I am being treated for dry eyes, but want to have Eyelid Surgery. Is this safe, or should I see other treatments?

I have been undergoing treatment for dry eyes, but my lids are so bad, they are almost interfering with my vision. Would I be putting myself at risk if I have surgery? I also have very bad bags under my eyes, should I do injections as an alternative or is the surgery more effective in taking care of this?

Doctor Answers 7

It will be impossible to provide you a definitive answer in this forum.

Dry eye is very common.  Some people have dry eye that is more problematic than others.  For this reason, what you really need is a surgeon who will give you the right answer for you.  This is a problem because the surgeon makes their living performing surgery for there is an inherent conflict of interest.  There is really no avoiding this conflict so you need to proceed cautiously.  I recommend consulting with oculoplastic surgeons for eyelid surgery.  Unlike other surgical specialities like general plastic surgery (aka board certified plastic surgeon) and facial plastic surgeons, oculoplastic surgeons are board certified ophthalmologist who are deeply trained in eyelid plastic surgeon.  They will have the skill, training, and experience and just as importantly the actual equipment to determine the severity of your dry eye issue.  Unfortunately the conflict of interest is still there.  I personally have turned down patients for blepharoplasty due to dry eye.  I have also performed specially designed surgery for dry eye patients.  Primarily this entails doing a skin only blepharoplasty and not violating the orbicularis oculi muscle.  Hope this information helps.  Take it slow and get more than one opinion.  Talk with your treating ophthalmologist as well.

Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 26 reviews

Consider Nonsurgical Eyelid Rejuvenation Techniques To Avoid The Surgical Risk

Unfortunately, without photos, it is really impossible to say what course(s) of action would be best in this particular case. However, in general terms, there are currently a number of non-aggressive, nonsurgical approaches to rejuvenate the eye unit that pose little risk of causing or aggravating dry eyes. I have personally been using these methods to deal with ptosis (sagging) of the brows that gives rise to the appearance of the sagging and puffiness in the brow area and which can cause a large portion of the upper lids to be obscured. And I have also used them successfully to treat dark circles and tear troughs, and to camouflage bags under the eyes.

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.

Nelson Lee Novick, MD
New York Dermatologic Surgeon
4.9 out of 5 stars 30 reviews

Lower eyelid surgery requires special techniques for patients of dry eyes

The first and most obvious answer is that you should not have lower eyelid surgery if you have 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.

It is possible for patients with dry eyes to have a blepharoplasty, but be conservative!

Although it is possible to have blepharoplasty and upper eyelid surgery for patient who has history of dry ice, it is important for the plastic surgeon to coordinate this operation with the patient's treating eye doctor, and to make sure that the problem is not made worse.  Even patient's with no dry eyes will occasionallyexperienced a period of a few weeks with eyes that are dry after the operation, but usually with time and the use of eyedrops and artificial tears, disc results and goes back to baseline.

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.

Reza Momeni, MD FACS
Summit Plastic Surgeon
5.0 out of 5 stars 44 reviews

Dry eye and blepharoplasty

Many patients will have some dryness after an upper eyelid blepharoplasty but will do fine with artificial tear supplements.  Even patients with dry eye can do fine with the surgery.  If you are already bothered by your dry eye in spite of treatments, you may not want to further aggravate the situation with a surgery.  But if you are comfortable and well controlled with drops, you may do fine.  Make sure you go to someone with a lot of experience with eyelid surgery, such as an oculoplastic surgeon.  If someone excises too much skin you will be very dry.  And an oculoplastic surgeon can take a good look at your cornea to see if you are a candidate for the bleph.     

John J. Martin, Jr., MD
Coral Gables Oculoplastic Surgeon
5.0 out of 5 stars 27 reviews

Dry eye patient wanting eyelid surgery

Dry eye is always a concern when evaluating a patient for eyelid surgery.  It isn't uncommon for a patient with mild dry eye before surgery to develop moderate to severe dry eye problems after surgery. This can happen when the muscle that closes the eye (orbicularis oculi) is removed with the skin, or too much skin entirely is removed. Both can cause the eyelids to not close properly, leading to dry eye.  What is important is that you have an oculoplastic surgeon evaluate your dry eye while assessing your eyelids. He/she may recommend a more conservative surgery or recommend against surgery.  

Matheson A. Harris, MD
Salt Lake City Oculoplastic Surgeon
5.0 out of 5 stars 6 reviews

I am being treated for dry eyes, but want to have Eyelid Surgery. Is this safe, or should I see other

Without an IN PERSON visit we can not offer you any guidance in this issue of eyelid surgery with dry eye syndrome... 

Darryl J. Blinski, MD
Miami Plastic Surgeon
4.6 out of 5 stars 173 reviews

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.