in preping myself for eyelid blepharoplasty procedure i'd like to know what to expect beforehand. Am I taking risks? what problems are possible? help me calm down!
Eyelid Belpharoplasty Risks, Problems, What to Know in Advance
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Doctor Answers 19
Blepharoplasty is defined as "any operation which...
Blepharoplasty is defined as "any operation which corrects a defect in the eyelids." This can be an upper eyelid procedure or a lower eyelid procedure. While it is important to know about both, lower eyelid surgery poses a greater challenge. Lower eyelid blepharoplasty usually aims to get rid of bags under the eyelids and produce a less tired look.
It is important to consult with a qualified surgeon before undergoing any surgical procedure and this article poses a few questions to ask the surgeon during a consultation.
What type of incisions will you use?
There are several approaches that can be used to access the lower eyelid. Some incisions are made on the inside of the lower eyelid and are not visible. Others are made just below the lash line and when healed, are nearly imperceptible. The approach used depends on many factors and the surgeon can discuss these thoroughly.
For the upper eyelids, the incisions are generally the same and involve an incision along the natural upper eyelid skin crease.
Is my lower eyelid loose?
When performing lower eyelid surgery, it is important to ensure that the lower eyelid is tight enough. If the eyelid is not tight enough, there is a greater risk of pull down of the eyelid after surgery and resulting dry eyes and eye exposure.
To test if the lower eyelid is loose, the surgeon will pinch the lower eyelid and pull it out. If it takes a long time to retract or requires a blink or two to return to a position against the eye, the lower eyelid is loose. If the lower eyelid is loose, a procedure can be performed to tighten the lower eyelid. This can be performed at the same time as lower eyelid surgery and should be discussed before proceeding with surgery.
Will this surgery take away the bags and lines under my eyes?
Most patients who have bags under the eyes have what is called pseudoherniation of fat. This means that the fat that normally exists around the eyeball has pushed out past the edge of the bone of the eye socket, producing the bags.
In some patients, the bags under the eyes are actually on the cheek and lower eyelid surgery will not fix this. In addition, if discoloration of the skin is a concern, it is important to ask the surgeon if just operating on the lower eyelid will fix the discoloration. Most of the time, the dark circles under the eyes are due to shadows from the fat. At times though, this discoloration is due to pigment in the skin. If pigment is the problem, additional procedures may be required to address just the discoloration below the eyes.
For upper eyelid surgery, do I need a brow lift?
For some people, a combination of an upper eyelid blepharoplasty and brow lift is needed. A crude means of determining if brow lifting is necessary is to manually elevate the brows and determine if the eyebrows are still in a good position and if some of the problem of the upper eyelids has resolved. Sometimes it is the brows that make people look tired, not just the upper eyelids.
What is my recovery time?
While every patient is different, bruising, swelling, and bleeding are generally the limiting steps for return to normal activities. Different approaches to the lower eyelid will produce different amounts of bruising and swelling. Be sure to consult with your surgeon about expected time away from normal activities.
Above all, research the procedures you are thinking of having and research the credentials of the surgeon you are considering. While this is not a complete list of questions you might want to ask, it is a starting point. It is of utmost importance to discuss your expectations with your surgeon to ensure that your goals can be reached.
Unfortunately, there is no surgical procedure without some form of risk. However, with upper lid Blepharoplasty, there is very little bleeding (all aspirin, NSAIDS, fish oil, vitamin E, blood thinners are discontinued well in advance of surgery), minimal risk of infection, typically very favorable scarring (the eyelid skin is very thin and almost uniformly heals very well). A significant risk I describe to patients is dryness of the eyes postoperatively. Most patients experience some degree of a gritty or irritated sensation due to diminished tear production. The exact mechanism for this phenomenon is poorly understood, but is is countered with frequent postoperative use of artificial tears. If a patient has severe dry eyes preoperatively, he/she may not be a candidate for the surgery. The major risk I describe is over-resection of upper eyelid skin, which leads top corneal exposure problems. This is an avoidable complication, by assessing the correct amount of skin via the "pinch" method while the patient is awake and able to move the eyelids dynamically.
Eyelid Surgery A Conservative Approach for a Natural Looking Result
The next time you flip through Vogue or Allure (guys, just grab one at the checkout stand) take a close look at the eyes of the models. In most of them, women in their teens and twenties, you will see only a sliver of the upper eyelid, if it is visible at all. In many, the upper lid is completely obscured by soft tissue fullness between the brow and eyelashes, which I sometimes refer to as the 'brow roll'. Perusing the fashion magazines provides quick confirmation that the youthful upper lid is not a skeletonized upper lid.
My approach to upper eyelid surgery is to be conservative with skin excision, and to reserve excision of fat for patients with significant fat excess. In my opinion, aggressive removal of upper eyelid skin and fat is a 'skeletonizing' procedure which risks making eyes appear more deep-set and aged, rather than younger. In fact, in many patients I perform structural fat grafting (using the patient's own fat, from the abdomen or hips) to help restore soft tissue volume around the eyes.
Structural fat grafting provides a mean for restoring or enhancing this 'brow roll' area. In patients that have always had, or who with age have developed a deep recess between the upper lid and brow, the addition of soft tissue volume can dramatically rejuvenate the appearance of the eyes. This novel aesthetic enhancement of the upper lids does not look like eyelid surgery - it just looks youthful.
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First you should know if you are a good candidate for...
First you should know if you are a good candidate for blepharoplasty (eyelid surgery). Anyone who has dry eyes should have an ophthalmologic evaluation to determine the degree of dryness as it can worsen in the postoperative phase.
A patient should have specific goals in mind regarding how you hope blepharoplasty will change the appearance of your eyes and if you want both upper and lower blepharoplasty done at the same time.
It is wise to do some research for a surgeon who is board certified and experienced in performing successful blepharoplasties.
Risks in Blepharoplasty
In general, in the hands of an experienced eyelid surgeon blepharoplasty is a safe procedure. The key is that one needs to be conservative so as to minimize post operative bruising, swelling and also long term problems of exposure. This is very uncommon if one does a muscle sparing blepharoplasty such as the 5-step blepharoplasty.
What are the risks of eyelid surgery?
Eyelid surgery is one of the safest procedures done in plastic surgery. The best thing you can do is pick a board certified plastic surgeon who has performed at least 30 of these procedures. Nonetheless, it is surgery, so here you go....
List of possible complications:
Abnormal lid position
Abnormal skin color
Decreased sensation in eyelid
Difficulty closing eyes
Dry eye syndrome
Gritty sensation in eye
Inability to close eyes
Reactions to medications
Complications of eyelid surgery, while rare, can cause prolonged healing, change in or loss of vision, unpleasant-appearing and painful scars, the inconvenience and cost of further surgery, and the possibility of requiring eye drops or ointment, temporarily or permanently.
The risk of permanent blindness is less than 1 out of 10,000. Vision loss is usually related to bleeding following eyelid fat removal.
This is a temporary condition that occurs in less than 1% of surgeries.
This condition is temporary and is easily treated by patching the eye for 1-3 days.
This condition is temporary and occurs in less than 1% of surgeries.
Difficulty closing eyes
This condition is usually temporary in rare cases. In rare cases, corrective surgery is required.
Dry eye syndrome
Dry eye syndrome is potentially dangerous. In rare cases it leads to damage to the cornea of the eye and vision loss.
Inability to close eyes
This condition is usually temporary. In rare cases, corrective surgery is required.
Tiny skin cysts can form on the scar line. This is normally temporary, but in some cases requires surgical removal.
A rare complication in which a pocket of blood forms behind the eyeball.
Eyelid surgery is safe...relax
Eyelid surgery is a little different depending on whether you are having upper eyelid or lower eyelid surgery.
Upper eyelid surgery is easily done under local anesthesia. The procedure takes 35-50 minutes and involves removal of skin plus/minus removal of fat. If done carefully, you can essentially be back at work within 1-2 days. If precise, gentle, etc. I find my patients to have almost no bruising or swelling for simple upper eyelids. You may have lagophthalmos or inability to close your eyes all the way for 4-5 days. This resolves by itself. It is important as a surgeon to be conservative with skin resection because excess skin resection will lead to permanent lagophthalmos. You can always take out more skin...you can't put it back in.
Lower lids are a bit more entailed. I find the majority of my patients requiring a bit of sedation along with local anesthesia. I feel this is so because the lower lids are a bit more sensitive, and there is a bit more dissection to do. The amount of swelling is directly proportional to the amount of work required. If a small amount of skin is excised, you may have minimal bruising/swelling. However, more extensive fat resection and muscle tightening procedures can lead to significant bruising. The majority of the bruising resolves within 5-7 days. The most dreaded complication of lower eyelid surgery is ectropion or scarring causing drooping of the lower eyelids. This is rare and preventable. This again goes back to my philosophy of conservative fat resection and conservative skin resection with counseling the patient that a touch-up might be required. Hope this helps
The common risks associated with eyelid surgery include blurred vision
The common risks associated with eyelid surgery include blurred vision, potential unsightly scars, and excessive tearing-particularly with lower eyelid surgery. Precise scar placement is very imiportant in both upper and lower eyelid surgery. In the upper eyelid, the ideal scar would be placed in the natural skin crease, so that it heals well and is very difficult to see. In the lower eyelid, the approach may be through the skin just below the eyelash margin, or through an approach known as a "transcongaunctival" approach. The approach that involves an incision in the skin is used when excessive skin in the lower eyelid needs to be removed. There is slightly increased risk with this approach, since when the scar in this location heals, it will contract. This contraction may produce a slight eversion of the lower eyelid with resultant increased tearing and decreased clearance of the tears, since the tear ducts are not quite as well aligned as they were preoperatively. Alternatively, the "transcongaunctival" approach is generally considered safer. Through this approach, the incision is made on the inside of the eyelid so that there is no risk of eversion of the lid to create scar contracture. There is also much less risk of the chance of any bleeding post-operatively and there's no visible scar. The "transcongaunctival" approach is my preferred approach in the lower eyelid for most patients.
Expectations Following Eyelid Surgery or Blepharoplasty
As with any procedure, there are always risks of infection and bleeding. Fortunately, these are both quite rare with eyelid surgery, or blepharoplasty. There are also potential risks of eyelid malpositioning, possible damage to the eye itself, and the chance you will need a touch-up or revision procedure for a suboptimal outcome. In the experienced hands of a board certified plastic surgeon these risks are markedly decreased. In a majority of patients having blepharoplasty they undergo the normal healing process and end up with a very nice aesthetic enhancement of the eyelids without significant complications. Good luck.
What to know before getting eyelid surgery.
- That you are in the hands of a properly trained and experienced surgeon.
- That the proposed surgery is proper (get more than one opinion).
- That the operation will be performed in an accredited facility.
- The risks
- The convalescence
- What to expect (I use video imaging)
- Policy should revisions be necessary.
- The cost.
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.