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Eyelid surgery:

Eyelid surgery (Blepharoplasty)

An eyelid surgery can be done to correct drooping upper eyelids, puffy fat pads in the upper and lower eyelids and sagging lower eyelid skin. Technically known as blepharoplasty, this procedure involves removal of fat and excess skin and muscle from the upper and lower eyelids. In some cases, the lower lid itself is tightened at the outer corner of the eye socket to correct laxity of the tone of the lower eyelid (canthopexy). In younger patients, fat can be removed from the lower eyelids using an incision on the inside of the lower eyelid (transconjunctival approach), if the skin elasticity allows. Eyelid surgery does not address crow's feet lines, dark pigmentation of the lower eyelids, or drooping eyebrow skin, but other procedures or treatments are available to address these concerns. Specialized surgery is done to add a crease to the upper eyelid in Asian patients, but will not erase other ethnic features, which define racial heritage. Eyelid surgery is frequently done at the same time as other procedures, such as a facelift or browlift.

What is blepharoplasty or eyelid tuck plastic surgery?

Blepharoplasty or eyelid tuck, refers to cosmetic surgery of the eyes. A blepharoplasty can correct sagging eyelids, pouches beneath the eyes and excess skin folds around the upper and lower eyelids. A thorough examination of the eyes and face will help Dr. Movagharnia to determine the amount, distribution, and type of excess skin and fatty deposits to be removed from the area.

Your eyelid tuck consultation

Dr. Movagharnia will take a medical history, with particular emphasis on conditions that may impact your candidacy for eyelid surgery. Underlying medical conditions, such as high blood pressure, bleeding disorders, heart disease, diabetes, thyroid disorders, or a history of dryness of your eyes are important issues that can increase the risks of an eyelid surgery. He needs to know about any prior eyelid surgery, eye muscle surgery, or laser vision correction. The medications you take may need to be altered prior to surgery, so be prepared to provide specific dosing information at the time of the consultation. Please inform him if you have any history of allergies to medications. Also, let him know if you wear any corrective lenses.

Dr. Movagharnia will do a thorough eyelid examination and will assess other related issues that impact the perception of eyelid aging, such as the effect of the eyebrows and the skin itself. He will answer all of your questions to the best of his ability, and you will be given the opportunity to look at examples of his work with other patients. On occasion, the he may feel that there are indications for you to seek a consultation with a board-certified ophthalmologist, and he will make this referral if necessary.

Risks of blepharoplasty

When an eyelid surgery is performed by a qualified plastic surgeon such as Dr. Movagharnia, complications are infrequent and usually minor. Nevertheless, complications can occur including bleeding, infection, reactions to the anesthetic medications, temporary problems with excessive tearing, prominence or firmness of the scars, asymmetry in healing or scarring, and milia or whiteheads where the sutures emanate from the skin. After the procedure, some patients may have difficulty closing their eyes completely while they sleep; in rare cases, this condition may be permanent. Another rare condition is ectropion, or a pulling down of the lower lids. Further surgery may be required to correct many of these complications.

Things to know before your eyelid tuck operation (blepharoplasty)

It is imperative that patients refrain from ingesting any medications or other substances that could potentially be the cause of surgical complications. A list of medications should be reviewed and discontinued at least two weeks prior to your operation. Patients are seen two weeks prior to their surgery date for a general physical examination to ensure that no underlying medical problems exist which may interfere with the safety of their surgery. Specifically, any infections, which arise prior to operation, however seemingly trivial, should be reported to our office. Even an otherwise innocent infection can result in a surgical wound infection, and must be treated prior to surgery.

Dr. Movagharnia recommends a homeopathic preparation of Arnica Montana to be purchased from a health food store to reduce swelling and bruising. A prescription for pain medication is also written so that you will have your pain pills when you return home from the operation. You will be given a prescription for antibiotics that you must finish. You may also be written a prescription for eye drops, depending on the exact nature of your procedure.

Pre-operative photographs are taken so that you can see the improvement from your surgery afterwards. We generally take post-operative photographs at 2-3 months after your procedure.

You will be asked to sign a surgical consent that enumerates the risks of the procedure in detail. These risks have been described herein and are also discussed at the consultation.

The following is a pre-operative surgery checklist to follow leading up to your eyelid surgery:

  • Please pick up liquid Ivory hand soap and cleanse the skin of your face with it for the three days prior to your operation.
  • Shampoo the morning of surgery and dry your hair well. Do not apply any hair care products afterwards.
  • Report any signs or symptoms of infection, such as fever, inflamed body parts, burning with urination, cough, diarrhea, or flu symptoms.
  • Do not wear contact lenses to your procedure. Wear your glasses, if applicable. If you use eye drops for glaucoma, take them prior to your arrival. Also take any blood pressure medication as you would normally, with a sip of water.
  • Wear a non-pullover shirt to your operation. We suggest a zipper-fronted sweatshirt. Wear slip-on shoes with smooth soles for ease of ambulation. Wear cotton underwear and clean white socks. Do not wear makeup.
  • Please remove any artificial nail material from both of your index fingers. We monitor your oxygen levels through your nail beds, and artificial nail products interfere with this.
  • Do not wear jewelry or bring other valuables to the office on the day of your surgery. Pierced body parts need to be free of jewelry for your safety.
  • Take any prescribed medications as directed.
  • DO NOT EAT OR DRINK ANYTHING FOR EIGHT HOURS PRIOR TO YOUR ARRIVAL.
  • Avoid smoking for one week prior to surgery.
  • Avoid alcohol for one week prior to surgery. It can lead to dehydration and can interfere with clearance of your anesthetic medications.
  • Stock up on Coca Cola Classic - it may help with any nausea you might feel after your anesthetic.
  • Purchase frozen corn and small re-sealable bags. Prepare handfuls of corn in several bags and keep them in the freezer to rotate as light cold compresses to your eyes.

You will need to arrange for an escort to drive you to and from hospital. Patients cannot operate motor vehicles after surgery, and we will not place recently sedated patients into taxis for transport home. We can arrange for medical transport in the event you cannot find an escort. It is a good idea to have someone stay with you for at least 24 hours after surgery, for your comfort and safety. You will also need transportation on your first follow up visit at 4-5 days.

How is the blepharoplasty surgery performed?

Prior to giving you any sedation, Dr. Movagharnia will carefully and artistically mark the skin incisions with a marking pen, following your natural skin creases, so as to minimize visibility of the scars after surgery. After this, an intravenous line is placed and sedative medication is administered gradually, under continuous monitoring of your vital signs. Local anesthetic is injected while you are unconscious, and you will be unaware of any pain during this part of the procedure. You will probably remember very little of the operation.

The excess skin, muscle, and fat are removed once the area is completely numb. Much of the operation is done with a very fine electrocautery, which controls any bleeding. The skin is then closed with very fine sutures. If you do not require removal of any skin from the lower eyelids, then Dr. Movagharnia will remove the bulging fat pads through a small incision inside the lower eyelid (transconjunctival blepharoplasty), leaving no visible scar. This is usually the case in patients with younger, more elastic skin, and may be combined with a chemical skin resurfacing procedure. Occasionally, the lower eyelid is very lax, and removal of any amount of skin could result in a pulling down of the lid. In this circumstance, the doctor may elect to perform what is called a lateral canthopexy. In this procedure, the actual lid structure is tightened up to the bone of the eye socket near the outer corner. This may result in a change in the shape of your eyelid, which is temporary, and this additional procedure will lengthen your recovery. There is an additional fee for this procedure as well.

In Asian patients seeking a more open-appearing upper eyelid, a special procedure is done to define a crease where one does not exist, or is indistinct. Dr. Movagharnia can discuss this special surgical procedure in greater detail at the time of your consultation. The indication for this procedure is not to create an "occidental" eyelid out of an "oriental" one, but rather to enhance an excessively hooded eyelid to create a more open appearance.

Following your procedure, you will be monitored briefly in our recovery room, and will then be discharged into the company of an adult escort. Written postoperative instructions will be given to that person and to you.

What happens after and eyelid tuck?

After an eyelid tuck operation (a blepharoplasty procedure) Dr. Movagharnia will place a lubricating ointment in your eyes, which may blur your vision temporarily. You may have tapes placed on your skin, and he will want you to continuously apply lightweight, ice-cold compresses to your eyes for the first three days. As mentioned, frozen corn placed into an inexpensive re-sealable bag works very well as a compress. You should avoid anything heavier than one ounce. Dr. Movagharnia recommends that you avoid using your eyes, and try to get as much rest as possible during the first week after surgery. Stay propped up on a couple of extra pillows in bed, or better yet, sleep in a recliner if you have one; this reduces swelling. Your blood pressure needs to be kept under tight control, as this can lead to bleeding complications that can affect your vision. Take the homeopathic pills, Arnica Montana, to reduce swelling and bruising.

It is important to avoid reading, watching television, or using a computer for the first week. Blinking your eyelids leads to increase swelling. Staring at a monitor is frequently accompanied by drying out of the eyes, which increases irritation and prolongs recovery. Take this opportunity to catch up on your sleep and avoid any interruptions which may cause you stress. To occupy your mind, we suggest listening to books on tape. DO NOT BEND OVER FOR AT LEAST 3 WEEKS.

Sutures are removed on the fourth or fifth day. Swelling and bruising usually lasts for ten to fourteen days, but makeup can be applied as a camouflage after the first week or so. When you go outside use sunglasses, as you may be very sensitive to light for a while. Avoidance of contact lenses for a week or so is necessary. You should not drive until you have normal vision, and are off of any narcotic medications. The eyes may fatigue easily for several weeks after surgery, due to any residual swelling in the tissues; frequent naps are helpful.

You should avoid strenuous activities such as bending, lifting, and sports for about six weeks. Drinking alcohol can lead to fluid retention, and delays recovery. Healing is a gradual process and it usually takes six weeks to three months for you to look completely natural, or no longer "surgical.” This may be more apparent to you than to others, and most people return to work in a week while still maintaining their confidentiality.

Scars may remain slightly pink for six months or so, but can easily be concealed with makeup. Eventually, they fade to a thin, nearly invisible white line. The more alert, youthful look that eyelid surgery gives one is very long lasting. For most people, the results are permanent.

What is the cost of an eyelid tuck cosmetic operation?

The fee for an upper or lower blepharoplasty can be obtained by calling our office. The procedure is not typically covered under any insurance plan because of its cosmetic nature.

For more information about blepharoplasty call our office at 770-951-7595.

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