Who are the best candidates for eyelid surgery?
The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.
What are the risks?
As with all surgical procedures there are risks. Your doctor will discuss these risks with you. Medical conditions including thyroid problems, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes may create more risks for this kind of surgery. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery.
The minor complications that occasionally follow eyelid surgery include double or blurred vision for days, temporary swelling at the corners of the eyelids, and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle.
Some patients may experience dryness or itchiness of the eyes which may be caused by failure of the eyelids to completely close during the healing process. This can be treated with eye drops and ointment. People who have dry eyes before surgery are at a greater risk.
Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.
Where is the surgery performed and what kind of anesthesia is used?
Eyelid surgery is performed in the operating room with local anesthesia and intravenous sedation. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
What happens during surgery?
Eyelid surgery usually takes one to three hours, depending on the extent of the surgery. If you're having all four eyelids done, the surgeon will probably work on the upper lids first, then the lower ones.
In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids - in the creases of your upper lids and just below the lashes in the lower lids. The incisions may extend into crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine stitches.
If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.
What happens after surgery?
After surgey, your surgeon will probably lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by your surgeon. If you feel any severe pain, call your surgeon immediately.
You should keep your head elevated for several days, and use cold compresses
to reduce swelling and bruising. (Bruising varies from person to person; it reaches its peak during the first week and generally lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Many doctors recommend eye drops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.
Your surgeon will follow your progress very closely for the first week or two. The stitches will be removed two days to a week after surgery. Once the stitches are removed, the swelling and discloration around your eyes will gradually subside, and you'll start to look and feel much better.
How long is the recovery?
You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.
Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing and your doctor's instructions, you'll probably be able to wear makeup to hide the remaining bruising. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.
Keep your activities to a minimum for three to five days; avoid more strenuous activities for three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.
Will there be scars? Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, they'll fade to a thin, nearly invisible white line.