Eyelid Surgery

At Buckhead Plastic Surgery, Atlanta

Patients today are realizing that a lot of their facial expressions are centered around their eyes and brow. If you have ever heard somebody say "you look so tired," the reason may be periorbital aging. Periorbital aging changes the eyes and the areas surrounding the eyes. If you have experienced these unwanted changes, a blepharoplasty may be just the procedure to give your eyes a more open, awake look.

Drooping, sagging skin on the upper and lower eyelids along with bulging fat and hollowness may all be treated with a blepharoplasty.

Problem: Are your eyes tired with heavy sagging skin and puffy bags? Is your lower eyelid long and bulging? Do you have hollowness beneath your eyes?

Solution: Eyelid surgery or blepharoplasty

What Is a blepharoplasty?

A blepharoplasty is a surgical procedure that removes loose skin and bulging fat pockets from both the upper and lower eyelids. The surgical incisions are usually well hidden in the crease above the eye and just below the eyelashes on the lower eyelid. Newer techniques allow for the preservation of fatty tissue to be placed into the hollow areas beneath the eye and to raise the lower eyelid/cheek into a more youthful position.

Everyone can see the old standard technique where all the fat is removed in the extra skin leaving a very hollow scooped out old-looking lower eyelid. Unfortunately this technique is still used today. The modern techniques of lifting the cheek, filling in the hollow areas with the excessive fatty tissue and re-draping the skin truly restore the lower eyelid and cheek area to a youthful position.

The upper lid blepharoplasty is often accompanied by a brow lift in order to hold the brow in a natural elevated position. Performing an upper lid blepharoplasty alone often lowers the brow causing the patient to look more tired and grumpy instead of awake and rejuvenated.

Fine lines, droopy skin and some wrinkles will be removed from the upper eyelid and the area over the lower eyelid. Crow's feet, the wrinkles caused by squinting or smiling, still need to be treated with Botox. Adding Botox to this portion of the eye is the finishing touch for a blepharoplasty.

Not everyone needs skin and fat removed from around their eyes.  Some patients just have bulging fat pads with nice smooth skin and other patients have sagging skin, excessive fatty tissue, bulging and hollowness. A consultation is needed to best determine which procedure is right for you. Often a younger patient who just has bulging fatty tissue can have this removed from an internal incision with no visible scarring.

How It's Done

There are several blepharoplasty techniques taking into account all the features that you and the surgeon wish to rejuvenate. Some plastic surgeons perform blepharoplasty in their office, as an outpatient, in a hospital, or ambulatory surgical facility. Dr. Alan N. Larsen performs blepharoplasty surgery in an office surgical setting. This facility is fully accredited with AAAASF.

Although an overnight stay is not needed, the option is available to all of our patients. Dr. Larsen usually performs eyelid surgery under general anesthesia although in some cases local anesthesia with sedation is used (upper eyelids only, possibly small revisions).

Eyelid surgery should only be performed by Board Certified Plastic Surgeons and qualified facial plastic surgeons. Eyelid surgery is tailored to each patient's specific conditions. Along with a buffer plasty many of Dr. Larsen's patients undergo a brow lift and facelift combination.

Your eyelid surgery starts with the consultation and continues right through carefully placed incisions in follow-up. The typical incision used by Dr. Larsen for the upper eyelid runs along the crease and just slightly out to the side. The lower eyelid incision runs just below the eyelashes and slightly out to the side.

A second type of incision for the lower eyelids is placed inside the lower eyelid and is completely hidden. This type of incision is only for removal or rearrangement of the fatty tissue and will do nothing to the skin. Careful planning will in most cases lead to a well hidden incision.

During the procedure, other aspects of the blepharoplasty are addressed. In addition to the incision, there are two fat pads above each eye and three areas of fatty distribution below each eyelid. One two or all of these fat pads may be removed, partially removed or rearranged into another around the orbit. The position of the lateral most portion of the eyelid, the canthus, is also corrected and held into position for healing. Excessive skin is re-draped over both the upper and lower eyelids, marked and removed.

The upper eyelid skin may be more prominent than you expected after surgery because excision of all of the extra skin would not allow you to close your upper eyelid. Additionally some patients may have more or less of an upper eyelid crease. After completion of the internal portion of the blepharoplasty, the incisions are closed and the sides of the eyes are taped. The sutures will be removed four to five days after surgery by Dr. Larsen. The tape is removed 14 days following surgery.

Your results depend on your genetics, anatomy, as well as the goals outlined prior to surgery. A great outcome depends on meticulous attention to details in the technical portion of the procedure as well as an artistic touch to create the balanced facial features you desire.

Recovery

Following surgery your eyes will be swollen and your vision will be slightly blurry because of the ointment that is placed in your eyes during surgery. Specialized ice packs will be placed on your eyes 24 hours a day for the first two days to help with swelling and discomfort. Most patients have some discomfort but don't complain of pain. The ice helps tremendously.

You will need to keep your head elevated for 10 days to two weeks following surgery. The ice is applied for the first 48 hours followed by warm compresses. Strictly keeping your head elevated with no movement leads to a speedy recovery. Patients usually resume a normal diet by the next day. As your eyes heal, they may feel dry for a couple of weeks. You should keep your eyes protected by wearing sunglasses when outdoors.

Assistance from a responsible adult is critical for the first few days to help decrease the chances of complications and lead to an uneventful recovery. Downtime is clearly a concern of patients having a blepharoplasty, especially when the procedure is performed on younger patients. Healing is a progressive process and is controlled by mother nature.

Usually at four to five days the stitches are removed despite swelling and noticeable incisions. Patients are usually ready to venture outside at this time. As with any surgery, wearing sunscreen and a hat to protect the healing skin from the sun is essential. In a few weeks you will be see a younger version of yourself. Complete healing will continue under the surface of the skin for quite some time. It is not uncommon for mild swelling and small lumps and bumps to take one to two months or more to resolve.

What to Expect

Initially after surgery you will be sleepy. You should not expect a lot of pain although tenderness will be present. The eyes will help a great deal with this. Initially your eyes will be slightly swollen. The swelling will continue for the first couple of days and then start to decrease dramatically by day three or four. Bruising will be present for seven to 10 days and possibly a little longer. 

During this period of bruising, dark sunglasses and sunscreen should be used. Protect your eyes and the healing tissues from the sunlight. Your vision may be a little blurry immediately following surgery and for the next couple of days from fluid on your eyelashes. Your eyelashes will be sticky from the ointment that was used to protect your eyes during surgery. Any persistence in the visual changes should be brought to the attention of Dr. Larsen.

Risks

Risks of surgery include bleeding beneath the skin. Extremely rare risks include blindness, loss of eyelashes at the incision sites and thickening of the scars. Asymmetry is possible although most likely only noticeable to you. Keep in mind that before surgery one side of your forehead did not match the other side. Your eyelids may sag. There is an extremely rare complication of nerve injury.

You may also need minor revisions to achieve your goals when tissues begin to loosen. As with any surgery there are risks associated with anesthesia. Your skin will also be tight and you will experience numbness for several months. These are not considered risks of surgery. Please see informed consent blepharoplasty for a more complete list.

Recovery Timeline

  • Discomfort the first night which should rapidly resolves.
  • Strict head elevation for the first seven to 10 days after surgery. Discomfort resolves quickly over the first two to three days.
  • Your eyes may feel dry for a couple of weeks following surgery. Eyedrops help greatly with this sensation.
  • Sutures are removed four to five days after surgery.
  • Five to seven days after surgery you will return to a more normal routine.
  • Most patients return to work about one to two weeks after surgery.
  • Skin starts to soften somewhere around two weeks after surgery.
  • Four weeks after surgery, you may return to full activity.
  • Continue skin care, diet and exercise to maintain results.

Complementary Procedures

Brow lift: This surgery will remove the excess skin from your forehead, raise your brow, reduce wrinkles and control the wrinkles formed by muscle contraction.

Facelift: This surgery will remove the excess skin from your face, cheek, neck and jaw line as well as reposition the sagging deeper tissues.

Chin implant: Restores a nice mandibular angle and chin.

Skin resurfacing: Often laser is used around the eyes or around the mouth to resurface, smoothen and tightened the skin.

Learn More About Eyelid Surgery in Atlanta

Learn more about eyelid surgery in Atlanta by contacting the office of double board certified plastic surgeon Dr. Alan N. Larsen. Our plastic surgery office is located in the Buckhead area of North Atlanta. Call (404) 367‐9005 to inquire about a consultation.