Blepharoplasty

Blepharoplasty (BLEF-uh-roe-plas-tee) is a type of surgery that repairs droopy eyelids and may involve removing excess skin, muscle and fat. As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, excess fat may gather above and below your eyelids, causing sagging eyebrows, droopy upper lids and bags under your eyes.

Besides making you look older, severely sagging skin around your eyes can reduce your side vision (peripheral vision), especially the upper and outer parts of your field of vision. Blepharoplasty can reduce or eliminate these vision problems and make your eyes appear younger and more alert.

To help decide if blepharoplasty is right for you, find out what you can realistically expect and explore the benefits and risks of blepharoplasty.

Why it's done

You might consider blepharoplasty if droopy or sagging eyelids keep your eyes from opening completely or pull down your lower eyelids. Removing excess tissue from your upper eyelids can improve your vision. Upper and lower lid blepharoplasty can make your eyes appear younger and more alert.

Blepharoplasty may be an option if you have:

• Baggy or droopy upper eyelids
• Excess skin of the upper eyelids that interferes with your peripheral vision
• Excess skin on the lower eyelids
• Bags under your eyes

You may undergo blepharoplasty at the same time as another procedure, such as a brow lift, face-lift or skin resurfacing.

Insurance coverage may depend on whether the surgery repairs a condition that impairs vision. If you have the surgery only to improve your appearance, the cost probably won't be covered by insurance. Lower lid blepharoplasty is almost always done just for cosmetic reasons.

Risks

Possible risks of eyelid surgery include:

• Infection and bleeding
• Dry, irritated eyes
• Difficulty closing your eyes or other eyelid problems
• Noticeable scarring
• Injury to eye muscles
• Skin discoloration
• The need for a follow-up surgery
• Temporarily blurred vision or, rarely, loss of eyesight
• Risks associated with surgery in general, including reaction to anesthesia and blood clots

Talk to your doctor about how surgical risks apply to you. Understanding what's involved in blepharoplasty and weighing the benefits and risks can help you decide if this procedure is a good option.

How you prepare

Before scheduling blepharoplasty, you will meet with a plastic surgeon and an eye specialist (ophthalmologist) or a plastic surgeon who specializes in eye surgeries (oculoplastic surgeon) to discuss:

• Your medical history. Your surgeon will ask questions about previous surgeries and past or current conditions, such as dry eyes, glaucoma, allergies, circulatory problems, thyroid problems and diabetes. Your doctor will also ask about your use of medications, vitamins, herbal supplements, alcohol, tobacco and drugs.
• Your expectations. An honest discussion of your hopes and motivation for surgery will help set the stage for a satisfactory outcome. Your surgeon will discuss with you whether the procedure is likely to work well for you.

Before your eyelid surgery, you'll undergo:

• A physical examination. Your surgeon will conduct a physical examination, which may include testing your tear production and measuring parts of your eyelids.
• A vision examination. Your eye doctor will examine your eyes and test your vision, including your peripheral vision. This is needed to support an insurance claim.
• Eyelid photography. Your eyes will be photographed from different angles. These photos help with planning the surgery, assessing its immediate and long-term effects, and supporting an insurance claim.

And you'll be asked to:

• Stop taking warfarin (Coumadin, Jantoven), aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), naproxen (Naprosyn), and any other medication or herbal supplement associated with increased bleeding. Ask your doctor how long before surgery you need to stop taking these medicines. Take only medications approved by your surgeon.
• Quit smoking several weeks before your surgery. Smoking can reduce your ability to heal after surgery.
• Arrange for someone to drive you to and from surgery if you're having outpatient surgery. Plan to have someone stay with you for the first night after returning home from surgery.

What you can expect

Before the procedure

Blepharoplasty is usually done in an outpatient setting. Your surgeon injects numbing medication into your eyelids and administers intravenous medication to help you relax.

During the procedure

If you have surgery on your upper and lower eyelids, the surgeon generally works on your upper lids first. He or she cuts along the fold of the eyelid, removes some excess skin, muscle and possibly fat, and closes the cut.

On the lower lid, the surgeon makes a cut just below the lashes in your eye's natural crease or inside the lower lid. He or she removes or redistributes excess fat, muscle and sagging skin, and closes the cut.

If your upper eyelid droops close to your pupil, your surgeon may do blepharoplasty with a procedure called ptosis (TOE-sis) that provides additional support to the eyebrow muscle.

After the procedure

After surgery you spend time in a recovery room, where you are monitored for complications. You can leave later that day to recuperate at home.

After surgery you may temporarily experience:

• Blurred vision from the lubricating ointment applied to your eyes
• Watering eyes
• Light sensitivity
• Double vision
• Puffy, numb eyelids
• Swelling and bruising similar to having black eyes
• Pain or discomfort

Your doctor will likely suggest you take the following steps after surgery:

• Use ice packs on your eyes for 10 minutes every hour the night after surgery. The following day, use ice packs on your eyes four to five times throughout the day.
• Gently clean your eyelids and use prescribed eyedrops or ointments.
• Avoid straining, heavy lifting and swimming for a week.
• Avoid strenuous activities, such as aerobics and jogging, for a week.
• Avoid smoking.
• Avoid rubbing your eyes.
• If you use contact lenses, don't put them in for about two weeks after surgery.
• Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.
• Sleep with your head raised higher than your chest for a few days.
• Apply cool compresses to reduce swelling.
• After a few days, return to the doctor's office to have stitches removed, if needed.
• For about a week, avoid aspirin, ibuprofen (Advil, Motrin IB, others), naproxen sodium (Aleve, others), naproxen (Naprosyn), and other medications or herbal supplements that may increase bleeding. If needed, use acetaminophen (Tylenol, others) to control pain.

Seek medical attention immediately if you experience any of the following:

• Shortness of breath
• Chest pain
• An unusual heart rate
• Severe new eye pain
• Bleeding
• Vision problems

Results

Many people express satisfaction with the results of blepharoplasty, such as a more rested and youthful appearance and more self-confidence. For some people, results of surgery may last a lifetime. For others, droopy eyelids may recur.

Bruising and swelling generally subside in 10 to 14 days, which may be when you feel comfortable going out in public again. Scars from the surgical cuts may take months to fade. Take care to protect your delicate eyelid skin from too much sun exposure.