Eyelid lift (blepharoplasty) is a safe, effective procedure performed to restore a more youthful appearance and less fatigued look while maintaining or improving visual function. Blepharoplasty is one of the most common facial rejuvenation procedures performed.  It generally involves the removal of excess skin and fat around the eyelids.  In today's competitive corporate workplace more women and men are increasingly seeking eyelid surgery to restore a younger look that more typifies their energy level.

When patients come to see Dr. Lopez seeking facial plastic surgery, it's not uncommon for them to focus on a single aspect of their appearance rather than the overall picture. Blepharoplasty alone is not always the answer to redundant skin about the eyes. Premature aging and dropping of the brow can cause a tired, angry look with frown lines and sagging skin. It is not uncommon for patients who come to Dr. Lopez for evaluation of the eyelid area to simultaneously discuss an browlift.

Along with baggy eyelid skin, an additional source of concern is textural or surface changes (fine little lines) in the skin around the eyes. Although some improvement in facial wrinkles can be obtained from a blepharoplasty, it will not address all the superficial lines that come from premature aging, overexposure to weather, and genetics. Blepharoplasty addresses excess skin and fat; skin resurfacing such as chemical peels and laser surgery addresses textural wrinkles and imperfections.  Dr. Lopez often recommends the use of Botox to correct many of the wrinkles around the eyes as well as prevent them from occurring.

As Dr. Lopez is a board certified facial plastic surgeon, trained to perform plastic surgery exclusively on faces and necks, he knows that his responsibility is to evaluate not only the areas of concern but also the motivation behind the requests. Some patients that are not ready for cosmetic surgery are better served with conservative measures, such as Botox for treatment of fine lines and fillers for deeper wrinkles. Patients who educate themselves about facial rejuvenation know when and if the time is right to proceed.

When discussing rejuvenation procedures the best place to start is by looking at before and after photos to see just what can be accomplished. As you will see in the photos, patients often ask to combine an eyelid lift with other cosmetic surgery. Facelifts, chin implants, rhinoplasty (nasal surgery), otoplasty (ear surgery) and lip surgery can also be performed in conjunction with blepharoplasty.

For traditional lower eyelid blepharoplasty, it is common that an incision is made in the lower eyelid skin with removal of excess skin and fat to achieve a refreshed look.

An alternative technique is the transconjunctival blepharoplasty. With this approach, the incision is made just inside the lower eyelid and no external incision is required. Dr. Lopez will evaluate your lower eyelids and determine which approach will produce the optimal result.

At your initial consultation, Dr. Lopez evaluates your bony and soft tissue architecture as well as the form and function of the eyes. Assessment of the upper and lower eyelids along with the eyes themselves provides the basis for what one may expect from blepharoplasty. Skin type, ethnic background and age, along with the degree of deformity and function are important factors influencing the outcome of surgery.

As with all facial plastic surgery, a thorough health assessment and realistic expectations are prerequisites. Your understanding of procedures and routines is essential to a successful final result. Following your consultation, we continue our discussion at the preoperative appointment.

BEFORE EYELID LIFT SURGERY

At your preoperative appointment Dr. Lopez will provide all the instructions for you to follow before and after surgery. An eyelid lift (either upper or lower eyelids) takes about an hour depending on the structure and amount of excess tissue prior to surgery. If you are having a combination of procedures your surgery will take longer. Recovery time from the anesthetic takes about an hour and you will be discharged about four hours from the time of admission.

PREOPERATIVE EYELID LIFT INSTRUCTIONS

AFTER EYELID LIFT SURGERY

When you wake up from surgery you will notice cold packs on your eyes. These help to minimize swelling and bruising. Your vision will be blurry due to the eye ointment that was placed in your eyes after surgery. You may also notice that tears run down your cheeks, which is due to swelling and will subside during the first week following surgery.

POSTOPERATIVE EYELID LIFT INSTRUCTIONS

Wound care

For the first 72 hours after surgery, keep cold packs on the eyes.  While you are awake cold packs should be placed every twenty minutes around the eyes.  A small bag of frozen vegetables may also be used. Make sure the bag is not placed directly on the skin. Use a washcloth or towel between the bag and your skin.

At bedtime clean any excess ointment off sutures with a Q-tip. Then apply the eye antibiotic ointment on the eyelid sutures and inside the lower eyelid. Until the sutures are removed, you will apply the eye ointment three times a day to the sutures. It is only necessary to apply the ointment inside the lower eyelid at bedtime. Ointment inside the lower eyelid will make vision blurry, so best to do this immediately prior to retiring for the evening. Sutures that have been kept lubricated with ointment are less painful to remove.

Medications

Most patients complain of discomfort more than pain. Use pain medication as directed/as needed. Vicodin and Percocet contain Tylenol. Do not take additional Tylenol or acetaminophen while taking Vicodin or Percocet. Do not drive or drink alcohol while taking pain medication. Taking pain medication with food helps minimize nausea sometimes associated with pain medications.

Diet

Advance diet from liquids to soft food (oatmeal, French toast, yogurt, soup, pasta) to your regular diet as tolerated. You have no diet restrictions.  Often the anesthesia you received can make your stomach feel uneasy for the first 24 hours so avoid large meals.

Activity

Rest for entire day after surgery. Sleep with head of the bed elevated or use two to three pillows for one week after surgery. Absolutely no bending, lifting or straining. If you have little children, bend at the knees or sit on the floor and let them climb on to your lap. No driving for one week following surgery. Seven to ten days off work is recommended.

Bruising can be camouflaged at one week postoperatively with make-up. Always protect your face from the sun. At this point, a hat and sunglasses are a good idea. It is ok to apply sunscreen, cosmetics or facial creams two weeks after surgery. Avoid unprotected prolonged sun exposure for three months following blepharoplasty to prevent pigmentation of incision lines.

Tearing, bruising, swelling, eye fatigue and disrupted sleep are very normal postoperative symptoms and will decrease as the healing process occurs. Since vision is temporarily compromised, assistance with daily activities is recommended.

Final Result

Following blepharoplasty, it takes time for the swelling to subside and for the skin to heal. Most patients return to work one to two weeks following surgery, depending on the degree of privacy one is trying to maintain. At three weeks postoperatively, swelling and bruising may be apparent to you but not to many of your coworkers and closest friends.

Final results following an eyelid lift are not apparent for one full year following surgery. Dr. Lopez will want to see you 3, 6 and 12 months after the surgery to ensure that you are healing as anticipated.

FREQUENTLY ASKED QUESTIONS

1) Do I need an upper eyelid lift or browlift?
The brow position determines if a browlift is necessary of if just an eyelid lift will suffice. During your initial consultation, Dr. Lopez uses his hands to raise your forehead skin to the appropriate level.  If most of the upper eyelid skin disappears, then you would most likely benefit from a forehead lift. If improvement is noted when the sagging brow is lifted and excess skin remains on the eyelids, a combination of a browlift and upper eyelid lift may be recommended to achieve a more youthful appearance.

2) Will I look like someone else after surgery?
Many of my patients report that when they return to their normal life, their friends comment, “You look great. Are you getting more sleep?" or "You look less stressed and tired”.  Dr. Lopez will not change the way you look, just enhance it.

3) Will my incision be visible?
All upper eyelid lifts require a skin incision that is extremely well hidden in the upper eyelid crease.

Dr. Lopez performs two types of lower eyelid lifts. The method that he chooses depends on your individual deformity. If you have a significant amount of excess skin and redundant muscle, he may make an incision just under your lashline to remove the excess skin, muscle and fat.

An alternative technique involves making the incision on the inside of the lower eyelid to remove the fat that is causing the puffy, tired appearance.  Dr. Lopez is extremely well versed in both procedures and will individualize the surgery to your needs.

Occasionally Dr. Lopez combines a blepharoplasty with some kind of skin resurfacing such as laser or peel to remove any fine textural face lines in the skin.

4) Will an eyelid lift take away the crows feet and all the fine wrinkles?
Many patients are not only concerned about the baggy eyelid skin, but also would like improvement of the fine wrinkles that have developed with time around the eyes.  The crow’s feet are most often significantly improved with the addition of a skin resurfacing procedure combined with Botox.

5) Will I be asleep during surgery?
Dr. Lopez performs most of his upper eyelid lifts using an oral medication to relieve the anxiety that is normal when one undergoes a surgical procedure along with numbing medicine (local anesthetic) that is administered with a very small needle.

Patients that are having a lower eyelid lifts often prefer IV sedation (medicine administered through a vein in your arm) and a local anesthetic.  Patients often fall asleep during surgery and do not hear or feel anything during surgery.

6) Is the surgery painful?
Fortunately, most procedures on the face cause mild discomfort.   However, Dr. Lopez does provide all patients with prescriptions for pain medication.  Most patients may use the prescription medication for one to two days after surgery and then switch to Extra Strength Tylenol.

7) Do I need a ride home after surgery?
Yes. Surgery around the eyes can cause swelling that can restrict your field of vision and make driving dangerous.  In addition the effects of anesthesia can disorient patients for a variable time, so patients are not able to drive themselves home after the surgery.

8) Do I go home after surgery?
Most patients that have an eyelid lift are able to go home that same day. Dr. Lopez does require that an adult stay with you overnight and to drive you to his office for your first postoperative appointment. Patients having surgery must stay in the San Antonio area overnight

9) How long do I stay in the San Antonio area?
Most patients stay in San Antonio about seven to ten days following surgery for postoperative care to include suture removal. After that it's ok to fly or travel long distances.

10) When can I return to work?
Most of Dr. Lopez’s patients take about two weeks off of work. After two weeks, most of the residual bruising and swelling can easily be camouflaged with make-up.

11) When can I exercise?
Dr. Lopez prefers that aerobic activities be avoided for two weeks after surgery.  In addition, heavy weightlifting or more strenuous workouts should be avoided for three weeks postoperatively. It is extremely important to avoid bending, lifting or straining during the early postoperative period as these activities can increase swelling and delay healing

12) Will I bruise and swell afterwards and how long will it last?
Unfortunately it is impossible to do surgery without causing swelling.  Dr. Lopez does everything possible to minimize the amount of swelling that occurs.  Generally, postoperative swelling begins to resolve at the end of the first week.  Bruising is extremely variable.  Patients that have a tendency to bruise will generally bruise for about 10 days.  Patients that don’t tend to bruise may have minimal if any bruising.   Complete resolution of bruising and swelling may take two to three weeks. However, bruises may be camouflaged fairly easily at seven to ten days with a concealer stick.

EYELIFT PREOPERATIVE INSTRUCTIONS

13) Should I do anything before to prepare for surgery?
You will have a preoperative appointment with Dr. Lopez and his staff to go over the preoperative instructions.

14) Why do I need a preoperative appointment?
This is an essential appointment to prepare you for your upcoming surgery.  Dr. Lopez will take preoperative photographs at the visit as well as go over the procedure again to ensure that everyone is on the same page.  All questions that you have will be answered on that visit as well.  You will often times be given your prescriptions on the preoperative visit day.

15) What else can I do to prepare for surgery?
Dr. Lopez likes to have patients that have well controlled blood sugar to drink three eight ounce glasses of pineapple juice for at least one week before surgery.  Pineapple juice can help minimize the postoperative swelling. Patients that use tobacco will be asked to stop for six weeks before and six weeks following surgery. Tobacco has properties that impede wounds from healing.  Dr. Lopez will encourage tobacco users to not resume smoking at all after surgery; in fact many of his patients have used the surgery as their motivation to quit smoking.

 16) What about my daily medications before surgery?
In general you will be allowed to take most of your daily medications.  Medications that thin the blood such as ibuprofen, vitamin E, and herbal supplements need to be stopped two weeks before surgery.   You can continue to take a multivitamin.  Aspirin needs to be stopped three weeks before surgery.  Dr. Lopez will provide a "Medication List" that reviews all medications and supplements to avoid prior to surgery.

17) Do I need any special prescriptions before surgery?
Dr. Lopez will generally give you a prescription for an antibiotic, a pain medicine, antibiotic ointment, as well as an anti-swelling medication.. Dr. Lopez does prefer patients to start Arnica, a natural herbal substance, the day before surgery in order to minimize bruising. He also asks you to start Vitamin C before surgery.

BROWLIFT POSTOPERATIVE INSTRUCTIONS

18) What do I look like the day of surgery?
After the procedure, you will have cold packs on your eyes with antibiotic ointment on your incisions. The antibiotic ointment may partially blur your vision.  Your eyelids may be swollen. The swelling along with the bruising will continue to increase with the maximum occurring around 24-48 hours after the procedure.

19) How will I feel after surgery?
Most patients that have IV sedation will feel groggy after the procedure.  Once the numbing medicine wears off you may experience some mild discomfort that is usually well controlled with the pain medicine that Dr. Lopez prescribes. After 1-2 days most patients are taking Extra Strength Tylenol for the mild discomfort.

20) When can I drive after surgery?
You can resume driving when you are no longer taking prescription pain medicine and your visual fields are not restricted from swelling.  The usual time period is 3 to 4 days.

21) Can I be home by myself overnight the night of surgery?
No. For your safety, Dr. Lopez requires that a responsible adult stay with you the first night following surgery.

22) Are there any foods to avoid following surgery?
No. Dr. Lopez encourages you to eat a well-balanced diet.  You may notice that saltier foods can cause you to swell for a longer period of time.

23) What medications do I take following surgery?
Dr. Lopez will ask you to take the following medications starting the day of surgery:

  1- An antibiotic- generally Keflex for one week
  2- Pain medicine- Vicodin or Percocet to take as needed
  3- Antibiotic ointment- to place on the incision sites at least three times a day.
  4- Antiswelling medication- for patients that are not diabetic a Medrol dosepak will be given.
  5- Vitamin C for one week following surgery to promote healing.
  6- Arnica place under the tongue three tabs three times a day before meals for two weeks.

24) How long does the bruising and swelling last?
Most patients experience swelling that lasts about a week. Patients that bruise easily, can have the bruises persist up to two weeks, however, this is uncommon.

25) How can I minimize the swelling and bruising?
Most of Dr. Lopez’s patents will have a little bruising. He minimizes bruising by having patients stop all blood thinners well ahead of surgery as well as using Arnica before and after the procedure. The cold packs around the eyes should be used every 20 minutes while awake after surgery to help prevent swelling and bruising.  The cold packs should be used for the first 72 hours.  You do not need to wake up to use the cold packs.  A good night’s sleep is vital to healthy healing.  Patients are also asked to sleep with their head at least at 45 degrees to minimize the swelling.

26) When can I shower?
Dr. Lopez prefers that you do not get the incisions wet for 48 hours following the procedure.  A shower from the neck down is acceptable while using a washcloth to cleanse for face.

27) When is my first postoperative appointment?
Dr. Lopez will see you 6-8 days after your procedure for suture removal and postoperative evaluation.

28) How often do I need to return for postoperative appointments?
Dr. Lopez likes to see his patients 3, 6. and 12 months after the procedure to ensure that the healing is going as expected.