Blepharoplasty

Eyelid surgery can help correct the hooding or heaviness of your upper eyelid. If you’re having a hard time putting on eye shadow because of the skin excess or skin laxity in your upper lid, upper blepharoplasty can help with that. 

Lower eyelid surgery can help to correct excess fat bags under the eye, loose crepe skin under the eye, and also help to smooth the transition between your lower lid and your cheek. 

Upper eyelid scars are placed in the natural crease of your upper eyelid. With time, this incision heals beautifully and is very inconspicuous.

Lower eyelid surgery can be “scar-less” in some patients who just have excess fat bags with minimal skin laxity issues. In these cases, the fat can be removed or repositioned from the inside of the eyelid, and the skin lasered. In cases of excess skin, however, a small pinch of skin is often required to be removed.

This is placed in the first wrinkle under the lower lid for optimal camouflage. As with the upper lid, this incision heals very well with time.

If you are having your eyelid surgery performed in our clinic procedure room, you can expect the following.

You’ll arrive at our office with a driver. Prior to surgical markings, you’ll be given a valium. After markings, you’ll be given another oral sedative called an MKO melt.

After being given the opportunity to use the restroom, you’ll be escorted to our procedure room. There, you’ll receive some Pro-box (laughing gas) while the local anesthesia is injected. After this, we will play some music and start the procedure. Once your procedure is completed, we will put cool compresses over the eyes and Occumend pads on your cheeks to help with bruising and swelling. We will review pertinent information with your caregiver/driver, and you’ll be free to travel home.

Most patients feel comfortable returning to work or social obligations 7-10 days following their eyelid surgery. On average, about 50% of your swelling will be gone in one week. In two weeks, about 80% of your swelling will be gone.

After two months, about 90% of your swelling will be gone. Adjunctive procedures, like fat grafting or CO2 laser, may slightly prolong this timeline.

It is exceedingly rare to have hypertrophic scars or keloids on the face or eyelids. Most patients with poor scars have them on the body where movement causes the scar to stretch and react by forming more collagen (scar) to protect itself. Scarring is often very favorable since the face and eyelids exhibit very little movement. If scars appear to be more pronounced than normal in the recovery period, they will be dealt with swiftly with injections and/or laser therapy.  

For the upper lids, the incision placement is very cut and dry (placed in the natural crease). There is no debate. In some patients, Dr. Velargo may be “on the fence” as to whether a skin pinch is necessary or whether our CO2 laser could tighten the lower lid skin enough. In those cases, the patient may choose which route to take. Remember, you are paying Dr. Velargo for his surgical expertise in getting you the best result possible — now is not the time to micromanage.

Patients are often concerned about getting a “cat-eyed” look after surgery. While you may appear tighter or pulled in the initial healing period, things will ultimately settle, and you will look “normal.” In cases of lower lid tightening (e.g., tarsal strip or canthopexy procedures), there will be some degree of change in the position of the lower lid — this is typically performed if the lower lid is weak or sagging, and the change can be demonstrated pre-operatively. In any event, the goal is to simply refresh your lids to where they were 10-15 years prior. 

When Dr. Velargo performs blepharoplasty, the goal is to make you a better version of yourself, not someone else.

Blepharoplasty can be performed on one eye, although this is rare. This is typically done in cases of facial weakness on one side (e.g., a result of Bell’s palsy) or significant asymmetry from birth or trauma.

Any surgical change produced from eyelid surgery is permanent and typically long-lasting. The durability of eyelid surgery often exceeds that of face or neck lifting. Having said that, minor tuck-ups may be needed, given enough time has elapsed. 

Done in isolation, many patients tolerate eyelid surgery with oral sedation, local anesthesia, and laughing gas in our clinic procedure room. If upper lid surgery is proposed in conjunction with a brow lift, patients will be given the option of having general anesthesia or in-office sedation, depending on their tolerance. If lower lid surgery is proposed in conjunction with fat grafting or fat repositioning, patients will be given the option of having general anesthesia or in-office sedation, depending on their tolerance. Certainly, if eyelid surgery is proposed with face or neck lifting procedures, general anesthesia is preferred for patient comfort.

Tr-eye-fecta refers to a three-part process of lower lid surgery for patients needing medial cheek support and skin quality improvement in addition to lower eyelid surgery. This typically involves lower lid blepharoplasty, fat grafting, and CO2 laser resurfacing.

Conventional lower lid surgery tightens skin by means of removal with instrumentation and then using sutures to close the skin. Laser lower lid tightening is a way of tightening the lower lid skin without an incision. This can only be done effectively if there is good skin elasticity and minimal skin excess (e.g., patients from 20ish to 40ish).

The advantage of tightening the lower lid skin with a laser is that no resultant skin scar is produced.

Every procedure has risks involved. With laser treatment, we take every measure to protect your vision by placing special contact lenses to prevent the laser beam from injuring your eye. We also prescribe an antiviral medication prior to surgery to avoid a herpetic outbreak following the treatment. Aside from feeling like a mild sunburn for a few hours after the laser treatment, the pain is minimal. The pain would typically be a sign of a breakthrough herpetic outbreak, which is rare.

Your eyelids will feel heavy and numb following surgery. You will likely have difficulty closing your eyes completely after surgery, which is normal because of swelling. We will discuss measures to keep your eyes lubricated during your pre-operative visit.

Upper eyelid surgery usually takes 45 minutes to complete. Lower lid surgery can vary from 30-90 minutes, depending on what is being performed.

If you are having this performed in our clinic procedure room, plan on spending the whole morning or afternoon with us (depending on when you are scheduled). This will account for surgical marking and prep as well as monitoring your recovery after the procedure.

Because you will be given sedatives, your eyelids will be swollen, and your vision blurry from ointment, you will not be allowed to drive yourself home following the surgery.

While you may appear tighter or pulled in the initial healing period, things will begin to settle around two weeks. Swelling will continue to rapidly decrease from there, and usually, by 2-4 months, patients are really enjoying the surgery results. 

Patients can expect swelling and bruising around the eyes as well as the cheeks that will peak out around three days after the surgery. After that, swelling and bruising will subside rapidly, with most patients feeling comfortable returning to work or social obligations 7-10 days post-op. We use special medicated pads called Occumend pads that help to shorten the severity and duration of swelling and bruising.

In the short term, eyelid surgery will usually worsen the severity of dry eyes. It’s important to let us know pre-operatively if you have dry eyes so that we can take extra measures with eye lubrication after surgery to aid your recovery. 

Blepharoplasty is performed to enhance the appearance of the area around your eyes. Often this is performed to remove excess skin and/ or sculpt the fat around your eyes in a more aesthetic fashion.

In the majority of cases, we are able to achieve the goals of the surgery. Significant complications are rare following eyelid surgery.

Blepharoplasty is performed to remove excess skin and/ or sculpt the fat around your eyes in a more aesthetic fashion. Blepharoplasty doesn’t stop muscle movement, which is what creates crow’s feet, but Botox or Dysport can be used to help this problem following surgery.

Similarly, eyelid surgery does not elevate a low-lying brow. We may recommend a brow lift if the brow is contributing to the heaviness of your upper eyelid.

If the dark circle is present because of excess fat or fat herniation, lower lid surgery can certainly help improve the appearance by fat repositioning and/ or sculpting. In some cases, the skin itself is dark in appearance.

In those cases, skin creams or laser treatments may be recommended in addition to surgery.

An in-person exam is best to determine what specific procedures are recommended in your unique case.

During the exam, Dr. Velargo can demonstrate in the mirror what a brow lift could accomplish, which will allow you to visualize how this impacts the appearance of the upper lids. In some cases, a brow lift alone may suffice. In others, a brow lift and upper eyelid surgery may be recommended simultaneously. 

The thin nature of the eyelid skin, coupled with the fact that we stretch this skin regularly (through rubbing, makeup application, contact application, etc.), makes our eyes age first.

As such, periorbital rejuvenation is one of the first things patients seek.

If you have hooded upper lids, crepy lower lid skin, and/ or excess fat/ dark circles under your eyes, you may be a candidate for eyelid surgery.

Patients must wait a period of 6 months following PRK or LASIK to receive a blepharoplasty procedure. This is because PRK and LASIK sever corneal nerves and would make you more prone to dry eye complications if blepharoplasty were performed too soon afterward.

As long as you are a consenting adult with a correctable eyelid condition and in good health, there are no age limitations for blepharoplasty. 

In some cases, excess upper lid skin may obscure vision. In those cases, upper blepharoplasty (and even brow lifting) can be considered a functional medical necessity. However, we do not accept insurance for these procedures. The techniques that we use to give you an optimal aesthetic outcome go beyond a typical “insurance job”.

Any time an incision is made on the skin, a scar will result. Eyelid scars are placed in the natural creases and folds of your eyelids. With time, these incisions heal beautifully and are very inconspicuous.

Compared to other procedures, eyelid surgery is one of the safest procedures to have performed. The risk profile is low, and satisfaction is very high.

In our practice, we are very conservative and meticulous with every procedure.

Every procedure has risks involved. Blepharoplasty carries risks of bleeding, scarring (very favorable usually), and eyelid malposition. Oozing small amounts of blood from the incisions is normal in the first 24-48 hours, and significant bleeding is exceedingly rare. Eyelid malposition is often a self-limiting complication and most commonly occurs in the lower lid. We take every measure to prevent this from happening — conservative skin removal/ tightening the lower lid when necessary. In rare cases, a subsequent procedure would be necessary to correct eyelid malposition. 

While most patients feel comfortable returning to work around 7-10 days after blepharoplasty, this timeline may depend on the type of work that you do. Patients with desk jobs or patients who work from home will easily be able to fit in this timeline. Patients with strenuous jobs should wait 10-14 days to return to work.

Dr. Velargo advises no strenuous exercise for two weeks post-op blepharoplasty. During this time, you may go on walks/ strolls — essentially activities that keep your heart rate and blood pressure low. After two weeks, you may start resuming your normal workout activities.

For a period of time, working out may exacerbate swelling, so listening to your body is the best way to proceed.

Most patients feel comfortable going to a restaurant or store or visiting friends around 7-10 days post-op depending on how much swelling and bruising remain.

You may shower starting the day after your eyelid surgery.

Contacts may be worn starting 10 days following your blepharoplasty if everything has healed.

Over time, the skin will continue to droop and become lax, and fat on the lower lids may become more prominent.

Conservative touch-ups may be performed as necessary. 

Once an exam has been performed and the surgical plan has been formulated, our patient care coordinators will discuss our pre-operative protocols and surgical availability.

This usually involves ensuring your labs are normal and you have had an eye exam within the last six months. 

The purpose of consent is to inform you of alternatives to the procedure (which often includes doing nothing since this is elective) as well as all pertinent risks of the procedure.

Once you are fully informed, you may consent to the procedure. 

We ask that you avoid certain medications, vitamins, and alcohol for a period of time prior to surgery.

We will provide you with a list of medications to avoid in the pre-operative period.

Alcohol use should be avoided in the post-operative period as it can cause adverse reactions when combined with the effects of your prescription medications. Salt intake should be kept to a minimum to keep swelling to a minimum.

You should also avoid any NSAIDs (I.e., ibuprofen) as this will increase your risk of bleeding. 

Prescriptions for blepharoplasty typically consist of a scheduled antibiotic, an as-needed anti-nausea tablet, and an as-needed prescription pain pill. If a laser procedure is performed simultaneously, a scheduled antiviral tablet will also be prescribed. We will also give you over-the-counter pain medication as well as eye lubricant to aid in the recovery process.