EYELID SURGERY
With fellowship training in oculofacial plastic surgery, Dr. Henry Lee is an "eyelid specialist".
What causes droopy eyelids?
Typically, when patients state they are worried about their droopy eyelids, they mean that the edge of their eyelids are low, there is excess skin folding down over their eyelids, or a combination of both. The drooping of the edge, or margin, of the eyelid is called ptosis. The accumulation of excess eyelid skin is called dermatochalasis.
Ptosis and dermatochalasis are caused by a variety of factors. Ptosis may be due to age-related changes, trauma, or nerve damage. It may also be congenital (from birth). The most common form of ptosis is age-related, where the muscle that is responsible for lifting the eyelid becomes stretched over time or detaches from where it inserts into the eyelid. This causes the entire eyelid itself to fall and get lower and lower with time. Long-term use of contact lenses, in particular hard contact lenses, may contribute to more rapid stretching of the eyelid lifting muscle.
Dermatochalasis is most commonly due to age-related changes. Over time, as gravity constantly pulls down on the eyelid and as the skin ages and loses elasticity, the skin of the upper eyelid can become stretched. Genetics and environmental factors, such as smoking, also play important roles.
What can be done about my droopy eyelids?
For ptosis and dermatochalasis, the treatment is surgery. Ptosis surgery is most commonly performed via an external incision or an incision along the inner aspect of the eyelid. Both procedures are very effective and have their own strengths and weaknesses. An in-person evaluation is needed to determine which method of ptosis repair is best for each individual person.
Surgery for dermatochalasis is called a blepharoplasty, or eyelid lift. During the procedure, the excess eyelid skin is removed. Depending on the patient, some of the underlying muscle layer may also be removed, and the fat pads found deep within the eyelid may be sculpted, excised, or repositioned as needed.
Will insurance cover the cost of my blepharoplasty?
A blepharoplasty may be covered by insurance. In order to be covered, insurance carriers require that there is a significant amount of obstruction of the peripheral vision from the drooping eyelid. The eyelid must also be causing symptoms related to the obstruction.
If the insurance criteria are not met, then the option of a cosmetic blepharoplasty (eyelid lift) can be considered.
What happens during a blepharoplasty procedure?
Blepharoplasties are typically performed in an outpatient setting, usually in an ambulatory surgery center. Before you receive any anesthesia, your eyelids will be marked for the procedure with a surgical marking pen.
Anesthesia is then administered by an anesthesiologist. The type of anesthesia used is most commonly referred to as twilight anesthesia, or monitored anesthesia care. General anesthesia is not necessary for blepharoplasty, or eyelid lift, surgery.
After anesthesia has been administered, local anesthesia is injected into the eyelids. Then, the incisions are made and the excess skin is removed. Additional removal of underlying muscle and removal or repositioning of deeper fat may also be performed. Finally, the incision is sutured typically with a non-dissolving suture.
What should I expect from recovery from an eyelid lift?
Bruising and swelling are expected. This usually worsens during the first 2-3 days or so. In order to minimize bruising and swelling, rest with the head elevated and frequent cold compresses are recommended during the first 2 days after surgery. After 2 days, warm compresses usually help the bruising and swelling more than cold compresses. The bruising typically lasts 1-2 weeks, whereas the swelling is expected to remain for at least 2 weeks.
There is usually mild, if any, pain after an eyelid lift. Most patients will take a Tylenol (acetaminophen) during the first 24 hours. Additional medication for pain is unusual.
If you wear contact lenses, it is recommended to avoid use for the first 2 weeks after surgery.
Total healing typically takes at least 4-6 months. In the early post-operative time period, a red or pink, firm, and bumpy incision is typically noticed. The incision becomes softer, smoother, and more skin-colored over approximately 6 months.
What kind of follow up care do I need after a blepharoplasty?
The first post-operative appointment usually occurs at 1 week. At this time, the sutures are removed and the operative sites are inspected. Post-operative photos are taken at very visit. Since most people do very well after an eyelid lift, the next post-operative appointment is scheduled for 2-3 months after surgery.