The upper and lower eyelids may contain wrinkles, loose skin, and bulges due to hereditary factors or the aging process. The bulges or bags of the upper and lower eyelids are due to herniation of the fat that normally surrounds the eyeball in the eye socket. These fat bulges may be removed along with excess skin. This condition can be present in the 20 to 30-year-old age group and eventually becomes present in almost everyone over time. Once present, no matter the age, it can be surgically corrected.
Upper and lower lid surgery is usually performed at the same time; however, each procedure may be performed alone as needed. Eyelid surgery can also be performed in conjunction with facelift or brow lift surgery.
Eyelid surgery is usually performed under Light Sleep Anesthesia in the Surgery Center. Light Sleep Anesthesia is the use of medicines to induce a state of relaxation and a light sleep. After arrival to the surgery center, additional medications are given intravenously that induce a state of profound relaxation. Most often patients go to sleep during the operation and have very little memory of the operation itself. Once the patient is asleep, medicines are given to produce numbness of the surgical area. This type of anesthesia is most frequently preferred by patients, because it requires almost no recovery from the anesthetics themselves, unlike general anesthesia which may produce nausea after the surgery. It also entails a lower risk of complication.
Incisions are made in the middle of the upper lid in a natural crease and just below the lash in the lower lid. Sometimes the lower incision is performed on the inside of the lower lid so that no scar shows. In this instance, laser resurfacing of the lower lid skin is sometimes performed. Excess skin and fat is removed and then the incisions are sutured closed. Sometimes loss of fat around the eye creates a sunken eye appearance. In this instance, fat is transferred to areas around the eyes rather than removing it.
There's More To It
Eyelid surgery generally involves very little discomfort or incapacitation. The operation itself is generally painless. There is normal swelling and discoloration after surgery which one needs to accept before contemplating this operation. Rarely, the whites of the eyes may become discolored. This disappears after several weeks.
The First Week After Surgery
Immediately after the surgery, the patient is taken to the recovery area for about one hour. Ice compresses are placed over the eyes, and the patient is instructed to keep ice compresses on the eyes for 48 to 72 hours. The compresses should be changed as often as is necessary to keep the eyes quite cool during this time. The patient should keep the head elevated to at least 30 degrees during this time. Six to eight days after the surgery, the patient will return to the surgery center for the first post-operative visit.
With careful attention to elevation and cooling of the eyes, combined with our gentle surgical technique, most patients can go back to work in eight to ten days. It is important to keep the head elevated and refrain from doing any straining, lifting, or exercising for three weeks. Regular activities may be slowly introduced at that time.
Possible Risks and Complications
As with any surgical procedure, there are some risks associated with it. Like any surgery, bleeding and infection are a risk (less than one percent). Blindness is another risk, affected less than one percent of patients undergoing this surgery. The patient should not rub or clean the eyes. Eyeglasses may be worn two days after surgery, and makeup may be applied gently after approximately eight days. Occasionally, small cysts, which resemble white heads, may appear in the suture line. These are easily removed in the surgery center.
Some blurring of the vision may occur for the first several days to two weeks after surgery. This is due to ointment that is placed in the eyes, and swelling. Notify us if you are concerned or if any visual changes should occur. Finally, if you are undergoing any procedure in conjunction with eyelid surgery, please be sure to read the pertinent information on that procedure as well.