More than any other facial feature, your eyes reveal the most about how you feel. When your eyes are open and alert, you appear energized and well rested. However, if you have lower-eyelid puffiness, dark circles or drooping upper lids, others may assume that you are fatigued, angry or unhappy. If you believe that your eyes are making you look tired, sad, or older than you really feel. An Akron, OH cosmetic surgery procedure known as blepharoplasty may be the right choice for you. Eyelid surgery can remove the excess fat and drooping skin of the upper eyelids, minimize bags under the eyes and tighten the lower eyelid skin. The result is a more alert and rested appearance.
What are some of the most common benefits of this procedure?
Most people are extremely pleased with the results of cosmetic eyelid surgery. It can often make a person appear to be a decade younger than their actual age. Upper eyelid surgery makes the eyes appear fresher and more youthful. Lower eyelid surgery can make a dramatic difference in the appearance of the face, alleviating the tired, aged appearance by eliminating the puffy areas and the excess, wrinkled skin beneath the eyes. The degree of improvement varies from person to person, but the results last for many years.
What will happen at the initial consultation?
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The initial consultation will begin at our cosmetic surgery office in Akron, OH, with a complete medical history and exam. You should tell our doctors if you wear contact lenses and about any related eye symptoms you may have, especially vision problems or dryness of the eyes. You should tell them if you have other medical conditions, in particular glaucoma, diabetes, high blood pressure or a history of thyroid conditions. You may be asked to look into a mirror and point out those areas around your eyes that you would like to see improved. Often, patients may focus their attention on excess skin in the upper eyelids and not realize that drooping of their eyebrows contributes to this skin excess. You should be very frank in discussing what you hope to achieve with surgery. This will help our doctors understand your expectations and determine whether they can realistically be achieved. Other options available to you will be discussed along with risks and limitations. The location where the surgery will take place, the estimated duration of the procedure, the type of anesthesia required and the costs of the surgery will be explained. “Before and after” photographs of patients will be available for your review. Your photograph will be taken and can be viewed with the computer imaging system if you wish.
Eyelid surgery is frequently combined with a brow lift or face lift as part of an overall facial rejuvenation plan. Because the forehead contributes so much to the excess upper eyelid skin, a forehead lift is usually performed at the same time. Laser skin resurfacing or chemical skin resurfacing is often combined to minimize the fine wrinkles and enhance the result. BOTOX® Cosmetic, a temporary, non-surgical treatment performed in the office, can be used to improve the “laugh lines” on the sides of the eyes (also known as crow’s feet) and the deep creases between the eyes.
Risks and Limitations
Eyelid surgery is one of the most common cosmetic procedures performed. Every year, many thousands of people undergo successful eyelid surgery and experience no major problems. However, anyone undergoing any type of surgery must be aware of both the benefits and the risks.
Who should have Eyelid Surgery?
Aesthetic eyelid surgery is performed on adults of all ages. Some people have eyelid surgery to correct problems that are a result of aging, while others have inherited traits that cause them to seek treatment as early as their 20′s or 30′s. Any one or combination of the following conditions may indicate that you are a good candidate for eyelid surgery:
- Excess skin obscuring the natural fold of the upper eyelids
- Drooping skin down toward and onto the upper eyelashes, perhaps impairing vision
- Bulging around the inside of the eyelid toward the nose
- A puffy appearance to the upper eyelids, making the eyes look tired
- Excess skin and fine wrinkles, crepiness of the lower eyelids
- Puffy “bags” and, in some cases, dark circles under the eyes, often with a depression along the bony border of the lower eyelids
Cosmetic surgery in Akron, OH can usually correct these problems, though other treatments may also need to be considered. For example, if the upper eyelid condition is accompanied by drooping of the eyebrows, then a forehead and browlift may be needed. Smoothing of crow’s feet may require BOTOX Cosmetic injections, chemical peeling or laser resurfacing procedures. Dark circles beneath the eyes caused by dark pigmentation may be treated with an injectable filler, bleaching solution or chemical peel.
The philosophy of Crystal is to keep you well – inside and out. For some patients with medical conditions, your doctor may ask you to have a complete preoperative medical exam by your primary care doctor. If you have a history of eye problems, you may be advised to see an ophthalmologist for preoperative clearance.
As with any surgical procedures, there are risks of bleeding and infection. Both of these complications are infrequent. Other potential complications include:
- Temporary feeling of dryness or irritation in the eye
- Temporary decrease in sensation of the eyelid skin
- Impaired eyelid function that sometimes may need to be corrected by additional surgery
- Retrobulbar hematoma (an extremely rare complication where bleeding extends behind the eye and can result in vision loss)
- Temporary problems with excessive tearing
- Prominence or firmness of the scars
- Temporary blurred vision
- Temporary swelling of the mucous membrane of the eyelid (chemosis)
- Difficulty shutting eyes completely (this is usually temporary, but, in rare cases, can be permanent)
- Pulling down of the lower lid, also known as ectropion
The details and frequency of occurrence of these potential problems are best discussed with your doctor in person. You can help minimize certain risks by following their advice and instructions, both before and after your eyelid surgery.
How should I prepare for surgery?
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Certain medications, such as aspirin, anti-inflammatory drugs and many vitamins and supplements, can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. If surgery is to be performed on an outpatient basis, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery. The week before surgery, get the medications and supplies you will need after the surgery so that you will have them at home. Crystal staff will provide these.
How is Cosmetic Eyelid Surgery performed?
There are a variety of techniques used for eyelid surgery. After your consultation with the doctor, the final technique can be determined.
Common techniques used for eyelid surgery include:
Upper eyelid blepharoplasty
Lower Eyelid blepharoplasty–skin approach
Lower Eyelid blepharoplasty–transconjunctival approach (incision on inside of eyelid)
Upper Eyelid Blepharoplasty
If a forehead and browlift is part of the procedure, it is performed first. For upper eyelid surgery, the incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into one of the laugh lines. Because this incision follows the natural contour of the upper eyelid, it will be well camouflaged when healed. Through this incision, excess fatty tissue and muscle is removed, followed by removal of the extra skin.
Lower Eyelid Blepharoplasty-Skin Approach (the incision is on the outside of the eyelid)
There are two approaches for lower eyelid cosmetic surgery. The traditional incision for lower eyelid cosmetic surgery is an incision in the skin just below the lower lashes in the natural crease. This technique is preferred if there is a lot of excess skin and it needs to be removed. The incision is well camouflaged by placing it in a natural crease. Through this incision, excess fat, muscle and skin are removed. Alternatively, the fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems, such as drooping and laxity of the eyelid, may be performed.
Lower Eyelid Blepharoplasty-Transconjunctival Approach (the incision is on the inside of the eyelid)
In some cases, the skin and muscle does not need to be removed and the bulging fat can be removed or redistributed through an incision placed on the inside of the eyelid-a transconjunctival approach. This technique requires no external incision, but it cannot be used to remove excess skin. With this technique, laser or chemical resurfacing of the skin is often used to improve the wrinkles and tighten the lower eyelid skin.
Will I need to stay in a hospital?
Cosmetic eyelid surgery may be performed safely in an office-based surgical suite, an outpatient surgery center, or a hospital. The surgery can be performed under general anesthesia-in which case you are completely asleep-or local anesthesia with sedation, in which case you remain awake, but drowsy and relaxed. You will not feel pain, but you may notice some gentle tugging.
The upper eyelid blepharoplasty takes one to two hours, and the lower eyelid blepharoplasty takes one to two hours. If only eyelid surgery is performed, most patients return home after the procedure. If other procedures are combined and the surgery time lasts longer than five hours, we usually recommend that you stay overnight.
What can I expect after surgery?
There is surprisingly little pain from the procedure. Of course, you will be provided with pain medication in the postoperative period. You should keep your head elevated 45 degrees for the first three days to help relieve the swelling. Cold compresses used 10 minutes every hour while awake for the first three days will help reduce swelling. Avoid a heavy compress. A Ziploc bag filled with frozen peas works well. In addition, your doctor will prescribe supplements that will help minimize the bruising and swelling. Not uncommonly, we will also prescribe an eye ointment or artificial tears to use after surgery to help lubricate your eyes. There will be bruising and swelling around the eyes, which will start to improve after three days. You may start wearing makeup within the first few days after surgery. The fine stitches will dissolve or be removed three to five days after surgery. Most people will face the public in a week to 10 days. You may be sensitive to sunlight, wind and other irritants for several weeks, so you should wear sunglasses.
You can expect certain conditions after surgery:
- Bruising and swelling–Remember this may get worse before it gets better. In most people swelling starts to improve after the third day. The bruising will subside in seven to 14 days.
- Blurred vision–This may be caused by the ointment that is used during and after the surgery.
- Tightness around the eyes–This sensation is produced by the swelling and will improve as the swelling resolves.
- Milia–Whiteheads where the sutures were removed.
You may resume non-strenuous activities within the first week. You should avoid straining, bending and lifting during the early postoperative period, the first seven to 10 days. You will be advised to wait two to three weeks before resuming strenuous activity and exercise. You may have difficulty inserting and removing your contact lenses soon after surgery, and you should wait at least two weeks before attempting to do so.
You should temporarily avoid exposure to direct sunlight and, for the long-term, be conscientious about the use of a sunblock to protect your skin.
What is the long-term outcome for most people?
Cosmetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months until they become barely visible.
The results of aesthetic eyelid surgery are long lasting, but they may be affected by your heredity and lifestyle factors. Removal of fat from your eyelids, which produce the puffiness and bags, is permanent, and these conditions generally will not recur. However, the skin continues to age, and skin laxity along with fine wrinkling of the eyelid area may return at some point. Sometimes sagging of the forehead causes drooping of the eyebrows which mimics a recurrence of drooping upper eyelids. If this happens, correction may require a forehead lift or a secondary eyelid procedure. Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time.