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Eyelid Surgery : FAQ

What is blepharoplasty?
Blepharoplasty or eyelid surgery is designed to remove the excess fat, skin and atrophied muscle from the upper and lower eyelids. It is a very popular procedure as hooded eyes seem to make us look older or more tired. Many individuals who choose this procedure are very aware that their upper eyelids, eyelashes, and a place to apply mascara or eye shadow has diminished within the sagging skin of the upper eye area. Fat herniation and skin drooping is quite normal and will happen to most of us as we age, and is very dependent on our family genetics. Sometimes one’s vision can be improved by removing the excess skin that may be sagging over the centre of vision. Thus, a blepharoplasty will result in a restoration of more vibrant and youthful looking eyes.

How is the procedure performed?
Dr. Cole performs blepharoplasties using local anesthetic. Patients are awake and alert and may listen to music and talk during the procedure. The incisions are made within the natural creases of the eyelids. Dr. Cole removes any herniated or bulging fat and excess skin, suturing the incision with very fine hair-like sutures. Dr. Cole’s philosophy is not to be too aggressive during this procedure. More skin and bulging fat can be taken at a later time if the patient desires, but excess skin and fat removal can lead to an unnatural look and possibly increase the risk of complications.

Is there any scarring with a blepharoplasty?
As with any surgical procedure some scarring should be expected. Any scarring associated with blepharoplasty is quite minimal and practically non-existent after several months. The scars are placed within the normal creases and folds of the upper and lower eyelids so that when the eyes are open, the scars are invisible. For the lower eyelids, Dr. Cole prefers a transconjuctival approach, when there are bulging fat bags, with moderately tight and healthy elastic skin below the eye. This fat is then removed through a small incision inside the lower eyelid, and the skin of the lower eyelid can be tightened a little, and rejuvenated by the use of a resurfacing laser, in lighter skinned individuals. In this case scarring is not visible, even in the healing stages. When there is bulging fat and excess loose and wrinkly skin under the eyes, a transcutaneous approach is done, where an incision is made just under the lash line to allow removal of the deeper bulging fat, as well as the removal of excess loose skin under the eyes. This heals very well, is virtually undetectable, and leads smoother tighter skin underneath the eyes..

At what age is blepharoplasty performed?
Although there is no set age when blepharoplasty is performed, the usual the age that patients start making consultation appointments for blepharoplasty is from 35 years and up. A patient needs to have realistic expectations when undergoing any cosmetic procedure. The goal is always improvement and enhancement, not perfection.

Will a blepharoplasty rid me of my eye wrinkles?
A blepharoplasty is not designed to remove the wrinkles, sagging brows or crow's feet from the eye areas. It is designed to remove the excess skin and herniated fat from the upper and lower lid areas only. There are other procedures available that are area-specific to these concerns. We offer ultrasonic, laser resurfacing and skin tightening procedures, as well as Botox and injectable fillers that can help soften wrinkles significantly around the eye areas.

What should I expect post-operatively?
Swelling will be apparent at first and there may be some bruising. Your eyelids may feel tight and tender as the local anesthetic wears off. You will likely not require any medication, but Dr. Cole sends you home with some analgesics to ensure your comfort. Rest and ice or cold packs offer the most comfort after your procedure. Your vision may be a little blurry for the first few days due to swelling and an ointment he gives you to encourage rapid healing. You should not have any excessive discomfort. Patients describe post-blepharoplasty discomfort as mild, with the sensation of a sunburn, windburn, scratch or irritation of the eye.

When will my sutures be taken out?
Your sutures will be removed within 7-10 days of the procedure. The removal process is seamless as the fine sutures slip out quite easily.

When will I be able to see the results?
As the swelling goes down, you will be able to see a definite difference with the amount of overhang in the upper eye area, or the amount of bulging and loose skin in the lower lid area. Swelling improves greatly over the first couple weeks, but in many cases there is a slight amount of swelling that can be worse in the mornings, taking several weeks or months to fully resolve. Scars may initially appear pink and will fade with time. The incisions may become firmer and more palpable for the first few months before they begin to soften and disappear over the next several months. You must realize that when you wake up no matter what time of day, there will be increased swelling. This is due to fluids pooling, especially if you are not elevated properly. There is even increased swelling in the upper or lower eye area in individuals who have not had blepharoplasty. The tissues swell with fluid retention when you are at rest. If you sleep with your head well elevated (with two pillows) this will be less apparent.

What are the risks of blepharoplasty?
The minor complications that are associated with blepharoplasty include double or blurry vision for a few days, swelling of the clear tissue over the white of your eyes, or temporary swelling at the corners of the eyelids. It is possible to develop some asymmetry during the healing process.?It is important to note that both eyes are not identical, and that all of us have some facial asymmetry. This will remain true after eyelid surgery as well. It is possible that you may experience difficulty in closing your eyes when sleeping for the first couple weeks depending on your swelling. For lower lid surgery, there is the rare possibility of ectropion. Ectropion is a condition where your lower lids are pulled downwards and roll forward. If you should develop this, further surgery will be needed to correct it. If you have thyroid problems (hypothyroidism or Graves' disease) dry eyes or insufficient tearing, circulatory disorders or high blood pressure, having blepharoplasty may be more risky for you than an otherwise healthy individual. Other disorders that may increase your risks are cardiovascular disease, diabetes, a detached retina, glaucoma, poor circulation and poor elasticity. Please disclose all disorders and health concerns with Dr. Cole.