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
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
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
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
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
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
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
Please avoid any
aspirin, aspirin-containing products, or
ibuprofen (Advil, Aleve, etc.) for two weeks
prior to and two weeks following your surgery.
See our "Medication
List" for products to avoid prior to
surgery. If you are on any medications that
affect bleeding (such as coumadin or warfarin)
please notify the office immediately.
Please refrain from
tobacco products for six weeks and alcohol for
one week prior and three weeks following
surgery. Along with delayed wound healing,
persistent skin redness and other complications
may persist when tobacco and alcohol are not
Please notify us of
all routine medications and significant health
history. We ask that you remain on your daily
medications unless instructed otherwise. At the
preoperative appointment you will be told which
daily medications to take with just a sip of
water on the morning of surgery.
preoperative appointment you will be given
prescriptions for use following surgery
including an oral antibiotic, antiswelling
medication, antibiotic ointment and pain
medications. Please obtain these prescription
medications before your surgery so you will have
them ready for use when you return home after
We will ask you to
take Arnica, a natural herb that significantly
decreases bruising, before and after surgery. We
will also ask you to take Vitamin C (ascorbic
acid), which helps promote healing, before and
You may not eat or
drink after midnight the evening before the
procedure unless instructed otherwise. You may
brush your teeth. Your procedure will be
cancelled if you do not follow these
Remove all make-up
and nail polish before arriving for your
Someone will need
to drive you home after your surgery and stay
with you that evening. Transportation to the
office for dressing removal the day following
surgery is also required.
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
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
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
- Start your antibiotic (Keflex) when you
get home and one at bedtime. It is not
uncommon to have a low-grade fever for 24
hours following surgery.
Start swelling medication (Medrol Dosepak)
when you arrive home. Then follow package
directions. Take with food.
- Vitamin C helps promote healing. Take
1000 mg three times a day for one week
- Arnica, a natural herb that
significantly decreases bruising, is used
under the tongue three tabs three times a
day before meals for two weeks.
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.
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
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.
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.
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
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
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
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
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
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
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
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
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
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
No. For your safety, Dr. Lopez requires that a
responsible adult stay with you the first night
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
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
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
Dr. Lopez likes to see his patients 3, 6. and 12 months
after the procedure to ensure that the healing is going