Oculoplastics Program at Vance Thompson Vision
Oculoplastics Top Line
- Can be either a medically necessary or an elective procedure
- To be considered medical, more than 30% superior visual field loss is required.
- Surgery can take up to an hour to perform.
- Patients must use Maxitrol (or similar) ointment on incision line until sutures are removed.
- Can be combined with other procedures - brow lift, ptosis, or aesthetic procedures.
- Botox or fillers will not replace doing a surgical blepharoplasty procedure.
What is the procedure?
Blepharoplasty is the surgical modification of the eyelid which improves the appearance of the upper eyelids, lower eyelids, or both. It gives a rejuvenated appearance to the surrounding area of the eyes, making one look more rested and alert. Every year, one hundred thousand men and women choose blepharoplasty to improve the way the look. However, it won't remove crows feet or other wrinkles, eliminate dark circles under the eyes, or lift sagging eyebrows. Excess tissue, such as skin and fat are removed or repositioned, and surrounding muscles and tendons may be reinforced. Though blepharoplasty is often performed as a single procedure, your surgeon may also recommend a brow lift or other skin resurfacing to achieve the best results. It can be both a functional and cosmetic surgery.
When and Why Do It?
Blepharoplasty can be performed as an elective surgery for cosmetic reasons. Lower eyelid blepharoplasty is almost always done for cosmetic reasons, to improve the puffy lower eyelid "bags" and reduce the wrinkling of skin.
Blepharoplasty can be performed for functional reason. When and advanced amount of upper eyelid skin is present, the skin may protrude over the eyelashes and cause loss of the superior vision. The outer and upper parts of the visual field are most commonly affected and the condition may cause difficulty with activities such as driving or reading. This can be determined by performing a superior 36 degree Humphrey visual field. If more than 30% of the visual field is compromised, confirmed by doing both taped and non-taped eyelids, then insurance may cover the cost of the blepharoplasty. In this circumstance, upper eyelid blepharoplasty is performed to improve peripheral vision.
HOW IS THE SURGICAL PROCEDURE DONE?
Blepharoplasty is usually performed through external incisions made along the natural skin lines of the eyelids, such as the of the upper lids, and below the lashes of the lower lids. Incisions for the lower eyelids may also be made from the inside surfaces of the lower eyelid, transconjunctival blepharoplasty. This allows removal of the lower eyelid fat without an externally-visible scar, but does not allow excess skin to be removed. External skin resurfacing with a micro laser peel and / or profractional laser chemical peel may be performed following the procedure to further tighten the periorbital skin and reduce wrinkles.
The operation typically takes about an hour to complete. Initial swelling and bruising resolve in one to two weeks, however, at least several months are needed until the final result becomes stable. Blepharoplasty's effects are best appreciated by comparing before and after photos of surgical patients.
The anatomy of the eyelids, skin quality, age and the adjacent tissue all effect the cosmetic and functional outcomes. Factors which are known to cause complications include dry eyes - which may become exacerbated by disrupting the natural tear film during the healing period.
Post Op Care
- The recovery process after a blepharoplasty may take up to a few weeks. Patients will receive instruction for home after care and most of the time they will receive medication that ease the pain caused by the incisions.
- Up to 2 weeks after the operation has been performed, the patient receives an antibiotic/steroid ointment (Maxitrol) to keep the incisions lubricated. Doctors recommend keeping cold compress on the eyes to reduce bruising and swelling. Other eye drops may also be prescribed as they may help in pain management and in preventing infections.
- Different medications can help in moderating bruises and swelling resulted after surgery and also accelerate patient's healing. One of them is Arnica Montana, an agent that helps in moderating swelling. It should be administered before and after surgery, up to five times per day. There are, however, many products like these that could accelerate one's recovery and they must be discussed with one's surgeon.
- Using moist compresses is advisable after the procedure. Cold compresses work best to relieve swelling and itching. Warm compresses are good for keeping the incision clean and diminishing bruising.
- The stitches are usually removed 7 - 10 days after the operation. The patient's eyelids will be discolored and swollen for about seven to ten days and feel "tight" or "stiff" for a while. Patients should lubricate their eyes by physically exercising, closing their eyes or using lubricant eye drops or gels/ointments.
- During the first few weeks after blepharoplasty, patients may experience excessive tearing, light sensitivity, and sometimes blurred or double vision. Some patients may exhibit subconjunctival hemorrhages, which are normal. These symptoms usually disappear on their own within two or three weeks after the operations.
- Wearing contact lenses or eye makeup is prohibited until the incisions are completely healed. Patients who need them will be advised when it is safe to wear them again, usually within 1 - 2 weeks.
- Numbness is normal during the first few weeks after the surgery. Sensations will gradually return to normal.
- Patients may go back to work within a week after the operation. The scars may still be visible, but one can use makeup to cover them.
- As a part of the blepharoplasty recovery, the patient must avoid bending at the waist for about five days and strenuous activity (especially activities which raise one's blood pressure such as lifting and rigorous sports) for about ten days to two or three weeks.
- Surgery will leave scars, but they are usually well hidden within the eyelid creases and normally fade with time.
The patient below had a Bilateral Lower Lid Blepharoplasty, Bilateral Mueller Muscle Resection, and a Bilateral Internal Browplexy.
Image taken at the evaluation appointment
Image taken at the 10 day post-op, suture removal appointment
Image taken at the 1 month post-op appointment
Non-surgical alternatives have shown improvement with patients exhibiting early indications of facial aging. Chemical peels, Botox, and dermal fillers are all used in some degree to treat periorbital tissue. Although effective, these procedures are often followed up by other Broad Beam and laser procedures to help improve skin tone and texture. Botox, it should be noted, is used to relax the muscles in the forehead and between the eyes, therefore not addressing most of the issues a patient seeking a blepharoplasty would want fixed.
Injectable dermal fillers are also used to temporarily increase volume in the trough area between the lower eyelid, the cheek, and around the eyebrows. These techniques are effective yet have not replaced surgical treatments, and should not be confused with blepharoplasty, which treats not only the superficial skin tissue, but also underlying connective and muscle tissues.
Our Artisan 57 clinic can help design a specific treatment package for you and your patients to improve, restore, and maintain skin health and appearance by reducing wrinkles, addressing skin laxity, poor skin tone and texture, vascularity, and pigmentation. Artisan 57, in combination with Vance Thompson Vision, offers both surgical and non-surgical treatment methods to promote a fresh and vibrant appearance to the areas around the eyes, face, neck, and hands. Your patients can receive a complimentary consultation by making an appointment in our clinic.