These informational materials presented to you is to aid you in making the decision regarding possible Eyelid (Blepharoplasty) Surgery. This online information is not meant to be a substitute for personal interest or attention. Each patient’s procedure always receives individual thought, planning and care.
Please read this information carefully and review it several times at your leisure. Please discuss any questions or comments relating to this information with Dr. DiGeronimo prior to making any FINAL DECISION TO ASSURE COMPLETE UNDERSTANDING OF ALL THE INFORMATION INVOLVED.
Aesthetic eyelid procedures including surgical Blepharoplasty are designed to reduce excess wrinkling, puffiness and fatty prominence in the areas of the upper and lower eyelids. The patient should be aware that the term “upper eyelids” refers to the area above the eye and the term “lower eyelid” refers to the area under the eye. Eyelid surgery (Blepharoplasty) can frequently minimize conditions that give individuals a “tired” appearance such as a wrinkled fold of skin on the upper eyelids or “bags” and sagging skin on the lower eyelids.
Fat in the eyelids is positioned behind a thin fibrous septum that for various reasons may become lax and allow bulging of orbital fat (the fat that surrounds and supports the eye.) This is often seen as “bags” under the eyes that give that tired appearance. The amount of orbital fat reduces somewhat with age but otherwise is constant and is almost never in excess.
For the past years, the majority of plastic surgeons routinely remove the bulging fat from around the upper and lower eyelids. Although the fat pads or bulges/bags are gone, often the eyes look different but not rejuvenated. If excess fat is removed from the lower eyelids, not only will it cause hollows below the eye, it will also create a sunken upper eyelid appearance.
Instead of this routine, older procedure which opens the fibrous septum and removes fat, this newprocedure repairs the laxity of this fibrous septum and repositions the fat back into its natural position giving the eyes a more youthful appearance.
Relocating,rather than removing herniating fat pads also has the added benefit of giving the globe of the eye itself a position and projection of youth.
Upper Eyelid Surgery
The incision is generally made in the crease of the upper eyelid and extended down and laterally to the side for a short distance. The excess skin is then removed and the fat is repositioned and secured in place. The incision is closed with sutures (stitches) which are removed over a 5 to 7-day period.
Lower Eyelid Surgery
there are two principal approaches:
- Lower eyelids with excess skin: The incision is generally aide just below the eyelash margin and extended laterally to the side. The fat is then repositioned into its natural position and secured in place. The excess skin is removed and the incision closed with sutures (stitches) which are removed over a 5 to 7-day period.
- Lower eyelids without excess skin: This is called a transconjunctival approach in which the incision is made inside the eyelid so as to avoid an external scar. The fat is repositioned into its natural position and secured in place. In this procedure sutures are self-dissolving and no sutures need be removed.
In certain instances, Dr. DiGeronimo may recommend laser skin resurfacing or a skin peel concurrent with the transconjunctival blepharoplasty or at a later date to reduce fine lines or crepiness which would not be addressed with a blepharoplasty procedure.
There are also instances where patients may have excess laxity in the lower eyelid itself which may reveal too much of the white of the eye (this may also lead to dryness or irritation of the eye) or predispose the lower eyelid to post-operative malposition. In these instances, an eyelid tightening procedure may also be recommended. This is generally done through the same eyelid surgery incisions.
While external incisions are made, scars always occur but generally are easily hidden in the natural lines and folds around the eye. There is however, unpredictability and variability with regard to the exact appearance and healing of any area following the surgery.
Dr. DiGeronimo may in certain instances decide, at his discretion, to remove portions of fat from around the eye during the upper or lower eyelid surgery in the standard fashion. Both the upper and lower eyelids can be operated upon at the same time. These are, however, separate areas and may be surgically corrected independently as well.
Bandages are generally not applied in any permanent manner over the eyelid area, although, they may be used in certain circumstances. Most often cold compresses will be applied to the area following the surgery and should be continued for at least a 48-hour period.
This surgery is generally performed in our outpatient surgical facility. It can be performed using local anesthesia with intravenous sedation or general anesthesia. The anesthesia is generally administered by a certified registered nurse anesthetist (CRNA). The final choice of anesthesia depends on several variables including specific surgery planned and your discussions with Dr. DiGeronimo.
Generally, the patient can return home following this procedure. However, depending on the type and extent of surgery, Dr. DiGeronimo might recommend a private duty nurse at home or recuperation in a recovery facility.
You will experience swelling and bruising of the upper and lower eyelids sometimes extending down into the cheek area. It generally takes one to two weeks from the day of surgery for most of the bruising and discoloration to subside. This condition generally subsided more rapidly in the upper eyelid area than in the lower eyelid area. Irregularities, tenderness and tightness can remain in the lower eyelid area for 4-5 weeks and frequently much longer. You may experience swelling, tingling, itching, numbness, irritation and a feeling of tightness and dryness as you heal. This will last for a variable length of time.
The exact degree of improvement is unpredictable and cannot be determined with certainty prior to surgery. Improvement is much more limited and unpredictable in the lower eyelid area than in the upper eyelid area. It is important that you understand this fact and discuss any questions you might have concerning the out-come of the procedure with Dr. DiGeronimo prior to the procedure.
Patients must also understand that no plastic surgical procedure can be expected to produce a perfect result or achieve complete correction of a particular problem. Significant improvement is the goal. Complications and poor healing can occur with any procedure leading to cosmetic deformity, medical complications and less improvement than anticipated or desired. For these reasons no guarantee of precise appearance or result of surgery can be given.
As with any surgery procedure around the eye, there are possible complications or problems. These include deformities of the eyelid. Excessive or abnormal scarring is unlikely, but can occur with the possible development or increase in asymmetry of the upper and /or lower eyelids. Other possible complications, though unlikely, can occur. These include difficulty with eyelid function or closing of the eyelids and problems with vision including decreased vision and double vision. Other possible complications may involve the tear function of the eye. Dryness, irritation or itching of the eye may occur. This may contribute to or be associated with a conjunctivitis or redness of the eyes.
Excessive tearing or tear production in addition to possible decreased tear production or drying of the eye can also occur. As with any surgical procedure, infection, bleeding and hematomas (collection of blood under the skin or around the eye) can occur and other complications/deformities may require additional procedures to attempt correction. These procedures would, of course, involve additional surgery, risk and expense.
Reactions to anesthesia, both local and general, and to medications can also occur.
Certain medical conditions and prescribed medications may also increase the possibility of complications associated with eyelid surgery. These medical conditions include, but are not limited to, diabetes, high blood pressure, circulation or heart abnormalities, lung or pulmonary abnormalities and certain blood and blood cell disorders. Smoking may also contribute to the increased possibility of complications and patients are required to stop smoking at least two weeks prior to the surgery to lessenthis risk.
All of the above factors should be fully understood and discussed prior to making any final decision to undergo eyelid surgery (blepharoplasty).
To Prepare for Surgery
1. Every patient must have a written medical clearance from his/her family physician with the following:
a) a history and physical and a letter stating that he/she is in good physical condition and able to undergo the surgery.
b) CBC; PT; PTT; Potassium study if you are hypertensive or taking diuretics (water pills/diet pills); Pregnancy test (female); HIV
c) Electrocardiogram if you are forty years of age or older or have cardiac problems
d) A letter from your eye doctor with the following:
1.) The results of an eye examination
2.) The results of a Schirmer’s test for tears
3.) The results of a visual fields test (if you are undergoing upper eyelid surgery and have been told that your upper eyelids are obscuring your vision)
2. Do not take any aspirin or medications that contain aspirin, Advil, Motrin, Ibuprofen or Vitamin E for two weeks prior to surgery and for two weeks following surgery. Tylenol may be taken as needed. Please refer to the list available from the office of aspirin related products to make sure you avoid them for at least two weeks prior to surgery.
3. Patients who smoke must refrain from doing so for at least two weeks prior to surgery and two weeks following surgery. Smoking will increase the risks and possible complications associated with surgery, healing and with anesthesia.
4. If you take any medications such as for your heart or high blood pressure pills, diabetes medication, birth control pills, etc., please be sure to discuss these with Dr. DiGeronimo. You will be given special instructions regarding the taking of these medications prior to the surgery. If you are going to a recovery facility following the surgery, bring all the medications with you on the day of surgery.
5. At least two weeks prior to surgery begin taking 1000mg of Vitamin C, 50 mg of Zinc, 200 mg of Bromelain and a multiple Vitamin that contains No Vitamin E on a daily basis.
6. In addition to your prescribed medications, please purchase 4 x 4 gauze squares or frozen peas/corn in bags.
7. If you wear dentures, please discuss this with Dr. DiGeronimo. In most instances, your dentures will remain in place during the surgery.
8. On the night before surgery be certain to take all medications that you have been instructed to take.
9. On the night before surgery take a shower and wash your hair. This should be repeated on the morning of surgery.
10. DO NOT HAVE ANYTHING TO EAT OR DRINK INCLUDING WATER after midnight the night before surgery.
11. If you are not returning home following the surgery, bring with you an overnight bag in which you have changes of underwear, a fresh robe which opens all the way down the front, pajamas which open all the way down the front, slippers without heels, toiletries and ALL MEDICATIONS.
12. Please be sure to provide the office with the name of someone to contact if necessary. If you are not going to a recovery facility or are not staying overnight in the hospital, please make arrangements to have a responsible adult drive you to and from the surgery and spend at least the first night with you.
The Day of the Surgery
1. As previously stated, shower the morning of surgery.
2. Brush your teeth (using a small amount of water) and use a mouthwash in the morning.
3. Do not wear any makeup, false eyelashes, hair spray, jewelry, pantyhose or stockings on the morning of surgery. Male patients must shave on the morning of surgery. Beards and moustaches are acceptable unless otherwise instructed. Leave all valuables at home.
4. If you wear dentures please be certain to advise the anesthesiologist, the nurse and Dr. DiGeronimo that you have dentures in place.
5. Please be prompt. Please be sure you have followed all the instructions. Preparations will begin when you arrive.
6. An Intravenous line will be started in your arm. You will receive medications through the intravenous line.
7. Surgery time varies with each patient. Please inform your family and friends that you will be with us for several hours.
After the Surgery
1. After the surgery is completed iced compresses will be applied to the eyes. There generally are no dressings fixed or tied over the eyelid area following surgery. You will have sutures (stitches) around the eyelids, (unless a transconjunctival blepharoplasty was performed)
2. You are to go home (or recovery center or hospital) and remain in bed with your head and shoulders elevated on two or three pillows with bathroom privileges with assistance. Continue to sleep with your head and shoulder elevated for several days following the surgery. Elevating the mattress at the head of the bed with two pillows placed under the mattress can also be helpful. This, of course, should be done prior to the surgery or by someone other than the patient following surgery.
3. Remain as quiet as possible for the first 48 hours following the surgery.
4.Take all medications as prescribed.
5. Apply iced compresses (iced gauze squares or frozen bags of peas or corn which have been wrapped in a cloth napkin) as tolerated for the first 24 to 48 hours following surgery. Moist heat may be applied after 48 hours. Avoid excessive heat as sensation in these areas may be decreased.
6. Apply the specially prescribed ointment to the incision lines and sutures (stitches) three to four times a day until the sutures (stitches) have been removed.
7. You may have moderate amounts of liquids and soft foods as desired and tolerated the first night following the surgery. The following day you may resume a normal diet. No alcohol for period of seven days following the surgery.
8. Some swelling and discoloration are expected. Excessive or uneven swelling (more on one side than the other) should be reported to the office. Any excessive bleeding or blurred vision should be reported immediately.
9. You may wash your hair carefully with a mild baby shampoo any time after the third day following surgery. do not use hot water. Be very careful not to get shampoo or soap in your eyes. DO NOT PULL OR RUB THE SKIN AROUND YOUR EYES. Pat the area dry very gently with a soft clean towel or gauze pad.
10. Avoid strenuous activity for at least one month following the surgery. Do not bend over from the waist or engage in any activity that causes blood to rush to the head for one month following surgery.
11. Make up may be worn one week to the day after the sutures have been removed. If any burning or itching occurs remove the makeup immediately with cool water.
12. Avoid the sun and heat until most of the swelling and bruising have subsided approximately one month). You should wear a floppy hat and sunglasses when outside during the day. Sun screens with a rating of 30 SPF should be worn on a permanent basis hen outside in the sun following surgery. Sun screen should be applied frequently during the heat of the day or if one is perspiring.
13. Contact lenses can generally be worn approximately 14 days following the surgery. However, you may find that you experience a sensation of irritation enabling you to wear the contact lenses for only a limited period of time.
14. You may resume regular activities on a gradual basis beginning with the fourth week following surgery.
