One of several surgical techniques may be suggested to improve the appearance of your eyelids. The particular technique that Dr. Moelleken recommends will depend on many factors such as the amount of excess fat and skin in your eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids. Because of individual factors, not everyone will achieve the same results from eyelid surgery and Doctor Moelleken will select the surgical technique that he feels will obtain the best outcome for your individual situation.
Blepharoplasties remove excess skin, especially from your lower eyelids, and reduce or remodel excess fat from around your eyelids. Not all patients exhibit the need for removal of both excess skin and excess fat (bags). In many cases, only one or the other procedure is needed and newer procedures include operations to mold existing fat under your eyes, preservation of the natural fullness below your eyes while reducing the bulges, and the cheek lift operation, which involves tightening of the eye muscle below your eye and elevation of the cheek pad complex in a purely vertical direction. The overly tight look where the lids are pulled down is now avoided.
For your upper eyelids, removing skin and focal pockets of fat is the most common procedure. Before the incision is made, the excess skin is outlined. The outline is drawn so that the incision line and resulting scar will fall within the normal skin crease when your eye is open. The incision is hidden within the natural fold of your upper eyelid and extends slightly beyond the outside corner into your laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed and because the incision follows the natural contour of the upper eyelid, it is usually inconspicuous. In summary, the incision is flared upward at the outer corner following the eyebrow line; the predetermined amount of skin is removed; the appropriate amount of excess fat is removed, and the skin is closed with fine sutures. For revisional upper eyelid procedures, Dr. Moelleken usually performs scar revisions and restoration of fat with LiveFill to your upper eyelid.
Surgery on your lower eyelids may be performed using one of several techniques. Conventional lower eyelid surgery (subciliary incision) involves removal of fat and sometimes skin. This procedure is performed from inside your eyelid known as laser blepharoplasty or transconjunctival blepharoplasty. By making an incision inside your eyelid, no incision is visible following your surgery. Through your incision, fat will be removed to correct baggy lower eyelids before fine lines in your skin can be softened using a C02 or erbium laser.
Another method, called the transcutaneous technique requires an incision along your eyelash margin. The lower lid incision is made on the lower lid 1/16 of an inch below your lash margin and at the outer corner of your eye, parallel to the lower lid margin to slightly past the outer corner and then curves into the wrinkles or “laugh lines” for approximately one centimeter. Through this incision, your skin is carefully dissectioned away from the underlying tissues and the approximate amount of excess fat (bagginess) is removed from below your eye before your skin is closed with fine sutures. Sometimes adhesive strips are applied across a portion of the incision. This incision will fade after a short time and after either of these procedures, laser resurfacing may be recommended.
The subciliary procedure is becoming less popular with doctors who perform a great deal of revision eyelid surgery because of the characteristic problems it can cause including the pulling down of your eyelid, alteration in your eyelid shape, and the hollowing out of your eyes. Revisions to the lower eyelid usually involve cheek advancement (cheek lift) techniques, canthal reconstruction, eyelid reconstruction, and eye volume restoration with LiveFill.
Dr. Moelleken typically does not perform pinch blepharoplasties as a standalone procedure. The reason for this is simple. It too often changes the eye shape to a pulled down or rounded appearance and the change usually does not appear for months. Patients notice their eyes look sad or that too much white shows. If you are having all four eyelids corrected, Dr. Moelleken will work on your upper lids first. He will make incisions and through these incisions; he will separate your skin from the underlying tissue and remove excess fat, skin, and muscle. He will then close the incisions with very small sutures, which will be in both upper lids that will remain for three to six days. The lower lids may or may not require sutures depending upon the technique used. Every wrinkle and fold of skin around the eyes cannot be removed. Dr. Moelleken will know the amount of skin that can be safely removed to affect the most suitable result for your particular problem.
An eyelid surgery is usually performed on an outpatient basis frequently under local anesthesia and intravenous sedation, although general anesthesia may be used in some cases. For your safety during your operation, various monitors will be utilized to check your heart, blood pressure, pulse, and the amount of oxygen circulating in your blood. This means you will be awake during your surgery, but relaxed and insensitive to pain. Blepharoplasty may take one to three hours and when your surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your vision will be blurry as a result of the ointment used to soothe and protect your eye during surgery as well as from the swelling that is a normal aftermath of eyelid procedures. There should be surprisingly little discomfort, however, from your eyelid surgery.
Following surgery, cold wrappings will be applied to help decrease swelling and bruising. After a period of observation, you will be permitted to go home and you should arrange for someone to drive you home and to stay with you for the next 24 hours. The first few days after surgery, you should rest quietly with your head elevated. Dr. Moelleken may instruct you to apply cold compresses to your eyelids and initially, you may feel a tight sensation around your eyes. Any discomfort can easily be controlled with prescribed or over the counter pain medication but remember, aspirin and anti-inflammatory medications can cause increased bleeding so you should avoid taking these.
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. During the first 48 hours following surgery, you may experience varying degrees of swelling and bruising. Some patients find that mild swelling may persist for several weeks and others may see swelling resolve in as little as one week. While swelling after any surgery is of course normal, if you are concerned it would be best for you to see Dr. Moelleken to make sure you have not developed an infection in the operated area. It is a bit unusual to see significant swelling in your face a week after a simple blepharoplasty. If there is no evidence of an infection, Dr. Moelleken may recommend warm or cool compresses and elevation of your head at nighttime. You may also want to discuss with him your activity level, which can worsen early postoperative swelling.
Bruising typically disappears within seven to ten days and within the first week you will be permitted to use makeup to conceal any discoloration. Stitches are usually removed within a week of your surgery and once this happens, the swelling and discoloration around your eyes will gradually subside. Your eyes may be temporarily sensitive to light after your eyelid surgery and you may experience excessive tearing or dryness. Dr. Moelleken may recommend eye drops to help relieve any burning or itching and you should wear dark sunglasses outdoors during your recovery to protect your eyes from wind and sun irritation. Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days although you might feel like going back to work just a few days after surgery. Your vision may continue to be somewhat blurry however which could make reading or other paperwork difficult. Your surgery scars are usually very indistinct when fully healed and lay hidden in the folds of your eyelids.
Fortunately, significant complications from aesthetic eyelid surgery are infrequent. Every year, thousands of people undergo eyelid surgery successfully without experiencing any major problems.
The subject of risks and potential complications will be discussed on a personal basis between you Dr. Moelleken during your consultation and some of these may include:
You can help minimize certain risks by following the advice and instructions of Dr. Moelleken prior to and after your eyelid surgery. The goal of Dr. Moelleken and his entire staff at Neo Surgery Center is to make your experience as easy and comfortable for you as possible. If you are a smoker, you will be asked to stop well in advance of your surgery since smoking impairs your ability to heal.