Changes around the eyes are one of the first signs of aging. In many people, under-eye sagging can develop as soon as the early 30s. Other people have eye issues since birth, with hereditary bags under the eyes causing a perpetual tired or sad look. Sagging and wrinkling can also be caused or exacerbated by chronic allergies, sun exposure, or excessive squinting and rubbing. Blepharoplasty, or eyelid surgery, is a broad name for a group of procedures performed to improve both the appearance and the function of the eyes.
It can be performed on both the upper and lower eyelids, and can reposition fat, tighten muscle, support tendons, and remove excess skin. This can help to repair sagging eyelids, bags under the eyes, and even certain lines and wrinkles.
Am I a Candidate for Eyelid Surgery?
Good candidates for eyelid surgery include anyone who has excess skin causing the upper eyelids to droop and possibly impairing vision, bags and dark circles under the eyes, or excess skin or wrinkles under the eyes. Ideally, patients will also maintain realistic expectations from the surgery and understand that blepharoplasty, like any procedure, will bring improvement rather than perfection.
A consultation at Dr. Clevens’ Melbourne office is the first step toward having eyelid surgery. During this meeting, you’ll explain your concerns, and Dr. Clevens will evaluate your eye area and discuss potential solutions. You’ll also discuss any additional procedures that you may like to have at the same time. Many patients opt to add a brow lift to correct forehead wrinkles, fillers or fat transfer to add a bit of volume, or laser treatments to help with fine lines.
After deciding on what you’d like to have done, you’ll also go over the aftercare and recovery process for your eyelid surgery as well as any precautions that you should take before the procedure.
About the Procedure
Blepharoplasty is generally performed under a local anesthetic with intravenous sedation to keep you comfortable. The procedure will begin by marking the eyelids to indicate exactly where the excess tissue will be removed. The process for the upper eyelid involves an incision on the crease to allow removal of skin, fat, and excess muscle. For the lower eyelid, the standard approach is to make an incision directly below the lash-line to allow removal of fat and skin, but it’s also possible to use an incision just inside the eyelid to remove fat, although this trans conjunctival approach does not allow for the removal of excess skin.
Once any extra skin has been removed, Dr. Clevens will redistribute the fat to reduce bulging or puffiness in the area. After this reshaping, the incisions will be closed with glue or self-dissolving sutures and you will be moved to the recovery room.
At first there will be quite a bit of swelling and bruising, but this will fade in a week or so. There may also be numbness, excessive tear production, light sensitivity, or double vision in the first few days after surgery. Your discomfort should be minimal and can be treated with over-the-counter medications like acetaminophen, although you should avoid aspirin and other drugs that can increase bleeding. Cold compresses can be used to help control swelling.
You should be ready to get back to life as normal in about two weeks. During those two weeks, you may need to use eye drops to keep your eyes properly lubricated, and you may need to avoid activities like reading that will tire your eyes. You should keep your head elevated as much as possible, including reclining during sleep rather than lying flat. Vigorous exercise should be avoided since the increased blood pressure will cause more swelling. Sunglasses should be worn as much as possible to protect your eyes from wind and sun.
Possible Risks and Complications
Blepharoplasty is a very safe surgery, but it does carry the standard risks of surgery. These include bleeding, infection, and hematoma. Many patients also experience changes in sensation such as tingling or numbness which may continue for several months. Dry eyes are another concern that results from friction from the swollen lids and typically resolves within a few days. Rarely, dryness can persist for longer, causing irritation to the cornea and requiring medical attention. In a few cases, eyelid surgery can result in malpositions such as eyelid retraction. This is quite uncommon, but it can be resolved with a revision blepharoplasty.
Eyelid Surgery FAQs
Q. Is eyelid surgery ever medically necessary?
A. Blepharoplasty is generally considered medically necessary when the eyelids cause functional problems. Usually this occurs when the upper eyelid droops so far that it obstructs the field of vision. To qualify for insurance coverage, most companies require documentation of at least a 25% obstruction.
Q. I’ve heard of a “skin pinch” option for eyelid surgery. What exactly does that do?
A. A skin pinch blepharoplasty is a somewhat less-invasive version of full lower-eyelid surgery. It removes a small amount of skin but does not touch the muscle. It’s useful for patients with less extra skin and for those who may be more prone to dry eyes. Dr. Clevens can determine its viability in your specific case after a professional evaluation.
Q. Will I be able to wear makeup again after my eyelid surgery?
A. Yes, absolutely. In order to allow the incisions to heal properly, though, you should wait for 2-3 weeks. Not only is the makeup itself irritating to fresh incisions, but the bacteria present on the brushes and the cleanser used to remove it can be very damaging as well. To minimize risks of infection, hold off on the makeup until everything is healed.
Q. Is eyelid taping a good alternative to eyelid surgery?
A. Eyelid tape can create a natural-looking crease on monolidded eyes, but it only lasts for as long as you have the tape on. It’s a good temporary option to make sure that you like how you look with the added crease, but for permanent results, surgery is necessary.
Q. How visible will the scarring be?
A. In most cases, the scars will be invisible or nearly so. Scars on the eyelids usually heal very well and become narrow, flat, and close to your natural skin color. Since the locations are well-protected in the crease or near the lash-line, they will not be very apparent. However, they may be quite red and raised for the first month or two, so it’s important to be patient while they heal.