of other appropriate procedures to be able to achieve the best results. 

Blepharoplasty can be an isolated procedure, but also can be done in conjunction with other facial cosmetic procedures, or in addition to other procedures (such as liposuction and breast surgery) done elsewhere on the body. 

There may be circumstances where you will be asked to have a complete evaluation by your personal physician or ophthalmologist prior to surgery. Referrals may be given if needed. 

You will be provided with pre- and post-operative instructions and all necessary prescription medications before the date of your surgery. You will also be given a list of vitamins and homeopathic medications that helps in promoting faster recovery and healing. You will receive a list of anti-inflammatory and aspirin-containing medications which should be avoided for at least three weeks before and after surgery.

Blepharoplasty Procedures

Blepharoplasty is done on an outpatient basis in a surgical center. Blepharoplasty can be performed under intravenous sedation, known as twilight sleep, or under a light general anesthesia. Local anesthesia is administered around the eyes in all cases, and in certain cases, the entire procedure may be done under local anesthesia only. 

Prior to surgery, the doctor will carefully mark the location of the incisions to be made. You can be assured that every effort will be done to assure that the incisions are placed in the most inconspicuous locations to maximize cosmetic healing and preserve natural eyelid shape and mechanical function. The amounts of skin and fat to be removed from each eyelid will be measured precisely to assure symmetry. Pinpoint electrocautery will be used for the fat removal and dissection to insure an almost bloodless operation. In effect, this will minimize bleeding as well as subsequent bruising and swelling, leading to a speedier recovery. All incisions are then carefully closed with ultra-fine sutures. 

For the lower eyelids, excess fat is removed either through the traditional skin-muscle flap technique or through the lining tissue of the lower eyelid, more commonly known as the trans-conjunctival technique. In certain cases, the arcus marginalis release technique is used where the lower eyelid fat is preserved and used to fill the hollow, dark circle or prominent lower border of the bony orbit. The excess lower eyelid skin can then be directly trimmed or resurfaced and tightened using chemical or laser resurfacing techniques. 

Blepharoplasty takes from one to two hours as an isolated procedure. 

Below are the different types of Blepharoplasty procedures: 

Traditional Blepharoplasty

The incision is made in the crease of the upper lid towards the corners of the eyes. After healing, this incision would not be noticeable when the eyes are open. Then, on the lower lid, the incision is made just below the lash line towards the corner of the eye. This incision will be hidden by lashes when healed. 

Trans-Conjunctival Blepharoplasty

This is a newer technique for lower eyelid blepharoplasty that involves an incision inside the lining of the lower lid. Fat can be removed through this incision. In order to attend to excess skin, a pinch of skin can be taken, or the lower eyelid skin can be tightened using chemical peeling or laser resurfacing, without the actual removal of skin. The upper eyelids are treated using traditional techniques only if required. 

Lateral Canthopexy or Canthoplasty

This procedure is performed in conjunction with a traditional lower blepharoplasty. It is normally reserved for patients with excessive laxity of the lower eyelid. Canthopexy is sometimes needed when large amounts of excess lower eyelid skin require removal, and where lower blepharoplasty alone might result in an abnormal appearance of the lower eyelid. This may make the eye appear somewhat narrower or less rounded. 

Laser Eyelid Resurfacing or Chemical Peel 

This is a non-surgical alternative procedure that may delay the need for a surgical blepharoplasty. Laser or chemical peel resurfacing causes a significant tightening of the skin around the eyes, but will not affect the fat around the eyes. It could also help improve dark pigmentation accumulating around the eyelid region. Laser or chemical peel resurfacing can be carried out alone or in conjunction with traditional or trans-conjunctival blepharoplasty techniques.

Recovery

An hour after surgery, you will be cared for in the recovery room where nurses will apply cold compresses to the surgical area to minimize swelling. You can be discharged soon after you wake up, fresh and alert from the procedure. 

Please make sure someone is able to assist and drive you home and be available to care for you continuously for the first 24 hours. The area around the eyes may remain puffy and slightly discolored for a few days following the surgical procedure. 

Here are our recommendations for a smooth recovery: 

• Keep your head elevated at all times for the first several days after surgery. 

• Continue to use cold compresses to minimize swelling and bruising, which should begin to subside on the second or third day after the procedure. 

• There should be minimal or no pain at all after the surgery, although pain medications will be given for use only if needed. 

On some occasions, you may experience a dry and scratchy sensation on the eyes, with excessive tearing and sensitivity to bright light. This condition does not usually come about, and the use of eye drops during the day and eye ointment at night will help lessen its occurrence. Also, some blurring of vision or transient double vision is normal after this procedure, and you may notice the eyes to be easily tired while reading or watching television. 

In four to seven days, the stitches will be carefully removed. The swelling and bruising may persist for up to 10 days. Women can start wearing makeup to help conceal it after about 5 days, or after healing of the skin is complete, if you have had laser or chemical peel resurfacing of the eyelid skin. 

From a week to 10 days, you may anticipate to resume normal work and social activity. Wait for 10 days to wear your contact lenses. In 10 to 14 days, you may do some exercise or other strenuous activities. From within 6 months to a year, your incisions will start to fade. 

Risks

It is rare for complications to happen after a Blepharoplasty procedure. It may be highly unlikely, but some of these complications include: 

• Dryness or irritation of the eyes. 

• Bleeding and swelling. 

• Delayed wound healing or infection. 

• Drooping of the upper or lower eyelid, asymmetry, and double vision. 

In the event of the following, it is usually advised to have additional surgery to correct these problems. 

Frequently Asked Questions

Q: Will this surgical procedure improve my peripheral vision? 

A: If excessive upper eyelid skin and a drooping lateral brow is the reason for the impairment of your vision, blepharoplasty alone will not improve your peripheral vision, a combination of the brow lift and upper blepharoplasty will be required. 

Q: Is the Blepharoplasty going to be painful? 

A: Usually, there is minimal discomfort for the patient after this surgical procedure. Some patients might feel a scratchy sensation in the eyes because of the dryness or possible irritation of the cornea during surgery. This is usually controlled by the use of eye drops during the day or ointment during the night. If there is any other pain observed, do not hesitate to ask for a consultation. 

Q: Is it normal for my eyes to be unable to close completely after this procedure? 

A: Your eyelids may not close properly or completely during the first few days after the blepharoplasty due to swelling and tightness. 

A few instructions to share: 

• Wear dark sunglasses when going outside to protect the eyes against excessive brightness and wind exposure. 

• Sleep with your head elevated on two pillows. 

• Massage your eyelids as instructed, and use iced compresses to speed up the resolution of your eye's swelling. 

Q: When can I wear makeup after the procedure?

A: Women can start wearing makeup after the stitches are removed. Although, if you have had laser or chemical peel resurfacing of the eyelid skin, please make sure the skin is completely healed before using makeup. 

Q: When can I wear contact lenses?

A: Patients sometimes develop a condition called chemosis after the procedure which is a transient, gelatinous-appearing swelling of the lining layer over the white portion of the eyes. The swelling usually resolves within the first 10 days after surgery. After 10 days, patients may resume the use of contact lenses. 

Q: How soon after the procedure can I shower or bathe?

A: Soap and water will not harm your sutures so you may shower, bathe, or gently wash your face and eyelid area immediately after your blepharoplasty. Afterwards, apply a thin layer of ophthalmic ointment to your external suture lines to soften dried blood on the suture lines, if there are any. In the occasion that the eyelids and eyelashes feel stuck together, just gently wash with soap and water or use a warm compress around the area. 

Q: When can I start doing my normal activities after Blepharoplasty?

A: You may gradually resume your usual physical activities approximately one week after Blepharoplasty if you have normal blood pressure. If medications control your blood pressure, make certain that your baseline blood pressure is within the normal range before doing exercises. Patients are reminded that they should avoid strenuous activities or any actions that may require bending where the head will be below the heart level. This tends to increase pressure in the small veins around the eyes that may lead to delayed bleeding complications. 

Q: Can Upper or Lower Blepharoplasty change the shape of my eyes?

A: In certain cases, blepharoplasty can change the shape of the eyes, making it rounder or more open. Also, it is not unusual for the two eyes to appear kind of different from one another right after the procedure. As the healing progresses and the swelling goes down, you will be able to adjust to your improved appearance. 

Q: Will Blepharoplasty resolve my crow’s feet? 

A: No, it will not. 

Q: Will my Blepharoplasty be covered by insurance?

A: Insurance generally does not cover blepharoplasty unless an optometrist or ophthalmologist documents an impairment of lateral (peripheral) vision. Oftentimes, patients do not meet insurance criteria for their operation to be covered by it.