Do you have to lift your eyebrow to stretch the upper eyelid skin to apply eyeliner or shadow? Do you have excess skin that folds over your upper lashes making your eyes look heavy and tired? Do you have bags under your lower lids or loose skin that add to that tired look? Would you like your “Asian Eyes” made rounder and more distinct by adding a fold in the upper lid? If you answered yes to any of these questions, upper and/or lower eyelid tucks may be the answer for you.
Description
Blepharoplasty (upper and/or lower eyelid surgery) involves the removal of excess skin, fat, and/or muscle around the eye give a more youthful, rested appearance. In the case of the Asian eyelid, this procedure will give the eye a more distinctive look without making it too westernized. Dr. McMenamin will carefully examine your eyes, discuss your goals, review pre and post operative photographs, and explain risks and benefits of these procedures at your initial consultations. Your past medical history will be reviewed to determine whether you are a good candidate for this surgery. Patients with circulatory, ophthalmological, or serious medical conditions may be required to get medical clearance for surgery from their treating physicians prior to surgery. An open and honest exchange of health information between you and your surgical staff will establish the basis for a successful outcome. The cost of this procedure will also be discussed at your initial consultation.
Upper Eyelid Tuck
Upper eyelid blepharoplasty requires careful preoperative planning because the skin is very delicate and can cause unfavorable complications if too much is removed. Dr. McMenamin will take careful preoperative measurements at your preoperative visit and use those measurements in marking your eyelid at the time of surgery. The goal is to remove excess skin with or without a small amount of muscle/fat to restore your upper eyelids to a more youthful, open look, and improve “hooding” of the eyelid skin. In “Asian eyelids”, a natural appearing crease can be achieved to open the eye somewhat while preserving the exotic curve of the eye. The incision is closed with a nylon suture that will be removed in approximately 4 to 5 days.
Lower Eyelid Tuck
As we age, fat below the eye can protrude from under the globe causing unsightly bags and tired looking eyes. Also as we age, the skin can loosen and wrinkle under the eyes. Sometimes, the muscles of the lower lids weaken allowing the lower lids to be too loose and show too much of the eye globe (ptosis). Through an incision made inside the lower eyelid (transconjuctival blepharoplasty), protruding fat pockets can be removed or adjusted to reduce the “bags.” The excess skin can be removed using an incision just below the lashes that heals with an almost imperceptible scar. At the same time, the lower lid rim can be tightened (canthopexy) at the lateral corner of the eye. The goal is a more youthful, rested eye with a very natural appearance. There are no sutures used to close the incision inside the eyelid and a very fine nylon suture is used on the incision under the lashes. Internal sutures are used for lower lid tightening. Skin sutures are generally removed in 3 or 4 days.
Where is the procedure performed?
This procedure is done in our accredited operating room under local anesthesia and either oral or IV sedation. Your vital signs (pulse, blood pressure, heart tracing, oxygen levels) are monitored throughout the procedure and until it is determined you are stable to go home.
Recovery
Recovery after eyelid surgery, regardless of where the incisions are, involves keeping the head elevated for several days. Elevation of the head to at least a 65 degree angle, even to sleep, (as in a recliner chair) will help decrease the amount of swelling which can be mild to less commonly extensive. Cold compresses and a cold pack or mask applied for about 20 minutes out of the hour for the first few days will help with swelling, too. The less swelling you have, the less discomfort you will have although most patients have minor discomfort after these procedures.
Bruising is a usual side effect to any surgery and in eyelid surgery it can be very minimal to diffuse. You be asked to refrain from all medications containing aspirin, anti-inflammatories (Motrin, Aleve, Excedrin, etc.), tobacco products, vitamins, herbal supplements, and alcohol for the two weeks before and after surgery. Your prescription medications will be reviewed prior to surgery also. This will minimize bruising as well as your risk for post operative bleeding.
Most patients take 7 to 10 days off from work after this procedure. At that time you may still have some bruising that can be camouflaged with makeup. You will most likely still have some swelling, too, however, not so much that you cannot return to work. Rarely, more time is needed from work.
Most of our patients need only Tylenol for pain after this procedure. You will be sent home with eye drops for lubrication and soothing of the eye as well as stronger pain medication. Following post operative instructions closely will greatly reduce the amount of swelling, bruising, and discomfort allowing you to get back to normal activities faster.
Dr. McMenamin, or in his absence, a staff member, will be contacting you daily in the early post operative period to check on your recovery status. Be sure to be available at the phone numbers you provide us and to write down non-emergent questions you may have. If you think you are having an emergency, you will have Dr. McMenamin’s phone numbers to reach him or page him or a staff member in his absence. Emergency symptoms in eyelid surgery include a sudden loss of vision, bleeding that doesn’t stop after 5 minutes of gentle pressure over the bleeding area, sudden increased pain in or around the eye, or other symptoms that are of great concern to you.
Risks in Blepharoplasty
As with all facial plastic surgery, good health and realistic expectations are prerequisites. Having good rapport with your facial plastic surgeon and doing research on the procedure that interests you can minimize misconceptions about the risks and benefits of eyelid surgery. Along with the expected side effects from surgery list above, changes in tearing and eye dryness may occur. A temporary change in vision secondary to swelling is not uncommon. You will not be able to wear contact lenses until given the OK from Dr. McMenamin. Mild to moderate discomfort is expected. Many patients have described their discomfort as more an irritation than pain. The eye drops and Tylenol generally provide adequate treatment. Other possible complications will be addressed by Dr. McMenamin.
Uncommon or rare complications of eyelid surgery include excessive removal of skin or fat resulting in a hollow look, eyelid retraction, scleral show, and/or incomplete eyelid closure. Asymmetry in appearance can occur but usually resolves over time. Blindness is an exceedingly rare complication caused by blood or fluid accumulation in the eye. Injury to the muscles that move the eyelids or eyeballs is also rare.
Facial plastic surgery of the eyelids can improve the signs of premature and normal aging that can undermine self-confidence. Additional procedures may be discussed with you to enhance your new look. By improving how you look, facial plastic surgery can help change how you feel about yourself.
Insurance does not generally cover surgery that is done purely for cosmetic reasons. Surgery to correct or improve vision or surgery for eye deformity or injury may be reimbursable in whole or in part. It is the patient's responsibility to check with the insurance carrier for information on the degree of coverage. Dr. McMenamin is not a provider for any insurance providers including Medicare and MediCal.
Dr. McMenamin and his staff are excited to help you reach your facial plastic surgery goals. Please call to ask questions and/or set up a consultation. (916) 564-8888
