Eyelid Surgery (Blepharoplasty) Information

EYELID SURGERY*
Cost Range: $1,500-$7,000

Average Total Cost
Upper and Lower Lids: $4,000
Surgeons fee: $2,500
Anesthesiologist: $700
Facility fee: $800

Lower Lids: $2,400
Surgeons fee: $1,600
Anesthesiologist: $400
Facility fee: $500

Upper Lids: $2,100
Surgeons fee: $1,200
Anesthesiologist: $400
Facility fee: $500

RELATED FEES**
Eyelid surgery $2,544
Facelift $5,007
Forehead lift $2,552
Laser skin resurfacing $2,243
Cheek implant $1,945
Lip augmentation (other than injectable materials) $1,570
Botox® injection (per injection) $388
Microdermabrasion $136

*Fees generally vary according to region of country and patient needs.
**These fees are averages only. Fees do not include anesthesia, operating room facilities, or other related expenses. Source: http://www. plasticsurgery.org/mediactr/average2001.cfm

initial consultation

At the initial visit, your doctor will likely ask you to describe in detail what you would like improved. Be specific about what you would like done. If your surgeon fully understands your expectations, she'll be able to determine whether your goals are realistic.

Your surgeon will assess your brow position as well as the extent of excess skin, skin laxity and fat deposits to determine the technique that will have the best results.

If you have high blood pressure, glaucoma, a detached retina or dry eyes, you should also be evaluated by an ophthalmologist to evaluate possible surgical difficulties.

Tell your doctor if you have any conditions such as:

cardiovascular disease
diabetes
dry eyes
hypertension or other circulatory disorders
thyroid problems such as hypothyroidism

These conditions increase your risk for complications. You'll want to discuss your medical history thoroughly with your physician before you choose to undergo surgery.

pre-op preparation

Before Surgery:
[ ] Do not take aspirin or anti-inflammatory medications (your doctor can provide you with a list of OTC medications to avoid)
[ ] If you smoke, quit smoking for at least 2 weeks pre-op (and anticipate no smoking for the recovery, smoking greatly increases your risk of complications)
[ ] Obtain a copy of your doctor's protocol
[ ] Make arrangements to have someone drive you to and from the operation
[ ] Arrange for someone to care for you the first 24-72 hours after surgery (consider hiring a nurse for the first 24 hours, this is can be very tiring and emotional for loved ones)
[ ] Fill prescriptions (especially pain medications) before surgery
[ ] Purchase any homeopathic medicines (i.e. Bromelain and Arnica Gel, for swelling and bruising) Be sure to discuss this with your doctor
[ ] Prepare and freeze meals in advance
You'll want soft foods that do not require much chewing for the first day or two.
Consider: Protein shakes, soup, pudding, applesauce, yogurt, oatmeal, cottage cheese, juice (purchase flexible straws for easier drinking)
[ ] Set up home recovery area: lots of pillows, books, magazines, journal, stationery, eye drops, lotion, baby wipes, tv, videos, remote control
[ ] Telephone with speaker phone near your bed (turn off ringer and place answering machine in another room so it won't disturb you)
[ ] Prepare Icepacks (can also use packs of frozen veggies) to reduce post-op swelling
Purchase large clips to hold packs in place
[ ] Moisturizers, scar reducing/minimizing creams (such as Mederma) and petroleum jelly for incisions
[ ] Laxatives (pain medications are often binding
[ ] Eye Drops (after any surgery, eyes can be dry)
[ ] Consider hand-held shower head and bathroom chair
[ ] Telephone with speaker phone near your bed
[ ] Night before surgery, thoroughly remove all makeup
[ ] Morning of surgery, wash face thoroughly and do not apply any products
[ ] Bring sunglasses to wear on the way home from surgery
[ ] On the day of surgery, wear loose clothing which will be easy to get off and on after operation (wear a shirt that buttons in front)
[ ] Follow your physician's directions carefully regarding medications, eating & drinking, etc.

basic procedures/techniques

Anesthesia: General, local or sedation
Location: Hospital, surgical center or office
Surgery time: 1-3 hours

Eyelid surgery will remove excess fat, muscle and skin from the upper and lower eyelids. It improves drooping lids and puffy eyes. It does not correct wrinkles, dark circles, sagging eyebrows. These problems may be corrected through other procedures, such as a brow lift or skin resurfacing techniques.

In some cases only upper lid surgery is performed and sometimes only lower lid surgery. Upper and lower procedures can also be performed at the same time.

During the operation, the surgeon making incisions above and below the eye tissue. These incisions follow the natural folds of the eye and allow the surgeon to separate the underlying fatty tissue and muscle. The surgeon then removes the fat and excises the sagging skin and muscle.

Upper Eyelid Blepharoplasty
Incisions are made in the natural skin crease of the upper eyelid. Excess skin and fatty tissue is removed and the muscles and orbital septum may be tightened to correct droopy eyelids. The incisions are closed.

Lower Eyelid Blepharoplasty
Lower eyelid surgery removes fat deposits and tightens loose skin. Incisions are made along the lower lash line and extends a little beyond the eye. Excess fat, muscle and skin are excised and the incision is closed. If your lower eyelids are loose, you may also require a lid tightening procedure. This results in more swelling and a longer recovery.

If you have fat pockets belowe your eyes, and do not have loose skin, your surgeon may recommend a transconjunctival blepharoplasty.

Transconjunctival blepharoplasty
Transconjunctival blepharoplasty does not tighten the skin, it simply removes excess fat. The incision is made inside your lower eyelid, leaving no visible scar. Excess fat and muscle are removed and the incision is closed.

recovery

Pain Level: Mild discomfort. 0-3 days of pain medication; may not require medication
Swelling and bruising: skin removal only: 3-5 days; skin & fat removal: 1-2 weeks
Stitches: if used, removed in 2 -5 days; no bandages
Work: Return after 5 days with makeup; After 2-3 weeks without makeup
Exercise: Wait 2-3 weeks
Sun protection: Six months with SPF 15 or higher
Final result: Seen after 1-2 months

Contact lenses may be worn in 1-2 weeks (glasses can be worn immediately)
Eye makeup can be work after 7 days

For faster recovery:

Sleep with your head elevated for the first few days after surgery to minimize swelling
Place ice compresses on your eyes for 1-3 days
Avoid activities that dry the eyes (reading, watching television, wearing contacts, and using a computer)
Avoid excessive blinking, which leads to increased swelling
Wear sunglasses to protect your eyes from wind and sun irritation
Avoid any activity that increases blood flow to the eyes (bending, lifting, crying and exercise)
Don't drink alcohol (can cause fluid retention and delay recovery)

Initial recovery takes anywhere from two weeks to one month, and the complete healing process takes up to six months as scars fade to thin white lines.

After surgery your eyes may feel tight, with minor discomfort that lasts for a day or two. Your eyes will be swollen and bruised. Your head will be kept elevated and cold compresses applied to reduce swelling and bruising. Your blood pressure will be monitored to avoid bleeding complications. Your eyes will be lubricated, which may blur your vision.

The incisions may be red and bumpy initially and will gradually flatten and fade. The swelling and bruising should disappear within 1-2 weeks depending on the extent of your surgery. During recovery, your eyes may be sensitive to light and your vision may be blurry the first few days. Your eyes may also experience, burning, itching, tearing or dryness. Your doctor will likely dispense eyedrops to alleviate any discomfort.

Wear sunglasses home. At home, keep your head elevated and take it easy. Apply light ice packs (try frozen peas in a plastic bag) over your eyes continuously for the first 48 hours.

The eyelids may become swollen and stuck together. If this occurs, clean the eyelashes carefully with warm water on a Q-tip. Some oozing from the incision lines and crusting along the eyelashes is normal. However, if you have increased bleeding or decreased vision, call your physician immediately.

Be sure to follow your doctor's advice carefully and go to all post-op visits.

Dr. Mark Gorney, a board-certified plastic surgeon in Napa, CA, wrote an article in the Aesthetic Surgery Journal that contained important information about preventing vision loss in the early post-operative period:

"In a survey of 5 consecutive cases of blindness after blepharoplasty, it was discovered that the only factor all patients had in common was that they were discharged very shortly after the termination of outpatient surgery. On arrival at home, all 5 patients did something to generate a sudden rise in blood pressure at the time of maximal reactive hyperemia as the epinephrine in the local anesthetic wore off, such as a constipated bowel movement, sudden coughing fit, or bending over and reaching down to tie a shoelace. It is imperative that all patients undergoing outpatient surgery involving undermining of heavily vascularized tissues be warned in writing not to perform any maneuvers that will generate a sudden rise in blood pressure. It is strongly recommended that no patient be discharged from an outpatient surgical facility until at least 3 hours after the last epinephrine-containing local injection and until there is evidence that all local anesthetic effects have worn off."
Source: Gorney M. Ten years' experience in aesthetic surgery malpractice claims Aesth Surg J March/April 2001;21:569-571

risks/complications

List of possible complications:
Abnormal lid position
Abnormal scarring
Abnormal skin color
Anesthesia reaction
Bleeding
Blindness
Blurred vision
Burning
Corneal abrasion
Double vision
Decreased sensation in eyelid
Difficulty closing eyes
Dry eye syndrome
Excessive tearing
Gritty sensation in eye
Inability to close eyes
Milia
Reactions to medications
Retrobulbar hematoma
Slow healing
Stinging
Visible scarring

Complications of eyelid surgery, while rare, can cause prolonged healing, change in or loss of vision, unpleasant-appearing and painful scars, the inconvenience and cost of further surgery, and the possibility of requiring eye drops or ointment, temporarily or permanenetly.

Blindness
The risk of permanent blindness is less than 1 out of 10,000. Vision loss is usually related to bleeding following eyelid fat removal.

Blurred vision
This is a temporary condition that occurs in less than 1% of surgeries.

Corneal abrasion
This condition is temporary and is easily treated by patching the eye for 1-3 days.

Double vision
This condition is temporary and occurs in less than 1% of surgeries.

Difficulty closing eyes
This condition is usually temporary in rare cases. In rare cases, corrective surgery is required.

Dry eye syndrome
Dry eye syndrome is potentially dangerous. In rare cases it leads to damage to the cornea of the eye and vision loss.

Inability to close eyes
This condition is usually temporary. In rare cases, corrective surgery is required.

Milia
Tiny skin cysts can form on the scar line. This is normally temporary, but in some cases requires surgical removal.

Retrobulbar hematoma
A rare complication in which a pocket of blood forms behind the eyeball.

scars

Surgical scars are permanent. However, the incisions are placed so that they are not normally noticeable except on very close observation. The scars run in the natural contours of the skin below the eye and in the upper eyelid. If only fat is removed, the incision may be inside the lower eyelid along the lower lash line, which is completely hidden. The scars should be almost invisible in 2 weeks.

Information provided is for general education about cosmetic surgery. This information is subject to change. Board Certified Database.com does not guarantee that it is accurate or complete, and is not responsible for any actions resulting from the use of this information. General information provided in this fashion should not be construed as specific medical advice or recommendation, and is not a substitute for a consultation and physical examination by a physician. Only discussion of your individual needs with a qualified physician will determine the best method of treatment for you.
Copyright 2002. All rights reserved.