I'm 60 and Want Upper and Lower Eyes Done, but Suffer from Severe Dry Eye. What Procedures Do You Recommend?

I've wanted to do my eyes for years. I have droopy uppers and the bulging bags on the lowers. My skin is extremely thin. I've read that patients that suffer from severe dry eye condition cannot have certain procedures. what would be best approach for me?

Doctor Answers 16

Conservative Eyelid Procedures for Dry Eye Sufferers

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    In a patient with dry eyes, skin only upper blepharoplasty and transconjunctival fat removal or transposition with or without fat grafting to the tear trough and surroundin landscape may produce the results needed without altering dry eye status.

Eyelid surgery for patient with dry eyes

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There is an extremely small chance that dry eyes can be made drier with an upper blepharoplasty.  It is important not to remove any orbicularis oculi muscle from the upper lids in dry eyed patients.  It is however, acceptable to conservatively remove excess skin and fat on the uppers and a transconjunctival fat removal on the lowers with minimal risk of making dry eyes worse.

William Portuese, MD
Seattle Facial Plastic Surgeon
4.8 out of 5 stars 155 reviews

Blepharoplasty with Dry Eyes

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If you have severe dry eyes, do not have a blepharoplasty performed unless cleared by an opthamologist. Patients with dry eyes when having blepharoplasty need a more conservative version of the procedure.

History of Dry Eyes

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If you have a history of severe dry eyes and are on Restasis or other medications, I would not recommend doing blepharoplasty unless you have had operative clearance with your Opthamologist. Even then, I would perform a very conservative upper blepharoplasty and not consider doing a lower blepharoplasty in most patients. Normally patients after blepharoplasty, without having a history of dry eyes, will have dry eyes for 4-6 weeks after blepharoplasty.

Rod J. Rohrich, MD
Dallas Plastic Surgeon

Eyelid surgery and dry eyes

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Blepharoplasty in patients with symptoms of dry eyes should be approached with great caution. Even though some surgeons will not operate on patients with dry eyes, I routinely will offer blepharoplasty for some well selected patients with dry eyes. There are a number of issues to consider – you should be evaluated and properly optimized for dry eyes prior to blepharoplasty; your aesthetic and functional eyelid anatomy has to be properly assessed and diagnosed so that a well chosen type of blepharoplasty is performed. In some patients I perform a brow lift in conjunction with very conservative upper lid surgery, some patients require more advanced type of lower eyelid surgery. Make sure you pick a surgeon that is experienced in dealing with this type of complex issue.

Boris M. Ackerman, MD
Newport Beach Plastic Surgeon
4.8 out of 5 stars 60 reviews

Dry eyes and blepharoplasties

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can be done but you have to be willing to accept the probable need for extra care for keeping your eyes lubricated whether it be through eye drops, gels when you sleep and even the silicone plugs mentioned by Dr. Sowder.  If you're willing to accept the anticpated outcomes, blepharoplasties could be done for you.  You should discuss your concerns thoroughly with your chosen surgeon.

Curtis Wong, MD
Redding Plastic Surgeon
4.8 out of 5 stars 33 reviews

Bleph and dry eye

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I would make sure you had explored all options for dry eye including punctal plugs.  These are little silicone plugs that are put into the small ducts that drain the tears into the nasal cavity.  They are usually well tolerated and they may improve your condition enough for you to have a very conservative blepharoplasty.  It is very, very important that your plastic surgeon communicates with your ophthalmologist.

If you have tried everything and your dry eye is still severe, I would not recommend surgery.

Lisa Lynn Sowder, MD
Seattle Plastic Surgeon
5.0 out of 5 stars 76 reviews

I'm 60 and Want Upper and Lower Eyes Done, but Suffer from Severe Dry Eye. What Procedures Do You Recommend?

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 IMHO, severe dry eye is a contraindication for upper and lower eyelid surgery toegther and maybe a contraindication for having either separately.  While it is possible that either, upper or lower, eyelid surgery could make your dry eye worse, it's unlikely that either would improve that condition.  I would have you think long and hard about eyelid surgery if your dry eye is severe.  Sorry, that I don't have better news.

Francis R. Palmer, III, MD
Beverly Hills Facial Plastic Surgeon
4.7 out of 5 stars 28 reviews

Can blepharoplasty be performed in patients with dry eyes?

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Upper and lower blepharoplasty can be safely done in patients with dry eyes if performed conservatively and using techniques that won't alter eyelid closure.  See an oculoplastic surgeon for evaluation.

Mehryar (Ray) Taban, MD, FACS
Beverly Hills Oculoplastic Surgeon
4.9 out of 5 stars 88 reviews

Dry Eye Prior to Blepharopladty

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There are several considerations regarding your dry eyes and Blepharoplasty. First, what is the cause of the dry eyes? Have you had them evaluated? Can the dry eyes be improved? Secondly, can the dry eyes be improved with modification of a Blepharoplasty procedure? Thirdly, if neither of these are possible, are you OK with increased dryness for a while after the Blepharoplasty? You need a consult with an experienced Blepharoplasty surgeon and perhaps an Ophthalmologist.

Robert T. Buchanan, MD
Highlands Plastic Surgeon

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.