Blepharoplasty - Eyelid Surgery
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As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing "bags" above and below.

Blepharoplasty, also known as eyelid surgery, is a surgical procedure to remove fat and usually excess skin and muscle from the upper and lower eyelids. This surgery can correct drooping upper eyelids and puffy lower lids which are features that may make you look older or tired, and may interfere with your vision. However, eyelid surgery will not remove all wrinkles or the dark circles under the eyes, or lift sagging eyebrows. To correct sagging eyebrows, a brow lift can be performed at the same time as blepharoplasty surgery. The eyelid surgery can add an upper eyelid crease to the Asian eye, yet it will not take away from your ethnic heritage.

Patients with medical conditions such as hypothyroidism and Graves’ disease, dry eye or lack of tears, high blood pressure or other circulatory disorders, cardiovascular disease, or diabetes may pose potential risks for the surgery. As well a detached retina or glaucoma will require clearance from your ophthalmologist prior to surgery.

With every surgery there are possible risks and complications:  
Dr. Yaker performs many blepharoplasties successfully each year. However; there are risks associated with this surgery. Possible complications following surgery include infection, bleeding, and poor healing and reaction to the anesthesia. Other complications such as blurred vision, excessive swelling of the eye, asymmetry in healing or scarring, and small white heads may appear after the sutures are removed - which are easily removed at the office. As well, some patients may have difficulty closing their eyes when they sleep, an ointment will be prescribed until the eye lid closes back to normal. Ectropion is a rare condition, where the lower eyelid pulls downward. This may require further surgery, although new techniques have made this condition avoidable is most cases.

Before surgery, the surgeon marks the incision sites, following the natural lines and creases of the upper and lower eyelids.	Underlying fat, along with excess skin and muscle, can be removed during the operation.	The surgeon closes the incisions with fine sutures, which will leave nearly invisible scars.

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.

About the Surgery:  
The procedure is performed in our on site AAAASF certified ambulatory surgery center under I V sedation or general anesthesia. The surgery generally takes 1 ½ - 2 hours for all 4 eyelids. Patients having the upper and lower lids operated on, typically the incision is made at the natural line of the upper eyelids, and just under the lashes in the lower lids. Depending on the amount of correction and the technique, the incision may extend to the outer corners of the eyes or into the crow’s feet. Through these incisions, Dr. Yaker separates the skin from underlying fatty tissue and muscle, removing excess fat, and often he trims sagging skin and muscle at the same time. In cases in which the eyes are deeply set, the fat pockets are preserved and placed above the orbital bone. The incision is closed with very fine sutures. Those with fat pockets of the lower eyelids, with no excess of skin, may be candidates for the transconjunctival blepharoplasty. In this surgery the incision is made on the inside of the lower eyelid.

Illustrations  above are courtesy of
ASPS (The American Society of Plastic Surgeons)  
(The American Society for Aesthetic Plastic Surgery, Inc.)

Pre-Operative Instructions for Blepharoplasty

 2 Weeks before Surgery:

• Do not take aspirin or ibuprofen products (You may take Tylenol)
• Do not take any diet pills or similar appetite suppressant medications, (i.e. Metabolife)
• Do not take any herbal preparations, (i.e. St. Johns Wart)
• Do not take Vitamin E
• Try not to smoke 2 weeks before, continuing 2 weeks after surgery

Fill your prescriptions given to you during your pre-op visit:

• Lortab or Darvocet is for the pain
• Keflex is an antibiotic (you will need to take all of these as directed)
• Extra-Strength Tylenol
• Q-tips
• Small tube of Bacitracin
• Artificial Tears

• Eat a bland meal - Nothing Spicy
• Before going to bed take a Pepcid AC

The Day for Surgery:

**Eating or Drinking Prior to Surgery Will Result in Cancellation of Surgery**

• Wear loose clothing, something very easy to put on after surgery. Wear a top that buttons or zips in front. (Do not wear tight clothing).
• Do not wear make-up.
• Leave all jewelry and valuables at home.
• The person caring for you after surgery will need to stay with you for at least 48 hours.

Post-Operative Instruction
for Blepharoplasty

• Take your pain medications for the pain. Do not take it on an empty stomach.
• Take the antibiotics as directed, until they are all gone.
• Sometimes patients will develop a yeast infection from the antibiotics, if this occurs call the office.
• Should you become constipated, you may use an over the counter stool softener. If you do not have relief from your stool softener, call the office.
• Should you experience itching, discontinue the pain medications and take Benadryl 25 mg: one capsule every 6 hours as needed.
• Remember no aspirin products until 2 weeks after surgery.

• If you feel you are in an emergency situations, please call the office at any time. Our phones are answered 24 hours a day. These calls include: sudden loss of vision, abnormal bleeding, abnormal swelling, severe eye pain, or a temperature over 101 degrees. Other calls should be made during business hours Monday - Friday 9:00 a.m. - 5:00 p.m.
• The skin of the eyelids is thin and you will have some swelling and bruising which should resolve in 7-12 days.
• Swelling can increase the first 48 hours, and then should start to go down over the next few weeks.
• Your eyes may be sensitive to light and tear more than normal, or have temporary dryness. Wearing dark glasses for a couple of weeks can help.
• Avoid straining the eyes to read or watch television.
• Once the sutures are removed and the incisions are healed you may resume wearing makeup.
• Sleep on your back with your head elevated with pillows to help reduce swelling.
• No bending forward, or lifting heavy objects for 5-7 days.
• Most patients take 5-7 days off from work.
• Use the eye pads and ice water, or a clear gel eye mask to cover your eyes to help with the swelling for the first 24 hours following surgery.
• You may take a shower the day after surgery. Do not let the water hit the eyelid area.
• Should your eyes itch or feel dry, use the eye drops or Lacrilube as much as possible.
• Post operative activities will depend on the type of the reconstruction done. Dr. Yaker will discuss with you these activities during consultation.

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