51 year old - hereditary dark circles and hollow eyes, Lower Eyelid Surgery

Here's a photo where you can see how well my eyes have healed. Very happy with the results! Big difference.

I'm continuing to heal. The bruises are SLOWLY fading. I went back to the doctor's office for a light treatment yesterday (day 13) and it definitely helps. On my right eye, I can barely see where the incision was under the eye - with the left eye, unfortunately there is an obvious red deep line. I'm wondering if I'm going to end up with a scar there. On the outer area of the left eye, there is a lump and the way the skin is joined I'm wondering if it will continue to be noticeable. Overall though I'm happy I had the procedure. I did this to get rid of my hollows and dark circles and they're significantly improved.

This is a bit long-winded but I’m giving a full accounting of my experience. I’m sharing this because there’s so little info about the procedure I had done. It usually falls under lower blepharoplasty but most of that is related to bags and many people have had both upper and lower at the same time. I did not have bags. I have hereditary dark circles and hereditary hollow under eye area with my left eye being more pronounced. Based on my family history, I think there is a chance that I might eventually have developed bags as well. To treat the dark circles, I had tried having restaylne injected into my tear trough (I did post a review of this and I had a very difficult recovery from that procedure) and it helped but didn’t really work well for me in that it never really took on the left side despite adding more and on the right side, I had a visible bulge possibly related to overfilling. I had the restylane removed with vitrase prior to this procedure; it was an easy thing to have done and was immediately effective. I was shocked at how pronounced my dark circles had become. I had experienced significant dropping of my cheeks.
Just a note: A few months before the surgery, I had some filler put in the cheek area hoping that would lift the hollow area and help my dark circles and it did help a little but but not much. The best before photo I could find, shows how low my cheeks are and this is after the filler. You can’t see the dark hollows because I was wearing makeup and the light was pretty good but overall BUT keep in mind that I had to wear makeup to cover the circles and even with it, it had gotten so bad that people were always asking me if I was tired or would say that I looked tired.
The surgeon recommended lower eyelid surgery and a fat repositioning - not adding or grafting but using what is already present. He gives very specific instructions for preop as soon as the surgery is booked. He gives a list of all medications, herbs, to avoid as well as a list of a few supplements that they recommend be started. I was very careful to follow the guidelines given. He also made sure to call in all the scripts I’d need at home prior to the surgery. I was given oral antibiotic, anti-nausea rapid release pills, pain medication and ointment to put on the stitch line. I recommend picking up sterile wrapped q-tips to put the ointment on your eye after the procedure. I picked these up at a local pharmacy. Easier to get from a mom and pop type pharmacies than brand and really soft gel ice packs that aren’t too big.
Day one: The day of the eye surgery, I was able to eat lightly and I had some coffee. My surgeon does the work in office. When I arrived, they hooked me up to machines to monitor my blood pressure, heart rate and oxygenation. They gave me a cocktail of oral medications. xanax, pain med, antibiotic and phenergan. Within an hour, I was extremely relaxed but not out of it enough so they did give me an extra xanax. When they started, I was definitely out of it; I don’t remember much but could hear the doctor on occasion. There was some very tolerable discomfort here and there but overall I felt nothing. I had arrived for the procedure at 8:15 and by noon they let my husband take me home. I was very sleepy - my husband put me to bed. I iced my face on and off but mostly slept. My husband woke me at 7. I had a tiny bit to eat, took one vicodin for pain and fell back asleep until 6 a.m. the next day. I really didn’t have any significant discomfort. I’m lucky to have a sleep number bed so I was able to easily sleep with my head elevated and continued to do that for seven days.
If anything, I think I should have been icing more the day of the surgery when I got home. I suggest setting it up ahead of time that whomever is with you at home after the surgery brings you ice packs every hour and encourages that you use them as directed. Usually it’s 20 minutes every hour. I had trouble with the ice packs I had and found that I couldn’t cover both eyes easily without them slipping off. Also, I didn’t need ice on my eyeballs but to prevent that I used small round cotton pads over my eyes so that the ice wasn’t directly on that area. It’s a tricky part of the face to ice effectively and I eventually figured out it was best to do one eye at a time holding the pack in place.
Day two: As you can see by my day two photo (one day post-op) - first thing in the morning, I didn’t look too bad. Really, had minimal discomfort. Hard to describe but my eyes just felt a bit sore, so extra strength tylenol worked well on that. I only needed two doses throughout the day (remember to limit tylenol to under 4000 mg a day because it is liver toxic). As recommended, I began taking arnica, bromelein and the antibiotic I was prescribed today and also placed ointment on the stitch line three times daily. Swelling increased quite a bit throughout the day and I had some significant bruising formed. I think I over did it and think it’s imperative to do nothing the day after the surgery. Sit upright, relax, ice… Unfortunately, I had bleeding from the outer corner of the right eye which is/can be normal but I think it might have been by the hard edge of one of the ice packs I used because it was too easy to poke my eye with them. I kept drying the blood but it did weep for quite a while.
Day Three: When I woke on day three, I had a blood blister on the sclera (white part of my eye) on the outer lower corner - same eye that had been weeping blood the night before. I called the Dr. and he said it was okay and not to worry about it. I also had a thick piece of dried blood on my stitches in the lower corner of my right eye. I was able to shower by the afternoon some of the swelling had come down also, my eyes had been pulled down in the outer in and inner corners from the swelling but by the afternoon, they were looking less pulled but still very misshapen compared to normal.
Day four: I was really hoping that the swelling might come down more but I think it hadn’t changed too much. It is frustrating and I think it’s important to remember to be patient and I would say not to look in the mirror too much. There’s no point. I knew from research I had done that swelling can last for months in some form and that bruising can take up to two weeks or more to go away. I’m lucky that I didn’t have to go back to work or anywhere significant.
Day five: Swelling still on the decline but definitely still present. As you an see from my photo, I have significant yellow/green around my eyes and still have dark bruises. The bruises do seem to be shrinking. I finished the antibiotic yesterday but still using the ointment on the stitch line. It’s a Monday - so I’m hoping that by Friday, the bruising will be dissipated enough that I can cover it with make up and go meet a friend out.
Day six was uneventful and just really impatient to be rid of the stitches. Occasional soreness out the outer corners of my eyes and also some itching. Swelling is down, bruises haven’t changed much. I had some definite eye fatigue later in the day and for some reason my eyes felt scratchy last night for the first time in a while, however, we had a big snow storm, the heat was up, and the temperatures outside had dipped to the teens, so I think the dryness in the house is what accounts for that. I have also had some very mild pains on the incision line in the evening.
Day seven - swelling is way down and I feel like my face is more normal shape in shape Still swelling but not as noticeable. In my photos, I think my right side looks more swollen but in reality, the left is definitely more swollen than the right and has been that way since the surgery.
Day eight: This morning I had the stitches out; Dr. did not do it and I actually did not see him which disappointed me. I’m a registered nurse and although I think things are fine, I do think the physician should do the follow up with the patient and at least take a look. They gave me a 20 minute light treatment to help speed healing which was really nice and seemed to help clear a lot of the yellowing around the bruises and my eyes. The bruises are still really dark and I’m wondering if I will experience a longer than usual bruising period.
Day nine: Really little swelling today. A lot of the yellow around my eyes is cleared from the light treatment. Sun is recommended for clearing bruises and it’s a sunny day I made sure to get some sun (protecting the incision line under my eyes from exposure). Knowing what I know now and looking at myself, I am SO glad that I blocked out two weeks for recovery. I tried covering the bruises with makeup and it’s not working for me but even if I could, the stitch line is SO visible and I can’t put makeup on that at this point. Everyone heals differently but I recommend blocking out two weeks.