There is no substitute for a very careful analysis of your situation to determine a clear plan for eyelid surgery. My personal approach involves talking with you about your goals for your eyelid surgery. It is sometimes very helpful to review with you older photographs dating back into high school and college. There is often an age when you think of yourself have peak beauty in which case, the goal of surgery needs to be as much as possible capturing this look. It is critically to get a detailed medication, allergy, medical, surgical, and social history to properly think about your health and welfare associated with eyelids surgery. Detailed photographs are then taken. A detailed examination of the eyes and face is then performed. This starts with a determination of your best corrected visions and measurements of facial symmetry including determining if the eyes project the same amount from the face on each side. It is very helpful to determine if the eyes sit at the same height on each side. I personally like to sketch my patients eyes and eyelids. I feel this forces me to very carefully see the potential issues that are present. Following this I do detailed measurements of the eyes which includes the palpebral fissure height on each side (a measure of how open the eyes are), the margin to crease height, the margin to reflex distance on each side, and a measurement of eyelid ptosis. Levator function is measures and lower eyelid laxity is then assessed. This is followed by a detailed motor and sensory assessment of the eyes, the eyelids, and the face. I assess the pupils and perform a confrontational visual field. Generally I will also perform a microscopic slit lamp examination of the eyelids and the front of the eyes to assess the health of the eyelid margins, conjunctive, cornea, anterior chamber, iris, lens. Intraocular pressure is assessed if you are not being actively followed by an ophthalmologist or there is a family history of glaucoma. I will then do a tear production test and follow this with a nondilated fundoscopic examination. When indicated, I will do some specialize testing to assess upper eyelid ptosis.Now I am in a position to discuss what your best options are for eyelid surgery. This assessment and an appropriately detailed discussion of risks, benefits, alternative, and likelihood of success. Is this level of detailed needed for every eyelid surgery? I personally think so. I think this profoundly increases the chance of the surgeon getting eyelid surgery right the first time. I think you deserve that.Assuming you need an upper blepharoplasty procedure, most people take 10-14 off from work. Often by that time, you are at a place where most people do not notice that you just had eyelid surgery. You might find you are ready to socialize a little before this or perhaps a few days after this. If you are very self conscious, you might not feel that you are really ready for 3 to 4 weeks but honestly that is quite unusual.
