Case Studies

Eyelid Surgery (Blepharoplasty), Lid tuck

Another of the very classic aesthetic surgery procedures, the modern version of blepharoplasty has been done for close to 100 years.  Techniques have changed.  New tools and new approaches have been added but the purpose of the surgery has remained the same – to smooth out the lid skin, remove relaxed or sagging skin, and to get rid of the bags under the eyes.

The eyelid skin is some of the most delicate skin in the body and as such is very subject to sun damage.  However, most of the problems I see in lid skin are due to premature aging from sun damage combined with genetic predisposition to skin relaxation and skin thinning.  This results in “crepe” of the thin skin of the lids (tiny surface wrinkles of the eyelid skin), bulging of the orbital fat (bags), and loss of elastin in the skin which allows the skin to bunch up when smiling causing “crows feet”.  Combine all of this with loss of subcutaneous fat which occurs naturally as we age and you have the classic aging eye – wrinkled, sagging over the upper eyelashes, with bags under the eyes and a hollow look above the cheekbones.

Before Surgery

Unless you have been diligent in the care of your skin, which most men are not, eyelid aging in men begins to occur in the early 40’s.  Because of a man’s thicker skin most men are not particularly worried about aging until some 7 -10 years after his female counterpart.  About this time men begin to see early lines about the eyelids and worry that middle age is approaching.  The relatively recent advent of really effective restorative skin creams, Botox and skin fillers has allowed many to delay the signs of aging for several years past the point when a previous generation would have sought surgical help.  But the time will come when all of the above will not alleviate the steady progress of aging.

A consult for blepharoplasty is the time to see if further delaying tactics are going to help or whether it is only spending money that would better be spent on something more permanent such as eyelid surgery.  Most men decide that the time is ripe for surgery when they develop difficulty with vision due to sagging skin of the upper lid or when the bags are so bad they cannot be ignored, even hiding behind glasses.  Many come in when someone comments, usually more than once, that they look “tired” or they are “getting on up there” when indeed they are not tired or old and realize that they need to work for quite a few years to come.

There are a myriad of techniques for correcting eyelid aging and no one technique will do for everyone.  In general, excess skin in the lids is removed by excision.  Bags which are usually caused by fat in the area are either removed or repositioned depending on the need, but, if you have only bags and not relaxed skin, you may not need a skin incision to remove the fat.  Wrinkled skin, especially “crepe”, is frequently treated in women with a skin resurfacing LASER which is the most effective tool for smoothing out the eyelid skin.  However, LASER resurfacing in the male skin is to be done judiciously as it can make a man’s skin too thin and shiny.  Sagging lower lids caused by stretching of the lid margin can be elevated a number of ways.  One thing to watch out for in correcting the “tired look” is attributing this to relaxation of the eyelids when it is really sagging of the forehead/brow.  “Hooding” or sagging of the lateral brow is the most frequent cause of looking tired.  Trying to correct that look with blepharoplasty will be a waste of time and money and may create a situation where true correction by brow lift cannot be done.  But, again, forehead or brow lift in men must be done very judiciously since elevation of the brow too much will cause feminization of the face and that is the last thing men want.  Forehead lift in men is still a great operation but the brow must never be placed above the orbit rim.  In women the brow is routinely place 1.5 cm above the rim.

Your first consultation will begin with a physical examination of the face.  Once the condition of the skin and adjacent tissue is known, a plan for correction can be developed.  All options for correction will be discussed including rejuvenating creams as mentioned above, Botox and fillers, and surgery in all its types.  After deciding what will be the best method to correct your problem areas, we will move on to an exact description of the planned techniques and what to expect for a result.  Possible complications and risks will be explained entirely as will the need for lab tests and other presurgical procedures.  Once you have decided on your course of action, the staff will assist you at every stage to prepare you for a great result.

The Surgery

Blepharoplasty alone can be done as an outpatient procedure.  My surgery is done at the IAS Surgery Center, a full ambulatory surgery center, with nurses and techs especially trained in aesthetic surgery.  Anesthesia is provided by doctors of Anesthesiology from St. Joseph’s Hospital.  Depending on the technique and amount of surgery to be done, the time in the operating room varies from 1 to 2.5 hours.  On completion, antibiotic ointment is placed in the patient’s eyes (which will cause things to look blurry on awaking) and the patient then removed to the Recovery Room for about half an hour.  Unless other procedures are being done at the same time, the patient will then be released to a responsible adult to go home.

Post Surgery and Recovery

So long as you live within an hour’s drive of the IAS Surgery Center you may return to your own bed for 24 hours of bed rest.  Sleeping or snoozing for a day is the best way to get off to a good recovery and rapid healing.  Pain is usually not severe.  You will be given prescriptions for pain meds, antibiotics, and an eye ointment which you will begin once you are at home.  Constant iced compresses, applied around the clock and changed about every 30 minutes, are the most important care following the surgery.  This will keep the swelling and bruising to a minimum and will allow quick recovery.  At 48 hours after surgery, the ice is discontinued and warm compresses are begun for 20 minutes 4x’s per day.  You will have been given a 2 page instruction sheet when surgery was scheduled with before and after surgery instructions and you must follow those instructions exactly.  Nobody wants a complication and these instructions have been specifically designed to prevent postop complications.

Your postop visits will usually begin at 5 days postsurgery (to remove the stitches), once a week for the next 1 - 2 weeks, at 6 weeks, and at 3 months.  The skin incision will heal in about 5-7 days.  Don’t expect things to look perfect when the stitches come out.  This isn’t the movies.  It will take 7-14 days for 95% of the swelling and bruising to disappear.  If you had LASER resurfacing, the time is longer.  With camouflage coverup you may usually return to work in a week.  It will generally take about 2 - 3 weeks before you will feel comfortable being out for a social event.  Photographs will be taken frequently.

Risk and Complications

This is a surgical procedure and therefore complications may occur.  I can’t imagine how many times I have said this to patients during the consultation.  Frequently about this time, a glaze comes over the eyes and the patient “tunes out”.  Risks of surgery and possible complications are not the most pleasant thoughts when you are excited about getting your new look but my advice, pay attention.  The cause of a complication may not be something done at surgery, but rather something you inadvertently do in the postop period.  The list of usual complications and their causes are covered in detail at the consultation so listen attentively.

The Cost

When budgeting for eyelid surgery, remember there is the fee for the surgeon,  the cost of the surgery facility and the fee for the anesthesiologist.  There are miscellaneous other costs such as lab tests, medications, preop physical, etc.  Once you are seen in consult and all factors evaluated, a final cost will be quoted for you.  If you would like to get a general range of fees, please call the office at 404-252-3672 and ask for the patient coordinator as she will be able to ascertain your general needs and give you a baseline average cost.

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