Types of Eyelid Surgery

Eyelid surgery, otherwise known as a blepharoplasty, can refer to the tightening of the upper eyelids, the lower eyelids, or both.

It involves the removal of excess droopy skin, and/or the removal of bulging or excess fat. With eyelid surgery, more is definitely NOT better. Too much skin removed, and you may not be able to close your eyes.

Too much fat removed, and the eyes can take on a hollowed out look, making one look older or tired. It is also critical to maintain different goals for men versus women.

In men it is better to “underdo” the eyelid procedure because too much lift or too much fat removal can make the eyes look too “crisp” compared to the masculine features, or it can “feminize” the eye region.

Who is a candidate?

Candidates for eyelid surgery are men or women with excess skin, and/or excess fat of the upper and/or lower eyelids.
*In some cases where patients believe they need their eyelids done, the actual problem is the brow. If the forehead or brow is drooping, then this must be addressed before the eyelids.

Patients with drooping forehead or brows often don’t realize they automatically raise their eyebrows when they open their eyes, and they do it in order to get the upper eyelid skin off of their lids so that they can see comfortably.

In these patients, if you take away the drooping skin from their eyelids, you actually don’t fix the problem.

Now that the eyelid skin doesn’t droop, it takes away the signal to raise one’s eyebrows, and once the brow relaxes the eyelids look droopy again, because now they are weighed down from above.

Therefore it’s important to first put the brows in the correct position, and then do the eyelid surgery. If you do the eyelids first and then try to raise the brow, you may not be able to close your eyes because too much was taken from the lids when the brow was low.

Will insurance cover my eyelid surgery?

The good news is that if your eyelids are so droopy that they interfere with your vision, then your insurance may cover the procedure (applies to upper lids only).

Typically insurance companies require proof of this in the form of Visual Field Testing, Taped and Untaped.

In this test, your visual fields are tested with your eyebrows and eyelids in their normal position (without raising your forehead), and they are tested again with your eyelids taped up so they don’t interfere with your vision.

The difference between taped and untaped results is used to determine if in fact you have a visual field deficit, and if so, if it is likely to be corrected by surgery.

Not all eye doctors are accustomed to doing this test, and if you are unsure if your eye doctor performs it, please call our office and we can give you recommendations.

Locations of incisions

Incisions for the upper eyelid surgery are typically placed along the eyelid crease (which may be hidden by excess skin, but can be found by the surgeon when your eyes are closed).

In this location, once the excess skin is removed, the incision fades into looking just like a regular eyelid crease.

While healing varies patient to patient, in general the upper eyelid incision heals well in all skin types and ages. The lower lid incisions depend on what is being done.

The preferred technique of Dr. Patel is one where the incision is placed on the inner surface of the lower eyelid, known as a “transconjunctival incision”, for removal of excess fat, or redraping of excess fat into the tear trough.

If there is excess skin also, Dr. Patel makes a second incision just under the lash line to remove a small pinch of skin. This method is also known as the “no-touch” technique.

What are the risks of eyelid surgery?

The standard surgical risks include pain; bleeding; infection; scarring; painful or hypertrophic scarring; visible scars; injury to vessels, nerves, surrounding structures; asymmetry; poor cosmetic result; prolonged edema, numbness, parasthesias; temporary or permanent nerve damage; need for further procedure and out of pocket costs; and risks of anesthesia.

There is also a risk of dry eyes, blurry vision, lid lag, ectropion, skin discoloration and swelling, and unmasking of true lid ptosis (problem with the muscles, not just excess skin, which may require additional surgery called ptosis repair that is not part of the blepharoplasty). Though rare, there is a possible risk of blindness from uncontrolled bleeding into the eye socket, or retrobulbar hematoma.

Therefore any sudden pain or swelling in the eye, especially if only on one side, should be reported and evaluated immediately.

What type of anesthesia is required for eyelid surgery

Typically eyelid surgery is done under either general anesthesia, or local anesthesia with sedation. Cases in which ptosis repair is required, in addition to the blepharoplasty, tend to be done under local anesthesia to assess for symmetry with movement. You can ask Dr. Patel which would be best in your case specifically.

Recovery

Walking the day of surgery is recommended. You may wash the face 24 hours after surgery. Gentle soap (non-perfumed, non-irritating soap preferred) and water over the incisions is okay.

Bacitracin ointment may be applied along the incision lines until stitches are removed. Opthalmic ointment to the eyes is also helpful the first week after surgery, to keep the eyes moist at night.

For the first 24-48 hours, you may gently ice the area (avoid ice directly on incision, place washcloth in between) on and off to help with swelling. Elevating the head of your bed is also helpful in preventing and alleviating swelling, and should be done for at least the first few nights following surgery.

Sutures are removed 1 week after surgery. Dr. Patel recommends avoiding exercise for 6 weeks following surgery, at which time you can ease back into your workouts. Light activity may be okay around 3 weeks after surgery.

Bruising, if it occurs, typically lasts 7-10 days, and can be vary in intensity from patient to patient.

You may return to work the week after surgery, depending on your pain level, stamina, and activities required in your occupation.

You may drive once you are no longer taking pain medications, and allow a 24 hour minimum window between your last pain medication dose and driving.

All recovery processes and recommendations vary patient to patient, so these general guidelines may not apply to every patient. You will want to avoid photographs or events requiring photo or video for at least 2 weeks.

Followup visits after surgery

Dr. Patel typically sees patients the day after surgery for followup check, a week after surgery for removal of sutures, 1-2 weeks later, at the 6 week mark, 3 month mark, and every 3 months thereafter for a year, and anytime during or thereafter as needed.