What is the goal of eyelid surgery?

The goal of aesthetic eyelid surgery is to restore a fresh appearance to the upper face. The optimal surgical plan will produce a clean and fresh look to the eyes without actually changing their expression or shape. A less tired look results without telltale signs of surgery.

How is this accomplished?

Rejuvenation of the eye area is achieved by performing one or more of the following procedures: removing excess upper eyelid skin and fat, removing excess lower eyelid fat, repositioning lower eyelid fat to eliminate circles, and removing excess lower eyelid skin.

Who is a candidate for eyelid surgery?

Aging changes begin around the eyes in the mid-thirties. Most women become candidates for eyelid surgery in their early forties and men about ten years later. A common early complaint in women is wrinkled upper eyelid skin that looks aging and interferes with makeup application. Men also complain of heavy upper eyelids but usually not until much later in life. Both men and women are troubled by bags and circles under the eyes. Sometimes loose or darkened skin contributes to the problem. All of these issues can usually be effectively addressed by surgery.

Do I need both my upper and lower eyelids done?

Early candidates for upper eyelid surgery frequently do not need their lower eyelids done at the same time. On the other hand, young individuals without upper eyelid aging changes that have hereditary lower eyelid bags and circles will benefit from lower eyelid surgery alone. Older patients usually exhibit aging changes in both the upper and lower eyelids that warrants a combined procedure. Doing one without the other in this setting often makes the untreated area more apparent by comparison afterwards.

Where are the incisions used in eyelid surgery?

Upper eyelid incisions are placed within the natural eyelid crease. The scars are not visible with the eyes open. They are permanent, like all scars, but are typically very subtle after healing is complete. Lower eyelid surgery that just involves fat bag treatment does not require a visible external incision. The fat can be accessed through an incision on the inside of the eyelid. If there is loose lower eyelid skin then an incision just under the eye lashes is used to tighten it. This incision also heals extremely well and is eventually difficult to detect.

What about the heaviness between my eyes?

Some individuals have deep vertical furrows between their eyebrows and heaviness of the inner eyebrows that together convey an angry look. This is due to chronic overactivity of the small corrugator muscles located underneath the inner part of the eyebrows. This area can be effectively smoothed out by using injectable paralytic agents such as Botox. These injections must be repeated every four to six months to maintain the effect.

What are dry eyes?

Some individuals have either decreased tear production or other physiologic defects that result in dry eye symptoms. These symptoms include eye irritation, itching, and paradoxically, watery eyes. This condition often develops with age. Eyelid surgery can produce these symptoms in unaffected put prone individuals, or worsen established symptoms. Those with suggestive symptoms should be seen by an ophthalmologist and tested prior to surgery.

Surgery can be performed conservatively in those with minimal dry eye symptoms but is not recommended in others more severely afflicted. It may be necessary to perform upper and lower eyelid surgery in two separate stages for maximum safety in patients with borderline dry eye symptoms.

What are malar bags?

Malar bags are small puffy areas sometimes seen on the cheekbone below the lower eyelid. They randomly occur in some individuals and often appear worse on one side. Unfortunately, there is no effective treatment for malar bags and they persist after successful lower eyelid surgery.

How long do the benefits of surgery last?

The beneficial effects of eyelid surgery last for decades. Browlifts rarely need to be repeated. While some develop small amounts of additional excess upper eyelid skin after many years, most patients have only one operation and remain pleased.

Where is the surgery performed and how long does it take?

Eyelid and browlift surgery is performed in the operating room or a procedure room as an outpatient procedure. Operating time correlates with the scope of the procedure, both reflecting the severity of the aging changes. Upper eyelid surgery requires about 30 minutes. Lower eyelid surgery ranges from 30 minutes to one hour.

What type of anesthesia is used?

Surgery is usually performed with deep intravenous sedation combined with local anesthesia. There is no awareness. A board certified anesthesiologist is present for the procedure and uses state-of-the-art monitoring equipment.

What are the risks associated with eyelid  surgery?

Eyelid surgery is seldom associated with complications. The most common complication is a hematoma, occurring in about one percent. A hematoma is an accumulation of blood that forms a lump under the skin. It usually requires removal in the operating room but does not adversely affect either short-term recovery or the long-term result. However, a hematoma occurring deep within the orbit can threaten vision and requires prompt treatment. Fortunately this is an exceedingly rare event. Other problems such as infection, eye irritation, delayed healing or excessive scarring are possible but unusual. Weak lower eyelids can droop after surgery and may require a corrective procedure. Patients prone to dry eye symptoms may experience worsening of their symptoms after surgery. This is usually temporary but in more extreme cases can be permanent.

Why is smoking so harmful for surgery?

Smoking severely reduces blood supply to the skin and also delays healing. It is therefore essential to stop smoking completely for at least three weeks before surgery. Simply cutting back is not enough. Nicotine containing patches and gum are equally harmful.

What is the recovery like?

Patients leave the office without any bandages. Cool compresses are placed over the eyes for the first twenty-four hours. It is not necessary to stay in bed. Vision is usually slightly blurred due to swelling and eye ointment used during surgery. This usually resolves in a few days. Most patients describe having low grade discomfort only. The corners of the eyes are sometimes painful for a few days in those requiring a lower eyelid tightening procedure..

Eyelid stitches are removed by six days. Regular eye glasses hide much of the bruising after a week. Most of the swelling and discoloration is gone by two weeks. A light cover-up may be applied to the lower eyelids beginning one week after surgery, or by two weeks if a chemical peel has also been performed. For women, other facial and eyelid makeup including mascara, eye shadow, and eyeliner may be conservatively applied beginning one week after surgery.

Flying and driving are not recommended for two weeks. Walking outdoors can begin after a few days, weather permitting. Mild cardiovascular exercise without impact such as a stationary bike can begin at two weeks. It is best to wait as long as six weeks before resuming more intense exercise and activities such as jogging, weightlifting, ball sports, yoga, pilates, skiing, and horseback riding.

What are some of the limitations associated with eyelid and forehead surgery?

There are pre-existing conditions that can adversely influence surgical outcomes. These include poor skin elasticity, heavy wrinkling, severe sun damage, deep lower eyelid hollows, very prominent eyes, very dark lower eyelid skin color, weak lower eyelid tone, previous eyelid surgery, previous injections with fat or other substances, and a history of dry eye symptoms. The best surgical effort will likely achieve a more modest result in the presence of one or more of these factors.

What are the costs involved in having surgery?

There are separate fees for surgery, anesthesia, and operating room use.

What are the steps involved in proceeding with surgery?

At the initial consultation your eyelids and forehead will be evaluated and a surgical plan proposed, provided that you are a good candidate for the procedure. Once the plan is agreed upon a surgical date can be scheduled. Photographs and preoperative laboratory studies follow. Patients with significant medical conditions will need to obtain clearance from their internist or other specialist beforehand.