Types of Blepharoplasty
For the upper lids, the most common procedure involves excising a thin strip of skin and muscle. For the lower lids, the approach can involve either a skin incision immediately below the lashes (transcutaneous) or through the conjunctiva (transconjunctival). Then, excess fat is removed to reduce the eyelid bags. Occasionally, a thin strip of skin is removed from the lower lid.
The anatomy of the eyelids is very complex, and differs between the upper and lower lids. Briefly, both lids are composed of outer skin, a middle layer of muscle that open the lids, and an underside called the conjuctiva which contacts the eye itself. In the lower lid, fat from the eye socket plays an important role in determining shape when too much fat is protruding into the muscle layer, then prominent bags will be seen. In the upper lids, excess muscle and skin cause problems by giving the lid a heavy, sagging look.
Suitable Patients for Blepharoplasty
Patients with excess skin, bags, or heaviness of the upper and/or lower lids make good blepharoplasty candidates. These patients will complain of looking tired or sad all the time, or looking like they are suffering from allergies. Ideal patients should also be in good health, and should be able to avoid blood thinning medications around the time of the surgery.
When you arrive at our Oakland plastic surgery office for a consultation, you will be asked to complete a detailed questionnaire about your medical and surgical history. Dr. Kabaker will then take standardized photographs and examine your eyelids closely. Most importantly, you will be given ample time to describe your complaints, and to learn about your proposed procedure and how it might help you.
As mentioned elsewhere in this website, we stress patient education. So, during the consultation, you will learn a great deal about the anatomic considerations that cause your complaints, how they will be changed, what you will experience during the recovery, and your risks and alternatives to treatment. You will be given much information in writing, and we are always available for a second consultation, if you wish to review anything.
The Pre-operative Process
For the two weeks prior to your procedure, you should refrain from using common medications that decrease your blood’s ability to clot, including aspirin, ibuprofen, Advil, Motrin, Bufferin, Naprosyn, and large doses of vitamin E. Our doctors will give you specific instructions based on your current medications. If you have any headaches or other pain, taking acetaminophen (Tylenol) is fine. You should also avoid smoking for two weeks before your surgery. The night before your surgery, you should eat a normal dinner but avoid all oral intake after midnight. This includes drinking anything, even water.
When you schedule your blepharoplasty, you will be given a detailed set of instructions that includes much more information. A copy of these Blepharoplasty Instructions is available for you to review now.
For the upper lids, an incision will be made across the top and bottom of the excess skin, and this skin will be removed. A small strip of muscle may also be excised, and then the edges will be sutured together carefully. For the bottom lids, excess fat will be removed, most commonly through incisions in the conjuntiva. It is possible that you will need a small amount of excess skin removed, in which case an incision will be made just under the lower lashes. If this skin incision is required, the scar is very well hidden by the lashes.
You will need to arrive about two hours prior to the start of your procedure. The entire procedure will take one to two hours, and you will stay in our recovery room about one hour. If you have sedation, someone should be with you to drive you home.
Blepharoplasties can often be performed with just a light sedation and local anesthesia. If other procedures are being done at the same surgery, then a deeper sedation will be used.
Eyelid Surgery Recovery
There is usually very minimal discomfort after eyelid surgery. Medications will be prescribed for you to control any pain you have. You will have mild swelling and bruising, which last about seven to ten days. Sutures placed in the upper lid incision will be removed after five to seven days. Usually there are no sutures in the lower lid. You should be able to return to light activities after one week, but heavy exertion and exercise should be avoided for up to three weeks. You should be aware that redness, and even small bumps, may be evident in the upper lid incisions for many weeks. While disconcerting, these problems do resolve.