I am being treated for dry eyes, but want to have Eyelid Surgery. Is this safe, or should I see other treatments?
Doctor Answers 7
It will be impossible to provide you a definitive answer in this forum.
Consider Nonsurgical Eyelid Rejuvenation Techniques To Avoid The Surgical Risk
The use of fillers, such as Belotero Balance combined with a small amount of a whitish-colored calcium-based filler, Radiesse, injected into the darkened, hollowed areas of the lower lid can restore both the lost volume to the region and lighten the color. There is also a suggestion of slight flattening of the wing of the upper inner cheek to the sides of the nose. A small amount of Juvederm UltraPlus XC injected directly into this region would not only revolumize the area, but would serve to provide more appropriate fullness, in addition to secondarily buttressing the region (i.e. providing a platform) under the eyes. Injections take only about ten minutes to perform and, in fact, is a nonsurgical approach often used these days in lieu of eyelid surgery to treat crinkles, tear troughs, hollows and dark circles.
To improve the upper lids, a nonsurgical browlift (check out the archives of Realself.com for more details), using volumizing fillers and Botox might be helpful for raising the brows a bit and improving the problem. However, with this degree of ptosis, The Ten Minute Eyelift, a procedure I developed over fifteen years ago, would be my first choice.
The technique is quite simple in experienced hands and literally takes about five minutes per side to complete. The "underbelly" of the excess skin (the part hidden from view) is first anesthetized with local anesthetic--making the procedure painless. Next, the focal areas to be treated are marked in a discontinuous, fractionated fashion--not in a continous line-like fashion. Finally, a simple cautery is then used to treat these focal areas
Almost immediately, the skin contracts vigorously in response to the probe, drawing the hooded portion of the lid backwards and upwards over the surface of the underlying normal lid. As it does so, the underlying eyelid is exposed and restored. Each wound is then covered with only a small amount of antibiotic ointment and left to heal spontaneously. The discontinuous, focal, nature of the little wounds typically leaves barely visible marks when completely healed--very much like when a dermatologist removes keratoses or skin tags from the upper lids in this fashion.
Healing is usually complete in seven to ten days. Slight bruising and mild swelling are common afterward and may take about a week before becoming less noticeable. Cold compresses can be used in the first 48 hours to minimize the bruising and swelling. This may be supplemented by the oral use of bromelain for three days. Bromelain, an enzyme, is a pineapple derivative that has demonstrated usefulness in preventing bruises and speeding their resolution. Pain medications are seldom necessary, but for some people who experience mild discomfort, acetaminophen (Tylenol) is ordinarily adequate. Most people can return to work the following day. I performed the procedure on myself a number of years ago standing in front of a mirror and hours later took a twelve hour transatlantic flight.
One treatment is ordinarily all that is required. The results are permanent and can be fully appreciated in just two weeks. When completely healed, faint, narrow, ivory or off-white lines are often all that can be seen at the treatment site, which are not visible when the eyes are open.
Consultation with a board certified core aesthetic physician with expertise and extensive experience in treating the periorbital area in concert with your ophthalmologist is strongly advised.
Lower eyelid surgery requires special techniques for patients of dry eyes
A very common complication of lower eyelid surgery is a downward pole of the lower eyelid called ectropion.
Ectropion if it occurs in a patient with dry eyes can be catastrophic can require significant reconstructive surgery.
Please see an expert oculoplastic surgeon for an evaluation. In some patients a canthoplasty or canthopexy can be performed during a lower blepharoplasty to improve the dry I and lessen the risk of problems afterward.
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It is possible for patients with dry eyes to have a blepharoplasty, but be conservative!
It is important to discuss your needs, wishes, recovery time constraints, and budget limits with an honest and experienced surgeon, and receive bias-free personal advice. ALWAYS consult a surgeon who is certified by the American Board of Plastic Surgery, to ensure the highest standards of ethical practice and safe surgery.
Reza Momeni, MD FACS
American Board of Plastic Surgery
American Society of Plastic Surgeons
American Society of Aesthetic Plastic Surgery
* The above commentary is not personal medical advice, and is intended for general education on the internet.
Dry eye and blepharoplasty
Dry eye patient wanting eyelid surgery
These answers are for educational purposes and should not be relied upon as a substitute for medical advice you may receive from your physician. If you have a medical emergency, please call 911. These answers do not constitute or initiate a patient/doctor relationship.