Am I a good candidate for eyelid surgery?

Any one or combination of the following conditions may indicate that you may be considered a good candidate for eyelid surgery:

  • Excess skin obscuring the natural fold of the upper eyelids
  • Loose skin hanging down from the upper eyelids, perhaps impairing vision
  • A puffy appearance to the upper eyelids, making the eyes look tired
  • Excess skin and fine, "crepe paper type" wrinkles of the lower eyelids
  • Bags and dark circles under the eyes
  • Lower eyelid droopiness

Your Personal Consultation

How will my plastic surgeon evaluate me for aesthetic eyelid surgery?

During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help your plastic surgeon to understand your expectations and determine whether they can realistically be achieved.

You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems, diabetes, etc. should be reviewed as these medical conditions may increase some risks associated with eyelid surgery.

Your plastic surgeon will want to know if you have allergies, especially if they affect your eyes. He or she may ask whether you have ever tried and were unable to wear contact lenses. It will be necessary for your surgeon to know if you were ever told by an ophthalmologist that you have a condition called "dry eye" or if you have any other problems with your eyes.

Your Surgical Experience (Preoperative Preparation and Recovery) for Eyelid Surgery Pre-Operative

The goal of your plastic surgeon and the entire staff is to make your surgical experience as easy and comfortable for you as possible. If you are a smoker, it is highly recommended to stop smoking well in advance of surgery. Smoking can impair your ability to heal. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions. Aesthetic eyelid surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you for the next 24 hours.

The Day of Eyelid Surgery

Your eyelid surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing eyelid surgery, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your vision will be blurry as a result of ointment used to soothe and protect the eye during surgery as well as from the swelling that is a normal aftermath of eyelid procedures. There should be surprisingly little discomfort, however, from the surgery. You probably will be permitted to go home after a short period of observation, although some patients may stay overnight in the hospital or surgical facility.

How Aesthetic Eyelid Surgery is Performed

One of several surgical techniques may be suggested to improve the appearance of your eyelids. The particular technique that your plastic surgeon recommends will depend on many factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids. Because of individual factors, not everyone will achieve the same results from eyelid surgery. Your plastic surgeon will select the surgical technique that he or she feels will obtain the best outcome for you.

Upper Eyelids

For upper eyelid surgery, generally an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed. Because the incision follows the natural contour of the upper eyelid, it usually is inconspicuous.

Lower Eyelids

For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. As in upper eyelid surgery, placement of the incision in natural crease lines allows for the scar to usually heal in an inconspicuous fashion. In some cases, you and your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. A laser may sometimes be used in conjunction with this method to tighten the lower eyelid skin.

Understanding Risks

Fortunately, significant complications from aesthetic eyelid surgery are infrequent. Every year, many thousands of people undergo eyelid surgery successfully, without experiencing any major problem. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and your surgeon, or with a staff member in your surgeon's office. The risks in most surgeries are similar. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection, changes in sensation, scarring, allergic reactions, damage to underlying structures, need for revisions, unsatisfactory results possibly necessitating additional procedures and medical risks. Following the surgery, there can be a feeling of dryness or irritation in the eye that requires treatment. There is a possibility of impaired eyelid function that sometimes may need to be corrected by additional surgery. You can help minimize certain risks by following the advice and instructions of your plastic surgeon, both before and after your eyelid surgery.

Eyelid Surgery Recovery

It is important to realize that the amount of time it takes for recovery varies greatly among individuals. The first few days after surgery, you should rest quietly with your head elevated. Your surgeon may instruct you to apply cold compresses to your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications. Initially, you may feel a "tight" sensation around the eyes and some mild discomfort that can be controlled with oral medication. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. Some patients find that mild swelling persist for several weeks, while others may see swelling resolve in as little as one week. Bruising typically disappears within seven to ten days. Within the first week or so, you will be permitted to use makeup, if desired, to conceal any discoloration. Stitches are usually removed within a week of surgery.

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. Some plastic surgeons recommend eye drops to help relieve any burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation. Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Although you might feel like going back to work just a few days after surgery, your vision may still be slightly blurry which could make reading or other paperwork more difficult.

Results of Your Eyelid Surgery

Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months usually becoming barely visible. The results of aesthetic eyelid surgery are usually long-lasting, but they may be affected by heredity and lifestyle factors. Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along with the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure. 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.

Maintaining a Relationship with Your Plastic Surgeon

You will return to your plastic surgeon's office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Please remember that the relationship with your plastic surgeon does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact your surgeon.