Blepharoplasty refers to eyelid surgery which is designed to remove the excess fat, along with skin and muscle, from the upper and lower eyelids. It is the second most common cosmetic procedure performed with about 50,000 persons having the procedure in the United States each year.
Eyelid surgery can correct drooping upper lids which can hang down and interfere with peripheral vision. By removing the excess wrinkled skin, blepharoplasty “opens up” the eyes and gives the face a fresher, brighter, and more youthful and rested appearance. During lower eyelid surgery, bulging fat is removed, as well as a minimal amount of skin. Thus blepharoplasty procedure improves over-hanging eyelid skin in the upper lids and removes the puffiness and swelling of the lower eyelids.
Eyelid surgery is very successful in patients who have been properly educated and have reasonable expectations. Realistic expectation on the part of the patient is critical to success. Sagging tissue of the eyelids and bulging fat pads can certainly be removed.
No, the blepharoplasty surgery will not be able to achieve all of this. As the skin tightens, many wrinkles go away. Some fine ones may not. Dark circles under the eyes may improve a bit if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.
Dark circles may be treated by lower eyelid surgery if it results from shadowing due to bulging fat or bags. If the dark circles result from pigmentation changes of eyelid skin, skin bleaching creams or light chemical peels may improve this condition.
When someone complains of the appearance of the upper eyelids, the first thing we do is evaluate whether the problem is excess skin in the upper eyelids, or if the eyebrows have lowered in position over time. If the eyebrows are in good position, then we can perform the upper eyelid surgery to remove the excess skin. If the eyebrows are particularly low, the doctor raises the patient’s forehead skin by hand to an appropriate level. If most of the upper eyelid skin disappears, a patient would most likely benefit from a forehead lift.
People look older and more tired once aging skin creates baggy or puffy eyelids, and since this occurs much earlier than wrinkles in the face, it is common for people to elect eyelid surgery years before they need a facelift.
A natural part of the aging process is the development of wrinkles, often around the eyes. Skin around the eyes also becomes less elastic, resulting in droopy eyelids. Sometimes this happens at an early age. You may start working your forehead muscles harder in an effort to lift your drooping eyelids. This may cause brow aches and fatigue. If you are having these symptoms, or simply do not like the way your eyelids appear, you may be a candidate for a blepharoplasty.
No, the best patients are those who are healthy, psychologically stable and well motivated. Patients with significant eye problems like glaucoma or dry eyes may not be eligible. Uncontrolled high blood pressure or thyroid disease is also of concern. If you are on a blood thinning medication, you are not a candidate for eyelid surgery. Through consultation and examination, we can determine if you’re a candidate for this rewarding procedure.
There is no correct age for obtaining eyelid surgery. Excessive skin in the upper lids, or bulging fat in the lower lids are commonly seen with signs of aging. The exact age depends on your heredity. Certainly, women in their forties and fifties comprise the majority of patients. If you are in good health without serious eye problems, your age alone should not keep you from having this procedure.
If drooping of your eyelids is interfering in your field of vision, the blepharoplasty procedure may be covered as a “medically necessary” surgery. Before surgery, your ophthalmologist will perform a comprehensive eye examination. Photographs are often required by insurance companies before surgery to determine if the procedure is medically-necessary. A visual field exam may be ordered to determine the extent to which the upper lid is interfering with your vision. Final decision is made by your insurance carrier after reviewing your condition. Lower eyelids are not covered by insurance unless there is a deformity. Patients should check with their insurance carrier about their coverage. As a general rule, insurance does not cover cosmetic surgery.
Most of the time there is no visible scar after the healing is complete. Incisions in the eyelids are made following natural skin folds and creases. Once healed, the hairline scars will fade, leaving a very inconspicuous incision line that becomes virtually unnoticeable after the healing.
If you have pierced ears, the way you healed there is a good indication of how you will heal from facial plastic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery. At the time of your consultation, it’s important to show your physician any previous scars (called keloid scars) that are of concern so he can give you a realistic assessment of your healing potential following facial plastic surgery. If you have a history of abnormal scarring, there are medications that can be used to help prevent excess scarring.
Your surgeon will show you how the crease can be created on your eyelid, and discuss with you where you would like it to be placed. The final decision is yours, together with what Dr. Tandon feels would work well with your own eyelid shape.
The goal is to create a permanent crease. Generally speaking, the benefits of a blepharoplasty are long lasting, and few people need to have the procedure done a second time. Fat that has been removed will not come back. Of course with aging, the skin gets looser and can hang down. The procedure cannot alter or retard the natural aging process. But the crease generally is permanent.
Eyelid surgery is usually performed by giving small local anesthesia injection to numb the deeper tissues. Generally, there is no pain during surgery. If you are very nervous, you will be given a Valium pill to help you relax. A light intravenous sedation is also given. Patients are awake during surgery. Patients do not feel anything and are comfortable during surgery. Eyelid plastic surgery is commonly done on an outpatient basis. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following surgery.
In conventional technique, a knife is used to cut the skin and remove the underlying fat. The skin is then closed with either regular or dissolvable sutures. In laser technique, CO2 laser is used to cut the skin and remove a thin strip of muscle and fat. Then stitches are placed to make the crease and close the skin. The stitches on the skin dissolve by themselves after a week or 10 days. Regular stitches may also be used.
The laser allows a much more precise surgery, with less swelling and bruising. During surgery proper care is taken to avoid any unnecessary exposure to the laser. There is no risk from the laser, and Dr. Tandon feels that there are important benefits in precision and faster recovery.
After any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. Patients have surprisingly little discomfort after most eyelid procedures. Generally over the counter Tylenol is all patients need (together with ice packs) placed over their eyes for 24 hours. An occasional patient will report unmanageable pain after surgery.
Your eyes are never patched closed. After surgery, patients usually spend at least one day resting with their head elevated on a pillow and often apply ice packs to reduce swelling. Some patients report a dull headache and tenderness or discomfort. You may also experience bruising and temporary numbness. Later on, you might experience some itching during the healing process.
Surgeon spends about half an hour with you discussing where the crease should go. The length of surgery depends on several factors including the complexity of each person’s eyelids. Usually, surgery takes about an hour.
No, you should not drive yourself. Someone will need to drive you home after your surgery and stay with you overnight. Someone will need to drive you back to our office for your first postoperative appointment.
Usually, patients look normal after about two to three weeks of surgery. Some patients heal faster, and others take longer. The crease is high just after surgery, and gets lower as the swelling resolves. You will look better at six weeks and even better still at six months. Final results are evaluated at one year. However, at two weeks you know you are well on the way to recovery. After three months, most patients have about 90% of their final result.
There is usually some swelling which gradually resolves after one to two weeks. There may be some bruising, but very little and this too fades rapidly. Women can camouflage bruises fairly easily at seven to ten days with make-up.
All surgeries have some risks. If performed by a competent surgeon, complications are infrequent and minor. The vast majority of these operations go perfectly well with excellent results and happy patients. All patients will experience some bruising and swelling for a few days after the surgery. The risk can include creases that do not form where they are planned, and can be too low or high, or not deep enough, or not exactly the same in both eyes. In addition, a temporary problem with closure of the eyelids is usually seen. Some may have temporary blurring of their vision, usually due to the ointments applied to the incisions post operatively. Any surgery has some risk of bleeding and infection. Wound disruption and heavy scarring are also possible. These are very rare in this surgery, and there are other complications are even less common. For some of these complications, a touch-up procedure might be necessary for correction. Dr. Tandon will discuss any possible risks with you before surgery is done, and answer all of your questions. Visual impairment is extremely rare. There may be some temporary sensitivity to bright light or wind and we recommend wearing dark glasses when outside.
New techniques have significantly reduced healing times. However, each patient’s healing time varies with the type of procedure performed, medical history and physical health. You can expect to go to your work place within a few days if you do not mind looking a bit swollen and possibly bruised. Many patients return to work in a few days wearing glasses. If your appearance is important then you need to take at least two weeks off.
You should plan to take it easy and put ice on the eyelids for two days, and not work out or play sports for a week. Aerobic and other exercise programs are not allowed for at least two weeks to decrease the risks of bleeding, swelling and bruising. More strenuous activities, such as weight-lifting and contact sports, are not allowed for at least one month. Absolutely no bending, lifting or straining during the postoperative period as these activities can increase swelling and delay healing.
It is very rare that a second operation is necessary. Rarely, the crease needs to be deepened or lengthened. Your surgeon will advise you on the pros and cons of a touch-up depending upon your unique situation.
Schedule a pre-op appointment with your eyelid surgeon at NeoVision Eye Center. In keeping with our efforts to maintain the highest standards of patient safety and in an ongoing effort to avoid possible complications, we ask that each of our blepharoplasty patients undergo an extensive and comprehensive eye exam by an ophthalmologist prior to surgery on the eyelids. During your pre-op visit, your health history will be reviewed, all your questions will be answered, you will be instructed on how to prepare for surgery, you will be given the prescriptions for use after surgery and we will tell you what to expect. If you are on blood thinners, you will be asked to stop them approximately two weeks prior to surgery. You will be asked to sign an informed consent. Full payment for your eyelid surgery is due at the time of your pre-op visit.
Informed consent means you have an excellent understanding about the benefits of surgery as well as any risks, and all the preoperative and postoperative information. You are making an “informed” decision as to whether surgery is right for you.
Yes. Postoperative prescriptions are provided well in advance of surgery day so you arrive home completely prepared. Postoperative prescriptions and over-the-counter medications for blepharoplasty patients include the following: an antibiotic ointment (Polysporin / bacitracin ophthalmic) to place on the sutures and gently in the corners of the eyes and pain medication as needed. You should start ointment the day of surgery. You will be asked to use ice pack for 24 hours after surgery.
Dr. Tandon will meet with you, examine you, discuss where you want the crease, discuss all the possible complications, answer all of your questions, and perform the surgery. Dr. Tandon, MD, PhD is a trained eye physician and surgeon from Stanford University. She is a Certified by American Board of Ophthalmology.
At NeoVision Eye Center, we believe the fairest approach is to offer eyelid surgery for one Flat Fee. That is why we offer one global comprehensive fee, which includes all pre-operative, surgical, and post-operative care. A price estimate will be given at your consultation for cosmetic surgery that includes the surgeon’s fee, fee for operating room, and fee for the anesthesiologist. Fees reflect the specific problem that you have and the extent of surgery to correct it. A typical fee for upper or lower eyelid surgery is $1500 for both eyes. In addition to our fee, you will be responsible for the payment to surgery center and anesthesiologist as needed. Surgeon’s global fee includes pre-operative examination, surgery and follow-up care for three months.
Most of these operations are cosmetic in nature and are not covered by insurance. In some older patients, if your vision is impaired by the excessive skin of the upper eyelids, some insurance plans will pay for all or part of the surgery. We will perform a test for visual field restriction, and if there is impairment in this area, we will dictate a letter of necessity for your insurance company. Final decision is made by your insurance carrier after reviewing your condition and the photographs. Lower eyelids are not covered by insurance unless there is a deformity. Patients should check with their insurance carrier about their coverage.
Before surgery, your ophthalmologist will perform a comprehensive eye examination. Photographs are often required by insurance companies before surgery to determine if the procedure is medically necessary. Final decision is made by your insurance carrier after reviewing your condition. Lower eyelids are not covered by insurance unless there is a deformity. Patients should check with their insurance carrier about their coverage.
Schedule a complimentary, no-obligation personal evaluation with your surgeon at NeoVision Eye Center to determine if you are a likely candidate for eyelid surgery. There is absolutely no-fee for this assessment, whether or not you choose to have the procedure done. Call toll free at 1-877-NEOVISION (1-877-636-8474).
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