Eyelid Surgery (Blepharoplasty)
Cosmetic Eyelid Surgery (Blepharoplasty) is a procedure that reduces skin and fat from the upper and lower eyelids. Cosmetic Eyelid Surgery can correct drooping upper eyelid skin and remove puffy bags from below the eyes. These features make a person look older and have the potential to interfere with peripheral vision. The current state of the art is to reinforce the anatomical structure of the surrounding eye tissue while removing less fat than was historically done in the past.
With the modern eyelid lift techniques, fat that was formerly removed during Cosmetic Eyelid Surgery is now repositioned to a more youthful position. The goal is to prevent a hollow appearance of the eye over the long term. Even though Cosmetic Eyelid Surgery does not reduce fine lines around the eyes, chemical peels and laser treatments are very effective with these, especially in combination with the surgical procedure. Cosmetic Eyelid Surgery can be done alone or in conjunction with other facial procedures, such as facelift or brow lift.
Whether you live in Marin County, Sonoma, San Francisco, or anywhere in the Bay area, Dr. Delgado is prepared to develop a unique treatment plan to get the results you desire. Our practice is dedicated to prepare our patients for the best surgical outcome, possible. Post -operative care is also a vital part of any procedure and patients often arrange for follow up visits at either the San Francisco or the Marin County Office.
WHO IS A CANDIDATE?
Even people in their early-to-mid 30’s will begin to notice early changes around their eyes. This is caused by fullness or puffiness, due to fat pads, as well as progressive laxity of the skin with age. Increase in the size of these fat deposits is generally unrelated to weight gain or loss, but is rather a result of genetics, facial anatomy and the passage of time. It is true that increases of salt intake, alcohol and sleeping in a dependent position will affect the fluctuation of fluid in the fat pockets. The fat pads have an important function; they act as shock absorber around the eye balls and provide important protection to the globes. With time, the connective tissue that once held this protective fat in position begins to stretch and loses its tone. Although it appears as if the fat itself is bulging, this phenomenon is actually caused by the relaxation of the tissue that encompasses it.
The best candidates for blepharoplasty surgery are men and women who are physically healthy, psychologically stable and realistic in their expectations. Many people feel that their eyes are their most attractive feature. When aging starts to steal that away, Cosmetic Eyelid Surgery is the most reliable and successful means of restoring a youthful appearance.
WHAT RESULTS CAN BE EXPECTED?
Eyelid Surgery gives a person a more youthful and rested appearance without changing the shape or expression of the eyes. In some cases, peripheral vision will be restored to levels not enjoyed for many years. The results will look natural and balanced without any surgical look. Although the results can be expected to last for many years, the aging process will continue. At some point in the future, a small amount of excess skin or fat could be removed to extend the effectiveness of the original procedure.
While the vast majority of our patients live in or around San Francisco, Marin and Sonoma County area, our practice has expanded to treat people from all over California and around the United States. Please don’t hesitate to call or read through our “Out of Town Patients” section.
Before Eyelid Surgery
The initial consultation can be scheduled at either Dr. Delgado’s San Francisco office at Union Square or the Marin County office near Santa Rosa. At this meeting, Dr. Delgado will discuss the patients concerns in great detail. Together, the patient’s goals and expectations are addressed. Digital photography may be used to put the patient’s image on the computer. Computer imaging can aid in evaluating a patient’s appearance and demonstrating the proposed changes that can be achieved. A patient’s medical history will be reviewed and a physical examination will be conducted. Dr. Delgado will determine if the upper eyelid sagging is due to the upper eyelid skin or laxity of the eyebrow or a combination of both. He will determine if there is laxity of the lower eyelids that could be improved with tightening or other procedures.
Dr. Delgado will advise the patient as to whether Eyelid Surgery is the best procedure. He will help the patient decide whether both the upper and lower eyelids need correction and whether a brow lift is advisable. At times, additional suggestions are made. For example, if one would like eyelid rejuvenation and this will make the face look significantly younger, he may suggest other procedures to balance the face and to create harmony.
The patient will be given a pre-operative instruction booklet that will explain medications that will be ordered as well as any preparations that need to be made at home for recovery. This pre-operative booklet provides a detailed list of aspirin and aspirin-containing compounds, including anti-inflammatory products, that must be discontinued two weeks before and two weeks after surgery, in order to minimize bleeding. However, it is permissible to take Tylenol (acetaminophen) during this time. But, do not exceed 1 gram over 4 hours or 4 grams per day from all sources since this can cause liver damage. The booklet also recommends vitamin supplements and homeopathic remedies that can be taken to minimize bruising and promote healing.
Eyelid Surgery in San Francisco
DAY OF SURGERY
The surgery takes place at Marin Cosmetic Surgery Center, Dr. Delgado’s private surgery suite, located in his Marin County office on the Sutter Marin County Community Hospital campus. This allows Dr. Delgado to offer his patients private, concierge medical care, while providing the extra measure of safety and reassurance afforded by the surgery center’s contiguous location to the hospital.
Before anesthesia is given, Dr. Delgado goes over the operative plan. A felt-tip marking pen, specially designed for this purpose, is used to mark the anatomy. Dr. Delgado takes great care, with the skin marking in order to create the most natural and balanced shape possible.
The surgical procedure involves excising an ellipse of skin from the upper eyelid. The incision is made in the upper eyelid’s natural crease so that when the incision line heals, it will be virtually invisible. A section of muscle underneath is also excised to create a clean upper eyelid crease and the fat distribution may be altered as well.
The esthetics of Cosmetic Eyelid Surgery has changed over the years. It has evolved from fat removal to fat preservation. As the face ages, it loses the fat that gives the face its youthful appearance. Therefore, often the fat of the upper eyelid is preserved while the redundant skin is excised. The goal is to rejuvenate the eyelids and not create a deep-set or hollow appearance. Dr. Delgado specializes in natural looking cosmetic surgery.
Lower Eyelid Surgery is the most sensitive area of the face to be operated. The tearing mechanism is altered for a while due to swelling and this takes time adjust back to normal.
Lower eyelid surgery is performed either through an incision inside the eyelid (transconjunctival blepharoplasty) or on the outside of the eyelid underneath the eyelash line. The transconjunctival approach is especially ideal for younger patients when there is no skin or muscle laxity. Some people have puffy lower eyelids either prematurely in life or genetically and this approach serves their purpose well. The procedure involves retracting the lower eyelid and making a very small incision in the inner eyelid. The fat is dissected free and partially excised and only the appropriate amount of fat is removed. The incision is closed and it heals internally.
Many patients require an external approach. This patient is usually older and displays skin, muscle laxity and fat prominence. This procedure tightens the skin, muscle and removes or repositions the fat pads. Once the incision is made, the dissection is carried down to the fat pockets and are trimmed, or in some cases, repositioned. The muscle that attaches to the overlying skin is tightened and anchored to the outer corner of the eyelid. The skin may be treated with a chemical peel or laser resurfacing to reduce crepiness.
Cosmetic Eyelid Surgery can be done with local anesthesia or IV sedation. It may be performed in conjunction with other procedures, such as a Face Lift or a Brow Lift. If multiple procedures are performed, general anesthesia is usually recommended. At Marin Cosmetic Surgery Center, only a physician who is board-certified in anesthesia administers anesthesia. Dr. Delgado and the anesthesiologist assist the patient in determining the best choice of anesthesia for his or her procedure. Additionally, the anesthesiologist calls the patient the night before surgery to review his/her medical history, confirm last minute instructions and answer any questions he/she may have related to the anesthesia.
After Eyelid Surgery
The first few hours after surgery are spent in the recovery room and cold compresses are placed over the eyes. The head and back are elevated above the heart to reduce swelling. When full alertness has returned the patient may be discharged to his/her home. It is necessary to have a responsible adult with the patient for the first 24 hours. The surgery is not painful, but a sensation of tightness from the swelling can be uncomfortable. During the first 48 hours, ice compresses to the eyelids will help significantly with reduction of this swelling. Some patients experience irritation and dryness after surgery. An ointment or eye drops will be prescribed until the symptoms resolve.
For both Upper and Lower Eyelid Surgery, it is recommended that a patient take five to seven days off work. If only the upper lids are done, then a patient could return to work after three to four days. The sutures are removed five days after surgery. The bruising resolves in seven to ten days and at this point, the use of eye makeup and contact lenses may be resumed. The incisions remain pink for approximately four to six weeks, gradually fading to inconspicuous lines in approximately 8-12 weeks. Strenuous exercise should be avoided for the first four to six weeks following surgery as excessive exercise can cause unwelcome and persistent swelling.
WHAT RESULTS CAN BE EXPECTED?
The surgery gives a person a more youthful and rested appearance without changing the shape or expression of the eyes. In some cases, peripheral vision will be restored to levels not enjoyed for many years. The results will look natural and balanced without any surgical look. Although the results can be expected to last for many years, the aging process will continue. At some point in the future, a small amount of excess skin or fat could be removed to extend the effectiveness of the original procedure.
FREQUENTLY ASKED QUESTIONS
About Eyelid Surgery
1. What is an eyelid lift, or blepharoplasty?
It is a surgical procedure that rejuvenates the upper and lower eyelid. It generally involves removing skin, a strip of muscle, and fat. The lower eyelid can be tightened to re-drape the skin and muscle. The addition of a chemical peel can smooth out the crepe paper skin that often appears with age on the lower eyelid. The result is eyelids that are more youthful, and a rested, energetic appearance to the face overall.
2. When should I have an eyelid lift or blepharoplasty?
In general, people start considering eyelid surgery in their mid-40’s to early 50’s. The eyes are a prominent feature and tend to be the first place to show signs of aging. This is especially true of people who have fair complexions and have had a lot of sun exposure.
The age to have an eyelid lift varies from person to person. People age at different rates and certainly all people do not feel the same about the changes that come with age. Also, a person may opt to have both upper and lower eyelids lifted; or simply an upper or lower eyelid lift alone.
3. What is the difference between a lower eyelid surgery through an internal incision versus an external incision?
An eyelid lift through an internal incision is called a transconjunctival blepharoplasty, or eyelid lift. This means that the incision is made on the inside of the eyelid. Therefore, there is no external incision. This is a good technique to remove “fat bags,” but does not tighten the skin. This procedure is appropriate for younger patients with good-quality skin tone that is still elastic.
The external eyelid lift is through an incision made just below the eyelash line. The advantage is that more tissue layers can be treated. The fat can be removed, the muscle tightened or trimmed, and the fat removed or re-positioned.
Dr. Delgado addresses the needs of each patient individually, explaining the advantages and disadvantages of each surgical approach.
4. Can other surgical procedures be done during the same operation?
Yes, patients who undergo blepharoplasty frequently choose to have additional facial procedures done at the same time. This may be a complete facelift, which includes the eyelid lift, an endoscopic brow lift, and a lower face/neck lift. Other non-facial surgical procedures, such as breast surgery or body contouring, can also be done in conjunction with an eyelid lift.
5. Will insurance cover my procedure?
Yes, in some cases. When the upper eyelids begin to restrict the vision, then it becomes a medical issue. If peripheral field of vision testing shows a reduction in eyesight, then the surgical procedure may be covered by insurance. The lower eyelid is rarely covered.
6. Is there a chance that I could go blind in one eye?
Unfortunately, yes. This complication is very rare, but does occur with 0.02% blepharoplasties. It occurs due to bleeding and is caused by a vein or artery that begins to bleed. This can be successfully treated if caught in time.
7. Is it a difficult recovery?
The upper eyelid lift is an easy recovery. The lower eyelid surgery is a more difficult recovery, particularly when an external incision is made and several layers are tightened. The eyes are very sensitive and highly reactive, and though pain is not the issue, the area becomes tight from swelling. At times, this swelling can temporarily affect tear duct function.
8. When can I return to work and exercise?
After an upper and lower eyelid surgery, the sutures are removed after one week and bruising resolves in approximately 10-14 days. Patients typically can drive by the end of one week, work by the end of the second week, and exercise after four to six weeks. Over time, the incisions heal beautifully to become practically invisible.
9. What is the cost of eyelid surgery?
The cost of an upper and lower eyelid lift/blepharoplasty is $6500. Lower eyelids alone are $4500, and upper eyelids alone are $4000. This includes the surgeon’s fee, anesthesiologist, outpatient surgery facility and all recovery appointments. The Upper eyelids can also be done in the office under local anesthesia for $2500. Note: lower eyelid surgery is performed in the operating room under general anesthesia.