Eyelid Rejuvenation Procedure
General Information
Blepharoplasty is performed to reduce the wrinkling and/or bulging of eyelid tissue.
Not all patients exhibit the need for removal of both excess skin and excess fat (bags). In many cases only one or the other procedure is needed. Newer procedures include operations to mold existing fat under the eyes, preservation of the natural fullness below the eyes while reducing the bulges, and the cheeklift operation, which involves tightening of the eye muscle below the eye and elevation of the cheekpad complex in a purely vertical direction. The overly tight look where the lids are pulled down is now avoided.
Every wrinkle and fold of skin around the eyes cannot be removed. The judgment of your plastic surgeon should be accepted as to the amount of skin that can be safely removed to affect the most suitable result for a particular problem.
The final result of plastic surgery is determined by a number of factors such as the physical condition of the face, the presence or absence of facial fat, the relative "age" of the skin, the quantity and quality of wrinkles present, the underlying bone structure and hormonal influence.
The length of time the surgical result will last varies with each individual person. In most cases the pouches beneath the lower lids do not recur. But as one grows older the skin becomes looser and more redundant and a "trim" of loose skin may be necessary at some time within the next seven to ten years.
Photographs are as important to plastic surgeons as X-rays are to physicians in other medical specialties. Therefore, preoperative and postoperative photos are taken on all our patients scheduled for eyelid surgery and become a permanent part of the patient's confidential medical record.
The surgery can be performed either in our office surgical suite or in the hospital. The decision as to the location will depend upon the desires of the individual patient and the judgment of the physician.
Patients who have surgery performed in the office return home two to three hours following the operation. If surgery is performed in the hospital, the patient may go home the same day or may stay overnight and go home the next day.
Work and social activities are usually curtailed for a period of ten to fourteen days following surgery.
Driving may be resumed in two to three days.
The Anesthesia
The operation is performed under general anesthesia. This anesthetic technique involves the combined administration of a "light" general and the injection of a local anesthetic into the tissues of the eyelid while the patient is asleep. All of the required monitoring, anesthetic delivery and emergency equipment are present at all times. The local anesthetic is administered by the surgeon; the intravenous medications are administered by a licensed, professional anesthesiologist who remains in attendance throughout the operation. Further information, including any questions you may have, will be explained and discussed fully by our anesthesiologist prior to surgery.
Pre-Operative Preparations
You must be in good health to undergo any elective cosmetic surgery. A physical examination and routine lab work will need to be performed by your own primary physician. If you do not have a primary doctor, we can refer you to local doctors in our area. We do not provide these services. It will be required that all this pre-op paperwork is in our office 1-2 weeks prior to surgery.
It is very important that our office is aware of any medical conditions and all medications you are taking.
It is imperative that you not smoke 2 weeks prior to surgery, and 2 weeks after surgery. This would impede your healing greatly. Talk to us about options.
It is a required that someone drive you home upon your discharge. Also arrange for transportation to and from our office for your post-operative appointments until your doctor gives you permission to drive.
DO NOT take aspirin or aspirin-containing products for 2 weeks prior to surgery and for 2 weeks after surgery.
An adequate diet with vitamin supplements, especially Vitamin C, is recommended. You should be in the best nutritional state possible prior to surgery.
If you will be preparing your own meals at home after surgery, have on hand easy to prepare foods.
The Surgical Procedure
The surgery takes approximately one hour to complete.
THE LOWER LIDS
The incision is made on the lower lid 1/16 of an inch below the lash margin and at the outer corner of the eye, parallel to the lower lid margin to slightly past the outer corner and then curves into the wrinkles or "laugh lines" for about one centimeter. The skin is carefully dissectioned away from the underlying tissues; the approximate amount of excess fat (bagginess) is removed from below the eye; the skin is closed with fine sutures. Sometimes adhesive strips are applied across the other portion of the incision.
THE UPPER LIDS
Before the incision is made on the upper lid, the excess skin is outlined. The outline is drawn so that the incision line and resulting scar fall within the normal skin crease when the eye is open. The incision is flared upward at the outer corner following the eyebrow line; the predetermined amount of skin is removed; the appropriate amount of excess fat is removed and the skin is closed with fine sutures.
Possible Complications
Complications are rare. Occasionally blood will accumulate under the incision edges. In some instances there may be enough blood to warrant removal in order to speed up the healing process. Infection is very rare. Occasionally the lid may be pulled away from the eye a slight amount. This may be caused by abnormal deep scar healing. The problem is usually temporary but may require surgical correction later.
Small bumps along the incision line may occur two to three weeks after surgery. These are cysts or plugged sweat glands. Most of these disappear but occasionally they need to be opened. This is a very minor procedure and can be done in the office.
What to Expect after Surgery
There is little pain associated with this type of surgery. What discomfort there is can be controlled with pain medication prescribed by your surgeon. Skin colored steri-strips are applied to incisions and worn for the first 5 days after surgery. The doctor or nurse will remove them on the second post op visit.
SWELLING, BRUISING AND DISCOLORATION of the eyelids varies with each patient and may be slight or considerable. Most of the swelling and bruising is gone within five to ten days, but it is not unusual for the discoloration to last longer. During this time the eyelids may appear baggy, irregular and asymmetrical.
DOWNWARD DISPLACEMENT OF THE LOWER LIDS The lid may pull away from the eyeball slightly. This is due to swelling and disappears as the swelling subsides. Because of this drooping of the eyelid, it is not unusual for the eyes to experience slight watering.
REDNESS OF THE EYEBALL may occur and is a result of the bruising of the soft tissue around the eye. It is harmless and painless. The stitches are removed from the eyelids approximately four to six days after surgery.
POST OPERATIVE CARE
It is important to use your ice mask during the first 24-48 hours after surgery. This mask will be provided by the surgery center immediately after surgery, and during your time in the recovery room. Continuous icing (with a few breaks) is preferred if you can tolerate it, otherwise, 20 min of icing to every hour will be fine. This will reduce swelling to some degree.
It is important to sleep on your back, with your head elevated. This will also reduce some swelling. Using pillows under your arms and knees will keep you from turning to your side.
AS WITH ANY FACIAL SURGERY, AVOID BENDING FORWARD, AS THIS CREATES STRAIN ON ALL INCISIONS THAT ARE HEALING.
Avoid getting the steri-strip tapes wet for the first 3 days following surgery. Avoid elevating your blood pressure either by physical activity, or emotional means. This causes strain on healing areas that would increase in swelling.
Make sure you have plenty of liquids and soft foods available for your convalescence. Fruit juices, carbonated beverages, and yogurt are particularity useful.
There is some degree of swelling and possibly bruising in most patients but usually very little in the way of pain or discomfort. It is also not unusual for a patient to experience a day or two of "blues" one to three weeks after surgery. After the initial excitement of the operation has worn off, but before you look as good as you would like to, this mild depression might be experienced. It is not unusual and no cause for alarm and should pass quickly.
Resumption of Physical Activities - General Rules of Thumb: Two, Four, Six Rule
First week:
TAKE IT EASY!! PATIENTS WHO ARE TOO VIGOROUS FREQUENTLY DEVELOP COMPLICATIONS!
At two weeks:
take long walks on a flat surface. No other kind of workouts. Any activity that would raise your blood pressure would compromise the healing incisions and newly developing blood supply.
At four weeks:
light exercise such as aerobics, but no weight training. Start light. For example, if you normally do 30 minutes on a treadmill, begin with 15 minutes, then increase as your body gets used to things. Use of vitamin C and E concentrate and scar-fade gel should begin as soon as the incisions are completely healed, usually 3-4 weeks.
At six weeks:
resume all previous activities with clearance from Dr. Moelleken. Avoid sun exposure to incision site for months following surgery, as this may result in a hyperpigmented scar.
