Blepharoplasty (Eyelid Surgery) FAQ
Q: What is a blepharoplasty?
A: A blepharoplasty is an operation that removes excess skin and fat that occurs on both the upper and lower eyelids. The lower eyelid surgery is always considered cosmetic and a majority of the time the upper eyelid surgery is also cosmetic. However, when the upper eyelid skin is touching the eyelashes and obstructing approximately 30% of the visual field, this may be covered under the patient's medical insurance.
Q: What is an upper blepharoplasty?
A: An upper blepharoplasty is a rejuvenation procedure of the upper eyelids. An incision is placed in the upper eyelid crease and excess skin and fat is removed. Occasionally, a small strip of redundant orbicularis occuli muscle is also taken to further deepen the upper lid crease when necessary. The upper lid incision is closed with absorbable stitches, which dissolve in five to seven days after the surgery.
Q: What is a lower blepharoplasty?
A: Lower eyelid surgery is also known as a lower blepharoplasty, which is done primarily for excess bags and puffiness underneath the lower lids. The invisible incision for the lower eyelid surgery is placed on the inside of the lower lid, which is called the conjunctiva of the inside of the eyelid. When needed, if there is extra skin on the lower lids, a small incision is placed at the lash line. This incision is directly below the eyelashes and a small pinch of skin, approximately 2 to 3 mm, is taken. The incision is closed with Histocryl tissue glue. There are no stitches in the lower lids.
Q: How long does a blepharoplasty last?
A: A blepharoplasty, when done for cosmetic surgery purposes, lasts approximately 10 to 15 years before the patient needs to have it redone.
Q: Are there any bandages placed on the outside of the eyelids after a blepharoplasty?
A: There are no bandages placed on the eyelids after blepharoplasty surgery. Cool compresses can be used, but avoid ice because we do not want patients to be frost-bitten after their surgery. Patients are discharged to home from the Seattle Facial Plastic Surgery Center.
Q: What is the average age that a blepharoplasty surgery is performed?
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A: Most blepharoplasty surgeries are performed for people in their mid 40s to early 50s who are starting to see the facial and eyelid changes of aging including sagging upper eyelids with excess skin and puffiness and bags underneath the eyelids.
Q: How long will the swelling last after my upper and lower lid blepharoplasty surgery?
A: Typically, the majority of the swelling subsides after the first two weeks following a blepharoplasty. Most of the bruising and swelling subsides by the 10th to 14th day after the surgery. We encourage patients to refrain from work or social activities for a minimum of two weeks if they do not want others to notice that they have had surgery.
Q: What type of stitches are used on an upper blepharoplasty surgery?
A: After the surgery is completed, there are very fine dissolvable stitches that are placed on the upper eyelids that close the incision. These sutures dissolve in 7 to 10 days after the surgery and do not need to be removed.
Q: What type of stitches are used on a lower blepharoplasty surgery?
A: There are no sutures placed for a lower blepharoplasty. The incision on the inside of the lower lid closes naturally on its own since it is a very small incision. If needed, the external incision at the latch line is closed with a Histocryl tissue adhesive. This glue flakes off at approximately 7 to 10 days after the surgery.
Q: Will I be able to see after either an upper or lower blepharoplasty surgery?
A: Yes. Patients are able to see after their surgery. However, we do not recommend driving for the first few days after the surgery since vision can be slightly blurry. The white part of the eye known as the sclera can also become swollen and can make for difficult reading in the first few days after the surgery. Patients also express the fact that their eyes are quite tired in the first two weeks of the postoperative phase.
Q: How is the puffiness taken away from my lower lids?
A: The puffiness is caused by diet-resistant fat. It is also called orbital fat on the lower lids. This fat is teased out through very tiny incisions on the inside of the lower lids and removed. If needed, a very small conservative portion of skin is removed from the lower lids on the outside through an incision right at the lash line. Skin removal is not performed on all patients.
Q: How is the upper blepharoplasty surgery performed?
A: An incision is made in the upper eyelid crease and excess skin is removed in a conservative fashion so that patients are still able to close their eyes. If needed, a small strip of the orbicularis occuli muscle can be removed to deepen the crease. There are two diet-resistant fat pads on the upper lids in the orbital septum. A portion of this is also removed to improve the puffiness look on the upper lids.
Q: I have dry eyes and would like to have a blepharoplasty.
A: If patients have dry eyes, they need to first have a Schirmer's test done by an ophthalmologist to document the extent of dryness. Sometimes the dryness can be addressed preoperatively through eye drops and punctal plugs. Once the amount of dryness is documented, upper &/or lower blepharoplasty can be performed. There is a very small risk, less than 5%, that dry eyes can become more dry after a blepharoplasty surgery.
Q: How do I know if my medical insurance will cover my upper eyelid surgery?
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A: Our office will preauthorize any upper blepharoplasty surgery if 30% of visual field is obstructed as documented on a visual field obstruction test. The visual field obstruction test is done by an ophthalmologist. Pictures of the patientís eyelids, visual field obstruction test, and medical documentation will be sent to the patientís insurance company for preauthorization prior to the surgery. Cosmetic eyelid surgery is not medically necessary and is not covered under the patientís medical insurance plan.
Q: Do you ever perform a forehead lift with an upper or lower blepharoplasty?
A: Yes. Many times patients have low eyebrows with very puffy upper lids and excess skin on the upper lids as well. Often, Dr. Portuese will do an upper blepharoplasty at the same time as a forehead lift to further balance the upper 1/3 of the face and facial aesthetics. Please see our before and after photo gallery under blepharoplasty and forehead lift for examples of this.
Q: I have very deep set eyes and would still like to perform a blepharoplasty.
A: If the patient has very deep set eyes, during an upper blepharoplasty, care is taken to not accentuate the deepening of the crease. Typically, there will only be skin removal in order to address the excess skin on the upper lids. If the lower lids are deep set, there usually is nothing that can be done other than just a simple skin incision at the lash line on the lower lids to remove excess skin.
Q: I have very prominent eyes and wonder if I could have a blepharoplasty.
A: Very prominent eyes typically have a lot of fat bulging on both the upper and lower lids. An upper and lower blepharoplasty can be performed for this condition to make the eyes look less prominent and more natural.
Q: What is the goal of upper eyelid blepharoplasty surgery?
A: The goal of upper eyelid blepharoplasty surgery is to primarily remove excess skin and a small amount of puffiness on the upper lids on the medial portion closest to the nose.
Q: What is the goal of lower eyelid blepharoplasty surgery?
A: The goal of lower blepharoplasty is to primarily remove the excess bags on the lower lids and the secondary goal is to remove a small amount of skin if there are excess wrinkles.
Q: How much does an upper lid blepharoplasty or lower lid blepharoplasty cost?
A: Typical cost for a cosmetic upper or lower blepharoplasty is in the $3,000 range depending upon the complexity.
Q: How much does both an upper and lower eyelid blepharoplasty cost?
A: Typically, the cost for a cosmetic upper and lower blepharoplasty is in the $4,500 range.
Q: Is the pain severe after upper and lower lid blepharoplasty surgery?
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A: No. There is mild-to-moderate discomfort the first day or two after a blepharoplasty. Many patients just take Tylenol for the entire postoperative course and do not find it painful. Some patients take two pain pills the first night to help them sleep. Many patients may experience a headache in the first day or two after the surgery. Tylenol is taken as needed for minor discomfort for the remainder of the week.
Q: When can I wear contacts after blepharoplasty surgery?
A: No. Contacts just need to be taken out the day of the surgery and for approximately 10 days in the postoperative healing period
Q: When can a patient wear eyelid makeup after a blepharoplasty surgery?
A: Patients are able to wear eyelid makeup approximately one week after the surgery to cover any bruising and swelling that may exist. The makeup can be applied both on the upper and lower lids to camouflage bruising and swelling approximately one week after the surgery. The Histocryl glue on the lower lids and the dissolvable stitches on the upper lids take approximately 7 Ė 10 days to dissolve. Once that is gone, makeup can then be applied.
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Q & A with William A. Portuese, MD
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