What Is a Blepharoplasty?
A blepharoplasty is a procedure performed on the eyelids to improve their appearance. Patients often complain that they always look tired because of the appearance of their eyes. The procedure can be performed on the upper eyelids (an upper lid blepharoplasty) or on the lower eyelids (a lower lid blepharoplasty).
In an upper lid blepharoplasty, excess skin is excised. Sometimes fat, particularly from the medial (inner) part of the eyelid, is also removed if the upper eyelid appears too full. In other cases, fat is added in the form of fat grafting to improve a hollowed upper eyelid.
Lower eyelids typically develop fine wrinkles and bulging of the fat beneath the eye, which leads to a crease between the eyelid and cheek, a sign of aging. In lower lid blepharoplasty, the objectives are usually to improve these fine wrinkles and re-create the smooth transition between the eyelid and cheek that was present in youth. There are several options to improve the fine wrinkles of the lower eyelid: sometimes a CO2 laser or a chemical peel is recommended, while other times a small amount of skin is excised. The lower eyelid bags are treated through an incision on the inside of the eyelid: some of the fat is removed, but most is repositioned down into the cheek to re-create that smooth transition.
Dr. Namin’s Philosophy
Rejuvenating the appearance of the eyes is one of the most powerful procedures in facial plastic surgery. Dr. Namin’s objective is to deliver a natural appearance through careful examination and a well-thought-out operative plan. While many individuals seek out blepharoplasty, several other facial features must be assessed before embarking on the procedure.
First, the eyebrow position is very important. As individuals age and develop excess upper eyelid skin, they often also develop descent of the eyebrow; for this reason, a brow repositioning procedure may be recommended along with an upper lid blepharoplasty. Second, the appearance of the upper eyelid in youth must be assessed. Some individuals have always had more hollow upper eyelids, while others have always had fuller ones, so determining the patient’s desired aesthetic and their youthful appearance is important before developing the plan.
Third, the presence of ptosis, or a “lazy” eyelid, must be carefully examined for; this sometimes requires a separate procedure known as a ptosis repair. Finally, and most importantly, the strength of the lower eyelid must be assessed. Lower eyelid blepharoplasty carries unique and potentially serious complications: as individuals age, the lower eyelid weakens and becomes more prone to scarring forces, which can lead to ectropion, where the lower eyelid becomes everted and retracted downward. Dr. Namin performs the deep repositioning maneuvers through an incision on the inside of the eyelid, which helps decrease the incidence of these complications.
Anticipated Postoperative Recovery
You will have bruising and swelling of the eyelids that peaks around three days after surgery and takes about two weeks to resolve completely. Applying ice packs or cool compresses for 20 minutes every few hours will help minimize this, and taking Arnica Montana as prescribed will also help reduce the bruising and swelling. Beginning on the fourth day after surgery, stop the ice packs or cool compresses and transition to warm compresses.
Gently clean the incisions as instructed twice daily, then apply bacitracin ophthalmic ointment to keep them moist. Use the artificial tears to prevent dry eye during the recovery period. Dr. Namin will see you about one week after surgery for suture removal. Light exercise may be resumed one week after surgery, and vigorous exercise two weeks after surgery; by two weeks, most bruising and swelling has resolved. Plan to sleep on your back with slight head elevation (1-2 pillows for comfort) during recovery, and avoid flexing your neck or elevating your head excessively.
Anticipated Postoperative Timeline
Day of Surgery. Dr. Namin will meet with your family or friend once the procedure is complete. You will typically spend one to two hours in the surgical facility afterward. It is important that someone stays with you the first night after surgery.
Post-Operative Days 1-3. Use cool compresses or ice packs for 20 minutes every few hours to help minimize swelling.
Post-Operative Days 4-5. You may begin using warm compresses. Swelling begins to slowly subside.
Post-Operative Day 7. You will return to clinic so Dr. Namin can see you. Sutures are typically removed at this visit.
Post-Operative Days 8-14. Bruising and swelling typically resolve during this period.
Post-Operative Week 2. Vigorous exercise may be resumed.