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.