Before Eyelid Surgery

Blink (Credit: coyotejack)

What is eyelid surgery? Let’s explore what eyelid surgery is all about and what are the steps involved.

As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing "bags" above and below. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat--usually along with excess skin and muscle from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look older and more tired than you feel, and may even interfere with your vision.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery.

The initial consultation with your surgeon is very important. The surgeon will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform your surgeon if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

In this consultation, your surgeon or a nurse will test your vision and assess your tear production. You should also provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses, be sure to bring them along.

Your surgeon will explain the techniques and anesthesia he or she will use, the type of facility where the surgery will be performed, and the risks and costs involved.

The Surgery: Eyelid surgery is usually performed under local anesthesia--which numbs the area around your eyes - along with oral or intravenous sedatives. The surgeon closes the incisions with fine sutures, which will leave nearly invisible scars. Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.

Before surgery, the surgeon marks the incision sites, following the natural lines and creases of the upper and lower eyelids.

In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.