One of the most frequently performed surgical procedures, upper eyelid blepharoplasty is used to remove the fatty deposits, loose skin and drooping that may form around the upper eyelids with age. Heredity and sun damage can accelerate these changes.
Younger people also elect to have this procedure done to eliminate puffiness of the eyes from congenital excess fatty tissue. Upper lid blepharoplasty can improve two common problem areas:
1. excess skin on the upper eyelid itself, often called “hooding of the upper lid", and
2. puffiness in the inner corner and middle of the upper eyelid caused by herniation (pushing forward) of fat
This procedure is frequently done at the same time as other procedures, such as a lower eyelid blepharoplasty, facelift or forehead lift, and can be combined with laser or chemical resurfacing to smooth skin wrinkles. When drooping of the upper lids interferes with vision (a condition known as ptosis), the procedure may be partially or fully covered by insurance. If you're considering upper eyelid blepharoplasty, the following information will provide you with a good introduction to the procedure. For more detailed information about how this procedure may help you, we recommend that you schedule a consultation with Dr. Kremer.
Frequently asked questions about Upper Eyelid Surgery (Blepharoplasty) by Dr. Michael A. Kremer:
Upper eyelid blepharoplasty can make a remarkable difference in the appearance of the face, alleviating the appearance of tiredness and old age. The eyes appear fresher and more youthful, and these results may last for many years. The degree of improvement varies from patient to patient.
During the consultation, you and Dr. Kremer will discuss the changes that you would like to make in your appearance. He will explain the different options available to you, the procedure itself, and its risks and limitations as well as the kind of anesthesia required.
Dr. Kremer will begin by asking for a medical history, and then examine the skin and fat around your eyes. He will also examine your eyesight, peripheral vision, and tear ducts. You should tell him about any related symptoms you may have, including any dryness of the eyes, changes in vision or eye pain.
Be sure to as all the questions you have about the surgery. Learning everything you can about your options, risks and benefits is the key to making an informed decision.
The upper eyelid incision is made in the natural skin fold. Excess skin and fatty tissue is removed, the muscles and orbital septum (a thin connective tissue membrane) may be tightened, and the incisions are carefully closed with very fine sutures. The external incisions are hidden within the natural fold of the upper eyelids. Much of the operation is done with a very fine electrocautery, which controls any bleeding.
Upper eyelid blepharoplasty generally takes about one hour to complete, depending on the technique used and the extent of the repair.
Upper eyelid blepharoplasty can be performed on an out patient basis, in the office or in an ambulatory surgicenter, under either local or general anesthesia.
Initially, you may feel a tight sensation around the eyes, with minor discomfort that lasts for a day or two. A mild pain reliever can be taken as needed. People who have had the procedure are often surprised at how painless eyelid surgery can be. Many times, isolated eyelid surgery can be performed under local anesthesia with a total recovery time as short as 7 to 10 days. Recovery time and privacy needs varies from person to person. If you are not too concerned if people are aware that you have recently had surgery, you may be able to return to light activities earlier.
After surgery, Dr. Kremer will lubricate your eyes with ointment to reduce dryness in this area. (Your vision may be blurred temporarily from the ointment.) The first evening after surgery, you should rest quietly with your head elevated. It will help to apply cold compresses to your eyelids. Although you can be up almost immediately, you should limit your activities.
At first the incisions will probably be red and somewhat bumpy. Eventually, the resulting scar should become flat and inconspicuous. Your skin stitches will be removed sometime within the first week.
The swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel better each day. Swelling and bruising varies considerably from person to person. Bruising typically disappears within seven to ten days. Within the first week you will be permitted to use makeup, if desired, to conceal any discoloration.
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. You may receive eyedrops to help relieve any burning or itching.
For the first week, you'll need to avoid activities that dry the eyes, including reading, watching television, wearing contacts, and using a computer. Also avoid excessive blinking, which leads to increased swelling. You should also wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation. The eyes may tire easily for several weeks. Frequent naps are helpful.
For the first three or four weeks, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and sports. Dr. Kremer will let you know when you are ready for exercise. Also avoid drinking alcohol, which can lead to fluid retention and delay recovery.
The more alert, youthful look that this surgery provides is usually long lasting. Thin scars may remain slightly pink for six months or so, but can easily be concealed with makeup. They eventually fade to a thin, nearly invisible white line. The removal of fat is permanent, but the looseness of the skin and fine wrinkling of the eyelid area may return in the future.
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. If continued loss of skin tone in the forehead later causes sagging of the eyebrows, a forehead lift or second eyelid procedure may be performed.
In general, the best candidates for upper eyelid blepharoplasty are people:
- 18 years of age or older
- In good physical health
- Psychologically stable
- Understanding the procedure's outcome
- Desiring correction of droopy, baggy eyelids
- With no known ophthalmic conditions such as glaucoma or detached retina
- With no known medical conditions such as high blood pressure, circulatory problems, hypothyroidism or other thyroid related conditions.
- Having realistic expectations for the outcome
The above is only a partial list of the criteria that Dr. Kremer will consider in determining whether or not this procedure is appropriate for you. Be sure to ask Dr. Kremer if he considers you an ideal candidate for upper eyelid blepharoplasty.
Upper eyelid blepharoplasty is frequently combined with a lower eyelid blepharoplasty, a facelift, or a foreheadlift as part of an overall facial rejuvenation procedure. It can also be combined with laser resurfacing or chemical peeling to further enhance the results. Usually, resurfacing will be recommended as a separate procedure, although it can be combined in certain situations. Dr. Kremer will discuss this with you if he thinks additional procedures would help your overall appearance.
Significant complications from upper eyelid blepharoplasty are infrequent. As with any surgical procedure, however, there is always a possibility of infection, bleeding or reaction to the anesthesia.
Other potential complications include:
- Retrobulbar hematoma (bleeding behind the eye). Rare, but can cause loss of vision
- Temporary problems with excessive tearing
- Decreased sensation in the eyelid
- Dryness, burning, stinging, gritty sensation in your eye(s)
- Prominence or firmness of the scars
- Asymmetry in healing or scarring
- Milia or whiteheads where the sutures emanate from the skin.
- Difficulty closing their eyes completely. In rare cases, this condition may be permanent. Further surgery may correct this problem.
You can help minimize certain risks by following the advice and instructions of Dr. Kremer, both before and after your eyelid surgery. Pre-existing conditions can also put you at risk, including thyroid problems, insufficient tear production or dryness of the eye, elevated blood pressure, circulatory disorders, cardiovascular disease, and diabetes. If you have any of these conditions, discuss this with Dr. Kremer before proceeding with this procedure. In this case, Dr. Kremer may require a clearance from your general practitioner or other physician.