Blepharoplasty (Upper Eyelid)

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1. What is the history of upper eyelid surgery?
2. Am I a good candidate for upper eyelid surgery?
3. What does upper eyelid surgery involve?
4. How do I plan my upper eyelid surgery?
5. How do I prepare for upper eyelid surgery?
6. What results can I expect after upper eyelid surgery?
7. Where will my upper eyelid surgery be performed?
8. What type of anesthesia will be used for my upper eyelid surgery?
9. What should I expect after upper eyelid surgery?
10. When will I be able to return to work following upper eyelid surgery?
11. Are there any side effects associated with upper eyelid surgery?
12. Are there any risks associated with upper eyelid surgery?

What is the history of upper eyelid surgery?

The first upper eyelid surgery was performed in 1890 by two physicians named De Mars and Marx. The first upper eyelid in the United States was performed by Dr. Kelly nearly a decade later. Over the last century upper eyelid techniques have continued to be refined.

Am I a good candidate for upper eyelid surgery?

In order to determine if you are a good candidate, your upper eyelid consultation will require evaluation of several items. First, the surgeon must assess degree of skin redundancy or flaccidity. This will determine the extent of the skin excision that will be required. In addition, the surgeon will evaluate the extent of excess and/or protruding fat that you have over the central and medial (close to the nose) eyelid regions. These fat pockets are located in specific locations in the eyelid referred to as the medial and lateral compartments. Secondly, your surgeon will ask you about any recent visual acuity changes, history of dry eyes, or double vision. If any of these conditions are present, then you will require a thorough work up by an ophthmologist prior to considering upper eyelid surgery. Most patients demonstrating upper eyelid aging signs that result in a “tired” look are excellent candidates for this surgery. A few patients may demonstrate drooping of their lids due to poor muscle function, which may be treated by upper eyelid surgery but does require more extensive surgery involving repairing the “lifting” muscle of the eyelid in addition to just removing redundant skin and fat.

What does upper eyelid surgery involve?

The upper eyelid procedure incorporates eliminating excess skin and conservative removal of protruding eyelid fat. Amount of upper eyelid skin removed is dependent on the degree of skin laxity. While waiting in the preoperative area and while the client is awake, the amount of redundant skin can be marked so that over resection of skin is avoided. Recent studies on aging have revealed a propensity for loss of overall fat volume in the face and eyes. These studies have prompted surgeons to be more conservative with removal of protruding eyelid fat. Many older clients who had more aggressive removal of fat are now returning to surgeon’s offices with a hollowed out appearance of their upper eyelid, termed the “gaunt” look. Fat pads in the upper eyelid are found in the central (middle) and medial (next to the nose) compartment. Today, conservative removal of fat is advocated and usually involves the medial fat pad only.

How do I plan my upper eyelid surgery?

On your initial visit, the surgeon will evaluate your health status, determine the amount of skin redundancy, and check your blood work. If you are a smoker, then you should quit for 1 month prior to upper eyelid surgery in order to allow your body adequate time to rid itself of any residual nicotine. Nicotine in your system results in shutting off of small blood vessels, which carry nutrients to the skin, which will hinder your healing and possibly compromise your surgical incision healing. If you have been experience recent visual acuity changes, you should have your eyes checked in order to have a baseline vision test prior to surgery.

How do I prepare for upper eyelid surgery?

Since your surgery may be performed with local anesthetic solution and/or minimal intravenous sedation, you must make minimal precautions prior to surgery. First, you don’t have to avoid eating and drinking after midnight on the day before surgery. Since, you will be administered minimal sedation if any at all, you will have a quick recovery with minimal grogginess. Most patients comment on the ease of their postoperative recover requiring minimal pain medications. However, due to localized swelling of the upper eyelid tissue, patients should have a friend or spouse look over them and drive them from the office as they will have obscured vision for the first 24 hours.

What results can I expect after upper eyelid surgery?

Following upper eyelid surgery, patients can expect a youthful upper eyelid contour with a well-hidden surgical incision line. You will be amused by friends and family complementing you on looking well rested and asking you if you have done anything. Your aesthetically improved results will last you several decades. On rare occasion, patients may request a touch up but only 20 to 30 years following surgery.

Where will my upper eyelid surgery be performed?

Since eye surgery can be performed using local anesthesia only or with minimal intravenous sedation, it is not uncommon for your surgery to be performed even in an office setting. Even when performed in the office, patients must be fully monitored and cared for by appropriate nursing staff. Patients may also request to have their surgery performed under general anesthesia which would necessitate their surgery to be performed in an office based operating room, surgery center, or hospital setting. It is of utmost importance for patients to make sure that a surgical accreditation body such as AAAASF has accredited the office-based operating rooms.

What type of anesthesia will be used for my upper eyelid surgery?

Upper eyelid surgery can be performed under local anesthetic only, intravenous sedation, or general anesthesia. General anesthesia is recommended when synchronous surgeries are being performed such as a brow lift or facelift.

What should I expect after upper eyelid surgery?

When you wake up from your surgery, expect to find your visual capacity limited, as your eyelids will be swollen and your vision blurry secondary to ocular lubricant that is placed in your eyes. You will notice minimal pain, which will be well controlled with pain medications. You will need a caretaker for the first 24 hours as your eyelids will be swollen and you will have some difficulty maneuvering in the house; however, most patients feel that they are independent as early as the day following surgery. Expect your sutures to be removed within one week at which time you will find complete resolution of eyelid swelling and bruising.

When will I be able to return to work following upper eyelid surgery?

For patients who undergo a standard upper eyelid surgery, expect to return to work no later than 10 days following surgery. If your job does not require direct consumer interaction you may return to work as early as 4 days following surgery. You will have tiny clear sutures that will be removed at one week following surgery.

Are there any side effects associated with upper eyelid surgery?

Side effects are events that may be experienced by patients as a result of your surgery and should not be considered adverse events. Our patients are counseled regarding these effects and if experienced they are tolerable and often temporary in duration.

There are several side effects that have been associated with upper eyelid surgery and these include:

1. Inability to close eyes (lagophthalmos) is a temporary condition that is common over the early period following surgery. Patients may note quick resolution of this difficulty when it is caused by paralyzed muscles, which will recover once the local anesthetic, wears out in a few hours. Minimal lagophthalmos may be present and will resolve over one week. Even if too much skin has been resected, the brows will compensate by drooping down to accommodate tightness in skin until the skin stretches on its own over the first month.
2. Redness of incision lines may persist while the incision line is healing over the first month following surgery. This is expected following surgery, which involves placement of surgical incision lines. Fortunately, the incision lines are placed in the naturally occuring crease of the upper eyelid termed the supratarsal crease and are not readily visible.
3. Asymmetry of the eyelids may be present postoperatively especially when there is asymmetry present preoperatively. When significant asymmetry is present, patients should expect considerable improvement in symmetry as the surgeon makes all attempts to correct any residual assymetry. As such, patients should realize that upper eyelids are not always identical and minimal asymmetry may be present.

Are there any risks associated with upper eyelid surgery?

Risks are unwanted events that may occur during or following surgery. These events are recognized as “complications” but their occurrence is minimized by appropriate patient selection, proper surgical decision making, effective surgical technique, and thorough preoperative and postoperative patient management.

1. Bleeding or small hematoma may occur and refers to the accumulation of blood in the early postoperative period, which pools into a pocket. Since the skin of the eyelid is limited, hematomas must be drained immediately as any increased build up of fluid may result in disruption of your incision line and/or increase pressure on the eye itself.
2. Infection: An infection can occur following upper eyelid surgery but is very rare. The eyelid tissue as is the facial skin is very well vascularized and not likely to get infected. In addition, upper eyelid patients are provided antibiotic eyedrops, which should suppress any bacterial growth.
3. Dry eyes: Dry eyes may develop as a result of changing pressures on the eyeball caused by the tightening of the overlying eyelid skin. The increase in pressure is believed to affect the eye lubrication and draining system (lacrimal system) which keep the moistened at all times. Patients who have a propensity for dry eyes preoperatively should be cautioned about developing this risk. Fortunately, as the eye accommodates to its new state, dry eyes tend to resolve over several months.
4. Visual compromise: Although this is an extremely rare complication, it is conceivable that direct damage to the globe of the eye and/or the vascularity of the globe could occur resulting in blindness.
5. Deep vein thrombosis (DVT) may occur in the legs immediately following surgery when general anesthesia is used. DVT refers to the clotting off of leg veins which may result in compromised blood flow return from the legs; a more critical consequence may develop from this clot if it is dislodged and travels to the lungs causing a pulmonary emboli. Fortunately, this risk is not commonly a concern as most upper eyelid surgeries are performed under local anesthetic and/or intravenous sedation alone.