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If you're considering eyelid surgery…
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. While it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift.
If you're considering eyelid surgery, this information will give you a basic understanding of the procedure, when it can help, how it's performed, and what results you can expect. It can't answer all of your questions since a lot depends on the goals of the individual patient and the procedure that Dr Lista feels will best suit your needs. Please ask Dr Lista about anything you don't understand. Dr Lista wants all of his patients to be as well informed as possible and encourages them to bring a list of questions to their consultation.
At the Plastic Surgery Clinic we perform several hundred cosmetic facial procedures a year. This makes Dr Lista a very experienced cosmetic surgeon. Dr Lista has one main philosophy when performing facial cosmetic surgery: to make all his patients look soft and natural, and perform the operation as safely as possible. We want the patient to look rested and relaxed, the way they looked 10 years ago. Dr Lista strives to avoid making his patients look tight or pulled. Today, a number of new techniques are helping plastic surgeons to provide patients with more precise results and quicker recovery times.
The best candidates for eyelid surgery
Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr Lista.
The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Patients seeking eyelift surgery are looking for improvement of the loose skin, puffiness, and bagginess of the eyelids. Eyelift surgery can make you look younger and fresher, and it may enhance your self- confidence in the process. Most are patients are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.
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 Office Visit
Dr Lista sees all his patients personally before surgery. If the patient lives in the Toronto area he prefers to see his patients twice, if possible, before their operation. In the consultation process we spend considerable time obtaining a careful history and physical examination. Facelifts are very individualized procedures. In your initial consultation Dr Lista will evaluate your face, including the skin and underlying bone, and discuss your goals for the surgery. We also spend a long time discussing the patient’s desires, goals and expectations. It is important that the patient discuss with Dr Lista their desired result. Not all expectations can be accomplished with surgery and it is important that these issues are carefully discussed before surgery. Photographs can be helpful in this regard and at The Plastic Surgery Clinic we have computerized digital imaging, which allows Dr Lista to show the patients examples of how they may look after surgery.
How Eyelid surgery is performed
Most eyelid lift procedures are performed at The Plastic Surgery Clinic. Dr Lista performs all of the procedures personally. He does not have any assistants or students assist with your surgery. Dr Lista is Chief of Plastic Surgery at the Trillium Health Center (The Mississauga Hospital) so your operation can also be performed at the hospital if you prefer. The operation is performed either at our clinic or in the hospital. Your operation may be performed under local anesthesia with sedation or under general anesthesia. At the Plastic Surgery Clinic general anesthetics are administered by specialist physicians who are board certified in the specialty of anesthesia. These doctors give the anesthetic, stay with the patient during the entire operation and are with the patient while they are waking up. The operation takes several hours. A friend or relative will need to come and pick you up and stay with you for 24 hours.
Preparing for your surgery
Dr Lista 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. If you smoke, it's especially important to stop at least two weeks before and after surgery; smoking inhibits blood flow to the skin, and can interfere with the healing of your incision areas.
Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you're having all four eyelids done, Dr Lista will probably work on the upper lids first, then the lower ones.
In a typical procedure, Dr Lista 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, Dr Lista 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.
Underlying fat, along with excess skin and muscle, can be removed during the operation.
If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, Dr Lista may perform a transconjunctival blepharoplasty. In this procedure an incision is made using a laser inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin.
In a transconjunctival blepharoplasty, a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed, and the incision is closed with dissolving sutures.
In order to achieve the best possible result, some patients require additional procedures to be performed at the same time as their eyelid surgery. Very wrinkly skin of the eyelids and wrinkles in the crows-feet area may require lasering of the lower eyelid skin. Some patients with very droopy upper eyelids may have a problem with droopy eyebrows. If the droopiness of the upper eyelid is due to sagging of the eyebrow, then a brow lift may be necessary. A brow lift or lasering of the skin may be performed at the same time as an eyelid lift if necessary. Newer techniques, such as endoscopic brow lift, allow this procedure to be performed with minimal incisions. To learn more about skin lasering or brow lift please go to those web pages in this website.
After your surgery
After surgery, Dr Lista will lubricate your eyes with ointment but bandages are not required. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed by Dr Lista. If you feel any severe pain, call your surgeon immediately.
Dr Lista will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Dr Lista may recommend eyedrops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.
Dr Lista will follow your progress very closely for the first week or two. The stitches will be removed two days to a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.
Getting back to normal
You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.
Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing and Dr Lista’s instructions, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.
Dr Lista will tell you to keep your activities to a minimum for a week, and to avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.
All surgery carries some uncertainty and risk
When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anesthesia. You can reduce your risks by closely following your surgeon's instructions both before and after surgery.
The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle.
Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.
Your new look
Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line. On the other hand, the positive results of your eyelid surgery, the more alert and youthful look, will last for years. For many people, these results are permanent.
Eyelid surgery (known as blepharoplasty) is a corrective procedure that can reduce dark circles or “bags” under the eyes, remove excess wrinkles, and provide a more youthful appearance to the eyes. One of the first things noticed about a person is their eyes. During the aging process, wrinkles, lines, and puffiness contribute to a tired or aged appearance. The blepharoplasty surgery is often performed in conjunction with other facial procedures such as a face lift or rhinoplasty (nose surgery).
Reasons for Considering Eyelid Surgery:
Dark circles or bags under the eyes.
Excessive skin or wrinkles surrounding the eyelids.
A tired appearance or puffiness due to inherited factors.
The surgical procedure includes tiny incisions made in the natural contours around the eyes which should leave no visible scarring. The surgeon will usually work on the upper eyelids first to remove any fatty tissue and tighten loose skin. Lower eyelids are completed next to eliminate puffiness and reduce dark circles. In some instances, laser technology may be used to smooth lower eyelid areas. Newer techniques may include Botox injections to firm fine lines and wrinkles.
The surgery generally takes about one to three hours and is performed in the physician’s office. If additional cosmetic procedures are being performed, the eyelid surgery could last longer.
Normally, post-operative instructions call for plenty of rest and limited movement in order to speed up the healing process and reduce the recovery time. Patients sometimes report minor pain associated with surgery which can be treated with oral medication. While complications are rare, patients can minimize the risk for potential problems by carefully following the post-operative directions given after the surgery. The healing process for this procedure is slightly longer than most other forms of cosmetic surgery; however, the benefits are long-lasting. Patients will have a more rested and youthful appearance.