1) How do I know if I need an upper eyelid lift or a browlift?
It depends on the position of the brow. During the initial consultation to evaluate the upper eyelids, the doctor uses his hands to raise the patient’s forehead skin to an appropriate level. When the forehead skin is raised, if most of the upper eyelid skin disappears, a patient would most likely benefit from a forehead lift. If raising the forehead skin has little or no effect on the upper eyelid skin, an upper eyelid lift (blepharoplasty – bleff-ar-oh-plasty, the technical term for eye lid lift) may be all that is in order. If improvement is noted when the sagging brow is lifted and excess skin remains on the eyelids, a combination of browlift and upper eyelid blepharoplasty may be recommended to achieve a more youthful appearance.
Look at the Before and After Photo of the patient who had a browlift. She had no upper eyelid skin excised. In this case, browlift alone was effective in creating a younger appearance because the actual source of her concern was a droopy brow. (Droopy brow is also known as brow ptosis.) Compare that with the Before and After Photo of the patient who had upper eyelid blepharoplasty and no browlift. In the preoperative picture you will see that this patient’s brow had not fallen, therefore removing upper eyelid skin alone was effective.
2) Will I still look like “me” after surgery?
Many of our patients report that, upon return to work and routine daily activities, friends and acquaintances make the following remarks: “Gee you look great. Did you change your hairstyle?” or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes.
3) Yes, but I want to dramatically change the appearance of my eyes. Can I do that?
This is an excellent question because it leads to evaluating realistic expectations. This question can only be answered on an individual basis. A sign of a good surgeon is one who can tell the difference between realistic and unrealistic expectations and one who will provide a truthful picture about meeting each patient’s desires. Our biggest referral source is from satisfied patients – ones who have had realistic expectations and were satisfied with results.
4) Will I have any incisions in my skin?
For traditional lower eyelid blepharoplasty, it is common that an incision is made in the lower eyelid skin (photo a) with removal of excess skin and fat to achieve a refreshed look. Eyelid skin is one of the most “forgiving” areas of the body and these incisions typically heal extremely well.
An advanced technique that has been performed successfully for the past five years is the transconjunctival blepharoplasty (photo b). (Wow! That’s a big word! The conjunctiva (con junk ti vah) is the pink inner lining of the lower eyelid.) With this approach, the incision is made just inside the lower eyelid and no external skin incision is required. Through the incision the offending fat (which is responsible for the “bags” or “circles” under the eyes) can be removed.
Occasionally blepharoplasty is coupled with some kind of skin resurfacing such as laser or peel to remove any fine textural face lines in the skin. Probably the most frequently requested procedure combines blepharoplasty with a face lift to remove the turkey wattle (that thing that hangs down on the neck of a turkey). Ask your facial plastic surgeon if you are a candidate for a transconjunctival approach for your eyelid surgery.
5) What if I have a history of bad scars?
If you have pierced ears, the way you healed there is a good indication of how you will heal from facial plastic surgery. Scars on the rest of the body typically are not an indication for how patients heal following facial plastic surgery.
At the time of your consultation, it’s important to show your physician any previous scars (called keloid scars) that are of concern so he can give you a realistic assessment of your healing potential following facial plastic surgery.
6) Will a blepharoplasty take away the crows feet and all the fine wrinkles?
Some patients find that, along with baggy eyelid skin, an additional source of concern is textural or surface changes (fine little lines) in the skin around the eyes. Patients who elect to combine blepharoplasty with a skin resurfacing procedure also remove textural imperfections and crows feet. Skin resurfacing, performed to address textural changes on the skin surface, includes laser skin resurfacing and chemical peels.
7) I had eyelid surgery done and I’m not happy with the results. Can you “fix” it?
While we’re on the subject of alternatives to traditional blepharoplasty, we would like to include a word about revision eyelid lift. It is not uncommon for patients to be referred to us for revision cosmetic surgery. The procedure instructions for blepharoplasty apply to primary as well as revision blepharoplasty. However, revision blepharoplasty patients have their own set of reconstructive challenges.
In revision blepharoplasty, a surgeon is working on an area that has previously undergone changes. If we are asked to correct previous surgery by another surgeon, revision blepharoplasty can be a bit more complex and, therefore, may take longer than the initial surgery. Also, swelling can be more pronounced with revision surgery as well as a slightly longer healing time.
8) Will I be awake during surgery?
Using IV sedation (medicine administered through an IV) and a local anesthetic (numbing medication administered in the operating room), patients are asleep during surgery. Patients do not hear or feel anything and are comfortable during surgery. Patients wake up very soon after the operation is completed. Intravenous sedation is a type of anesthesia; therefore all patients must have a responsible adult to stay with them through the night following surgery. Patients may not drive for 24 hours after their procedure and this time may be longer, depending on the procedure.
9) Is it painful?
After any surgical procedure, some discomfort can be expected. All patients are provided with prescriptions for pain medication. It is uncommon for patients to report unmanageable pain after surgery.
10) How long does my surgery take?
The length of surgery depends on several factors including the complexity of each person’s eyelids. Revision blepharoplasty can take a little longer because of corrections that need to be made as a result of the initial surgery.
11) Can I drive myself home after surgery?
NO. Because of the effects of anesthesia, patients are not able to drive themselves home after the surgery.
12) Do I go home after surgery?
Most blepharoplasties are done on an outpatient basis. Because you will go home after receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment.
13) When can I go back to work?
Most patients take two weeks off work but occasionally a patient returns after one week. After two weeks, any residual bruising and swelling can easily be camouflaged with make-up. Patients who are more concerned with privacy prefer two weeks off work.
14) When can I “work out?”
Aerobic activities should be avoided for two weeks following surgery and heavy weight lifting or more strenuous workouts should be avoided for three weeks postoperatively. It’s important to avoid bending, lifting or straining during the postoperative period as these activities can increase swelling and delay healing.
15) How long will bruising and swelling last?
Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take two to three weeks. However, you may camouflage bruises fairly easily at seven to ten days with concealer stick.
16) I’m not ready for cosmetic surgery. Is there anything I can do to improve my eyes?
Skin resurfacing including Botox, Collagen and light skin peels may be the treatment of choice for patients who for many reasons may not be ready to undergo surgery.
17) I really want to have the surgery but I’m nervous. What if I get stressed?
It’s ok to be nervous. (Frankly, we would be nervous if you were taking this step lightly!) Just contact us if you have any concerns. One of the best ways to deal with nervousness is to see what other patients have gone through. Remember, educated patients know when and if the time for surgery is right.