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In our office, Dr. Neal Nirenberg specializes in performing state-of-the-art
blepharoplasty, and is here to discuss your procedure with you in great detail
and answer all your questions. Please feel comfortable about asking him anything
you don't understand.
THE BEST CANDIDATES FOR EYELID SURGERY
Blepharoplasty can enhance your appearance and your self-confidence, but it
won't necessarily change your looks to match your ideal, or cause other people
to treat you differently. Before you decide to have surgery, think carefully
about your expectations and discuss them with Dr. Nirenberg. The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.
A few medical conditions make blepharoplasty more risky. They include thyroid
problems such as hypothyroidism and Graves' disease, dry eye or lack of sufficient
tears, high blood pressure or other circulatory disorders, cardiovascular
disease, and diabetes. A detached retina or glaucoma is also reason for caution. ALL SURGERY CARRIES SOME UNCERTAINTY AND RISK
When eyelid surgery is performed by a qualified surgeon, complications
are infrequent and usually minor. Nevertheless, there is always a possibility
of complications, including infection or a reaction to the anesthesia.
You can reduce your risks by closely following Dr. Nirenberg's instructions
both before and after surgery.
The minor complications that occasionally follow blepharoplasty include
double or blurred vision for a few days; temporary swelling at the corner
of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads
may appear after your stitches are taken out; Dr. Nirenberg would remove
them easily with a very fine needle. Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required. PLANNING YOUR SURGERY
The initial consultation with Dr. Nirenberg is very important. He
will need your complete medical history, so check your own records ahead
of time and arrive prepared to provide this information. Be sure to inform
Dr. Nirenberg if you have any allergies; if you're taking any vitamins,
medications (prescription or over-the-counter), or other drugs; and if
you smoke.
In this consultation, your vision will be tested and an assessment
made of your tear production. You should also provide any relevant information
from any previous ophthalmologist or records of your most recent eye
exam, if not already in our office. If you wear glasses or contact lenses,
be sure to bring them along.
You and Dr. Nirenberg will carefully
discuss your goals and expectations for this surgery. You'll need to
discuss whether to do all four eyelids or just the upper or lower ones,
whether skin as well as fat will be removed, and whether any additional
procedures are appropriate. Dr. Nirenberg will explain the techniques
and anesthesia he will use, the type of facility where the surgery
will be performed, and the risks and costs involved. (Note: Most
insurance policies don't cover eyelid surgery, unless you can prove
that drooping upper lids interfere with your vision. Check with your
insurer.) Don't hesitate to ask Dr. Nirenberg any questions
you may have, especially those regarding your expectations and
concerns about the results. PREPARING FOR YOUR SURGERY
Dr.
Nirenberg will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed. WHERE YOUR SURGERY WILL BE PERFORMED
Your eyelid
surgery will be performed in an outpatient surgery center.
It's usually done on an outpatient basis; rarely does it require
an inpatient stay. TYPES OF ANESTHESIA
Eyelid surgery is usually performed under local anesthesia - which numbs the area around your eyes - along with oral or intravenous sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Some surgeons prefer to use general anesthesia; in that case, you'll sleep through the operation.
YOUR SURGERY
Blepharoplasty
usually takes one to three hours, depending on the extent
of the surgery. If you're having all four eyelids done, Dr.
Nirenberg will probably work on the upper lids first, then
the lower ones. In a typical procedure, Dr. Nirenberg
makes incisions following the natural lines of your eyelids;
in the creases of your upper lids, and just below the lashes
in the lower lids. The incisions may extend into the crow's
feet or laugh lines at the outer corners of your eyes.
Working through these incisions, Dr. Nirenberg separates
the skin from underlying fatty tissue and muscle, removes
excess fat, and often trims sagging skin and muscle. The
incisions are then closed with very fine sutures. If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin. AFTER YOUR SURGERY
After
surgery, Dr. Nirenberg will lubricate your eyes
with ointment and may apply a bandage. Your eyelids may
feel tight and sore as the anesthesia wears off, but
you can usually control any discomfort with Extra Strength
Tylenol. If you feel any severe pain, call Dr. Nirenberg
immediately.
Dr. Nirenberg will instruct you to keep your head elevated for several days,
and to use cold compresses to reduce swelling and bruising. (Bruising varies from
person to person: it reaches its peak during the first week, and generally
lasts anywhere from two weeks to a month.) You'll be shown how to clean your
eyes, which may be gummy for a week or so. You may be prescribed eye drops,
since your eyelids may feel dry at first and your eyes may burn or itch. For
the first few weeks you may also experience excessive tearing, sensitivity
to light, and temporary changes in your eyesight, such as blurring or double
vision.
Dr. Nirenberg will follow your progress very closely for the first week or
two. The stitches will be removed five to ten days after surgery. Once they're
out, the swelling and discoloration around your eyes will gradually subside,
and you'll start to look and feel much better.
GETTING BACK TO NORMAL
You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while. Most
people feel ready to go out in public (and back to work) in a week to 10 days.
By then, depending on your rate of healing and Dr. Nirenberg's instructions,
you'll probably be able to wear makeup to hide the bruising that remains. You
may be sensitive to sunlight, wind, and other irritants for several weeks,
so you should wear sunglasses and a special sunblock made for eyelids when
you go out.
Dr. Nirenberg will instruct you to keep your activities to a minimum for three
to five days, and to avoid more strenuous activities for about three weeks.
It's especially important to avoid activities that raise your blood pressure,
including bending, lifting, and rigorous sports. You may also be told to avoid
alcohol, since it causes fluid retention. YOUR NEW LOOK
Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line. On the other hand, the positive results of your eyelid surgery-the more alert and youthful look-will last for years. For many people, these results are permanent.
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