Upper Lid Blepharoplasty

Drooping eyelids can be caused by stretching and increased laxity of the upper eyelid skin that is commonly seen in aging. Prominent fat pads in the tissues can also play a role. This can create a tired or sad look for the person suffering from this condition. In severe cases, the drooping of the upper eyelids can cause vision loss by constricting the field of vision.

Blepharoplasty is an eyelid surgery that can correct these conditions resulting in a more rested and youthful appearance. In certain cases, blepharoplasty can even improve peripheral vision. The surgery is performed on an outpatient basis with little to no discomfort following the procedure. Scarring is minimal and is easily concealed in the upper eyelid’s natural crease.

Blepharoplasty can be covered by insurance, if specific criteria are met. If your eyelids hinder your eyesight, a skilled ophthalmologist can perform simple tests to determine the degree of vision loss and inform you if you are eligible for surgery under your insurance policy. It’s important to note that only a trained ophthalmologist can perform and interpret these necessary tests. If you feel you may be a good candidate covered under insurance, please call us for a consultation. Many of Dr. Landes’ patients are covered by insurance. She can determine your degree of eligibility.

The Procedure

  • Eyelid surgery is performed in an outpatient setting and patients are able to go home after their procedure.
  • There is no need for general anesthesia. A mild sedative is administered to ensure that patients are totally comfortable followed by local anesthesia.
  • On average, surgery takes approximately 60 minutes.

After the Surgery

  • The first two days following surgery should be spent relaxing.
  • Antibiotic ointment and ice packs are applied for the first several days to promote healing and reduce swelling.
  • Usually any tightness of the skin and about 70-80% of the swelling disappears within the first week.
  • After two weeks, close to 90% of the swelling will have dissipated.
  • Any bruising should resolve within three weeks.

 

IMPORTANT INFORMATION BEFORE YOUR EYELID SURGERY

Blood Thinners

It is important for you to discontinue medications that might thin your blood prior to surgery. Failure to discontinue blood thinning medications at the very least will increase your bruising and delay recovery, and at the very worst could be a threat to your vision.

Prescription Blood Thinners

A few prescription medications like Coumadin (Warfarin), Plavix (Clopidogrel), Ecotrin (Aspirin), and prescription strength Fish Oil (Lovaza) thin your blood. Prior to discontinuing these medications you should discuss it with the physician who is prescribing the medication. Typically, Coumadin is discontinued 5-7 days prior to surgery and restarted the day after surgery. Plavix and Aspirin are discontinued 2 weeks prior to surgery and restarted 3 days after surgery. Medication for high blood pressure does not thin your blood and may be taken with a sip of water on the day of your surgery, as long as it is not a water pill.

Over-the-Counter Blood Thinners

Products which contain aspirin like Baby Aspirin, Excederin, and Ecotrin should be discontinued 2 weeks prior to surgery and restarted 3 days after surgery. If you are taking these for a medical condition such as coronary artery bypass surgery, atrial fibrillation, or heart valve abnormalities, then you should discuss stopping the medication with the doctor who recommended you use the medication. Over the counter, nonsteroidal anti-inflammatory drugs (NSAIDs) like Ibuprofen, Motrin, Aleve, and Naprosyn all thin the blood and should be stopped 2 weeks prior to surgery. If you need an over the counter pain reliever in the 2 weeks prior to surgery, it is OK to take Tylenol, as Tylenol does not thin your blood.

Other Blood Thinners

Many over the counter food supplements and herbal preparations thin your blood and can be dangerous to take prior to surgery. Examples include Fish Oil, Omega 3 fatty acids, Vitamin E, Gingko Biloba, Energy Drinks, Glucosamine, and many, many more. The safest thing to do is to avoid all aspirin containing medications, herbal medications, vitamins, supplements, and over the counter pain medications other than Tylenol for two weeks prior to surgery.

Coumadin should be stopped 1 week prior to surgery and may be restarted the day after surgery. All other blood thinners should be stopped 2 weeks prior to surgery and may be restarted 3 days after surgery. These include Plavix; Aspirin products; Fish Oil/Omega 3 fatty acids; NSAIDs such as Ibuprofen, Motren, Alleve; and herbal medications and supplements. If you are taking any of these medications based on your doctor’s recommendation, you will need to check with the prescribing doctor if it is safe for you to stop them in preparation for your surgery.

Risks of Surgery

The risks of eyelid surgery are generally: bleeding, infection, discomfort/pain, bruising, swelling, scar formation, damage to surrounding nerves or tissue, under correction, overcorrection, asymmetrical outcome, wound dehiscence, need for further surgery, tearing, dry eyes, injury to the eyes, blurry vision, and rarely, loss of vision.

Everyone will experience bruising and swelling. In fact, you can expect to have bruising and swelling for up to 2-3 weeks after your surgery. Any pre-existing tearing or dryness may temporarily worsen. Dryness is more of a risk if you have a surgery that lifts your upper eyelids.

All incisions made during surgery will result in scar formation. Scars will become less apparent with time, fading over the first 6 months. Upper eye lid scars will be hidden in the natural lid crease. Scars above the eyebrow will be partially hidden by the brow hairs and also somewhat camouflaged by the lines and wrinkles of the forehead. Scars located at the corner of the eyes are small and are camouflaged by the “laugh lines” often located there.

Even if a satisfactory outcome is achieved after surgery, with time and aging, the results may reverse. If you experience under correction, overcorrection, asymmetry, wound dehiscence, or a loss of a satisfactory outcome with time, you may require another procedure.

Your vision may be temporarily blurry after surgery due to the ointment you will be using and other potential contributing factors such as tearing, dryness, and swelling. However, if you experience a loss of vision, severe pain in or behind the eyes, or swelling that prevents you from opening your eyes, you must contact the Davis Eye Center immediately. These could be signs of a retrobulbar hemorrhage, or bleeding behind the eye. Although very rare, this is a serious complication that could lead to blindness if not addressed immediately.

Your surgeon will discuss with you the risks specific to your type of surgery and your individual circumstances.

Before Surgery

In preparation for your surgery, you will need to schedule an appointment with your primary care doctor/general practitioner to obtain medical clearance. Medical clearance must be received within one month of your surgery. If you have recently been seen by your doctor but there has been a change in your health, you should be seen again to make sure it is still safe to proceed with surgery. You need to be cleared to receive light sedation. This is not general anesthesia, and you will be able to breathe on your own. An anesthesiologist will be monitoring you throughout the case. 

Day of Surgery

You will be given instructions regarding which medications to take the morning of surgery. Generally we ask that you not take insulin, diabetic medications, water pills, or blood thinners the morning of surgery. 

You will not be able to eat breakfast the morning of surgery or anything after midnight the night before your surgery. You will be given a list of clear liquids that you may drink up to 2 hours before your surgery.

Make sure you bathe and wash your face the morning of surgery. Do not put on make-up and do not wear jewelry. Wear loose and comfortable clothing including a short-sleeved shirt or blouse that buttons all the way down the front.

You will be unable to drive yourself home after surgery. Please make arrangements to have someone drive you home after your surgery.

What to Expect

Expect to have some bruising and swelling for up to 2-3 weeks after surgery. Making sure to stop all blood thinners as directed, using cold compresses, and sleeping with your head elevated can decrease the amount of bruising and swelling and hasten recovery. Any postoperative discomfort should be controlled with over the counter Tylenol, if needed. Sometimes the suture (stitches) may itch.  Your surgeon may choose to use suture which dissolves on its own (these tend to itch more) or a suture that will need to be removed later in the office. If your surgeon asks you to use an ointment in or around the eyes, it will make your vision temporarily blurry. Once you are asked to stop the ointment your vision should return to your baseline. We typically don’t need to use eye patches after surgery, however if we decide to patch your eye, this would only be for 1-2 hours.

Post-Operative Care Instructions

Cold Compresses/Ice Packs

On the day of surgery and two days after surgery, you should apply cold compresses to your eyelid(s). The surgeon may place a patch over your eye(s) after surgery. You may begin applying the cold compresses after the patch has been removed. You may use an eye mask that can be frozen or make your own cold compress. In order to make a cold compress, first take a clean, wet wash cloth and rest it over the eyelids. Place either a bag of frozen peas or corn or a ziplock bag filled 2/3rds of the way with ice and 1/3rd of the way with water over the wash cloth. It is easiest to use cold compresses when seated in a reclined position. The more you use cold compresses the less you will bruise and swell after surgery and the faster you will recover. You should use the cold compresses a minimum of 15 minutes out of every hour while awake. When sleeping you do not need to use the compresses and getting adequate sleep is important to healing. It is useful to keep your head elevated when you sleep by using two or more pillows.

Warm Compresses

Warm compresses are used to help resolve bruising. If your face is not bruised then you do not need to use warm compresses. You may use an eye mask that can be heated or make your own warm compress. A warm compress can be made by boiling or microwaving a potato and wrapping it in a clean, wet wash cloth. You may also use a wash cloth that has been run under very warm water. To prevent scalding your skin, always test the compress out on the back of your hand before applying it to your face. Warm compresses should be applied to the bruised portion of your face for 15 minutes 3 times daily until the bruises turn yellow, starting only after the 3rd day after surgery and only if bruising is present.

Pain Control

If you have any post-operative discomfort, you may take Tylenol for the first 2 days after surgery. Please do not take Ibuprofen, Motren, Alleve, Napsosyn, or Aspirin until 3 days after surgery. If Tylenol is not enough to control your discomfort, please contact your surgeon.

Other

If you feel comfortable, you may begin driving the day after surgery. You may return to work whenever you feel ready to do so. If you need a note for time off of work we can provide you with that. You may bathe/shower the day after surgery. Avoid pools and hot tubs for one week after surgery. Avoid eye makeup for one week after surgery. It is very important not to rub your eyelids after surgery, even if they feel itchy. This can cause the stitches to break and the wound to open. 

Your surgeon may prescribe an antibiotic ointment to use on your eyelid(s) and possibly in your eye(s). Ointment in the eyes will temporarily blur the vision. Depending on your surgery, you may also be instructed to use artificial tears. Make sure that your hands have been washed before applying the ointment or using the artificial tears. 

Remember, if you develop severe pain, experience a decrease in vision which is not related to the ointment in your eyes, or develop swelling so bad that you cannot open your eyes, please contact the Davis Eye Center immediately or report to the emergency department without delay.