Blepharoplasty

Blepharoplasty (BLEF-uh-ro-plas-te) is surgery to repair droopy eyelids by 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, drooping upper lids and bags under your eyes. Besides making you look older, severely sagging skin around your eyes can impair your vision. Blepharoplasty can reduce or eliminate such impaired vision.

Blepharoplasty is usually done on an outpatient basis. To help decide if blepharoplasty is right for you, find out what you can realistically expect, and take time to explore the benefits and risks of blepharoplasty.

When considering an eyslid lift

You might consider blepharoplasty if drooping or sagging eyelids keep your eyes from opening completely or pull your lower eyelids down. Removing excess tissue from your upper eyelids, lower eyelids or both can improve vision and make your eyes appear younger and more alert. Blepharoplasty may be an option if you have:
Baggy or puffy upper eyelids
Excess skin of the upper eyelid that interferes with your vision
Droopy lower eyelids, which may cause white to show below the iris (colored part of the eye)
Excess skin on lower eyelids
Bags under your eyes
Blepharoplasty can be performed at the same time as another procedure, such as a brow lift, face-lift or skin resurfacing. If you have the surgery only to improve your appearance, the cost probably won’t be covered by insurance.

Risks

As with any surgery, blepharoplasty carries some risks, such as infection or reaction to anesthesia. Other possible risks specific to this surgery include:
Temporary numbness of the eyelid skin
Dry, irritated eyes
Temporary vision changes, such as double vision
Impaired eyelid function
Scarring
A very small risk of blindness due to bleeding behind the eye
Talk to your doctor about how these 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.

Preparing for facial plastic surgery

Before scheduling blepharoplasty, you need to meet with a plastic surgeon to discuss whether the procedure is likely to work well for you. This meeting generally includes:
Your medical history. Your surgeon asks questions about conditions you have or have had. Detailed questions may focus on dry eyes, glaucoma, eye-related allergies and other eye problems. Tell the doctor if you have circulatory problems, thyroid problems, diabetes or other serious medical conditions. Your doctor will also ask about your current medications, including over-the-counter medications. Make sure to tell your doctor about any herbal supplements you take, as some of them — including ginkgo, ginseng, garlic and ginger — may cause bleeding problems.
A physical examination. Your surgeon conducts a physical examination, which includes testing your vision and tear production. Special tools may be used to measure parts of your eyelids.
Photographs. Your eyes will be photographed from different angles. These photos help with planning the surgery and assessing its immediate and long-term effects.
A discussion of your expectations. An honest discussion will help set the stage for a satisfactory outcome. Be prepared to talk about your motivation for seeking blepharoplasty and what you hope the results will be. Your surgeon can tell you whether your expectations are in line with usual results.

Prior to blepharoplasty, you’ll be asked to:

Stop taking aspirin, ibuprofen (Advil, Motrin, others) and other nonsteroidal anti-inflammatory drugs (NSAIDs), as well as herbal supplements associated with increased bleeding. It’s best not to use these medications and supplements for two weeks before and after surgery. Take only medications approved or prescribed by your surgeon.
Avoid exposing your skin to excess sunlight for one week before surgery and two to three months 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 surgery.

How blepharoplasty is done

Blepharoplasty is usually done in an outpatient setting under local anesthesia. Your surgeon injects numbing medication into your eyelids and administers intravenous (IV) medication to help you relax. This may make you groggy, but you will not be fully asleep.

During the procedure

If you have surgery on your upper and lower eyelids, the surgeon generally works on your upper lids first. The surgeon makes an incision along the natural fold of the upper eyelid. Then excess skin and some muscle and fat beneath the skin is removed. The incision is closed with tiny stitches that leave a nearly invisible scar. Sometimes surgical tape or skin adhesives are used instead.

The incision on the lower lid is made just below the lashes in your eye’s natural crease or inside the lower lid. The surgeon removes excess fat, muscle and sagging skin. Depending on where the initial incisions are made, stitches may follow the lower lid’s natural crease or be placed inside the lower eyelid.

If your eyelid droops close to your pupil, blepharoplasty is done in conjunction with another procedure to address that problem, which is called ptosis (TOE-sis).

After your eyelid lift

Blepharoplasty usually takes less than two hours, depending on the amount and location of tissue being removed. Afterward you spend time in a recovery room, where nurses and their assistants monitor you for complications. You can leave later that day to recuperate at home.

After blepharoplasty a lubricating ointment will be applied to protect your eyes and prevent dryness. The ointment often may cause temporary blurred vision. You may also experience excessive tearing, light sensitivity and double vision just after the surgery. Your incisions will be red and visible at first, and your eyelids may be puffy and feel numb for several days. Swelling and bruising, similar to having “black eyes,” will likely last a week or more. Ice packs or cold compresses applied to your eyes can help reduce swelling.

Pain is usually minimal. You may be given a pain reliever, such as acetaminophen, for mild discomfort, but remember to avoid aspirin, ibuprofen (Advil, Motrin, others), other NSAIDs and herbal supplements that may increase bleeding.

If stitches were used, they’ll be removed in three or four days.

Take the following precautions for a week after the surgery, unless advised otherwise by your doctor:

  • Don’t lift anything weighing more than 20 pounds (9 kilograms).
  • Avoid swimming.
  • Avoid strenuous activities, such as aerobics and jogging.
  • Sleep with your head raised higher than your chest.
  • Follow your doctor’s instructions for cleaning your eyes and using eyedrops.
  • Seek medical attention immediately if you experience shortness of breath, chest pains, an unusual heart rate, new pain, bleeding or visual disturbance.

Results

Scars from the incisions may take six months or longer to fade. Take care to protect your delicate eyelid skin from too much sun exposure during this time.

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, but for others, eyelid drooping eventually may recur.