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Blepharoplasty (Eye Lids)

1. OVERVIEW

 As skin ages, it gradually loses its elasticity, and when coupled with the effects of gravity, can cause redundant skin of the upper eyelid to accumulate and consequently droop leaving you with a fatigued appearance. Similarly, aging of the lower eyelid results in loosening of the skin and of the underlying muscle and can lead to bulging of fat below the eyes making them look puffy despite adequate rest. Eyelid surgery, or blepharoplasty, is a surgical procedure used to enhance the appearance of the upper or lower eyelids. The procedure can also be used to help treat certain functional eyelid problems.

2. IDEAL CANDIDATES

 Ideal candidates for eyelid surgery are healthy, non-smoking adults, who:
  • Have realistic expectations with regard to the potential surgical outcomes; and who are generally bothered by one or more of the following eyelid-related issues:
  • Drooping (ptosis) of the lower eyelids, causing the sclera (white of the eye) to be visible below the iris.
  • Excess loose skin that creates folds or distorts the natural margin of the upper eyelid, which can sometimes impair vision.
  • Excess fatty deposits around the eyes, presenting as puffiness around the eyelids.
  • “Bags" under the eyes.
  • Redundant skin and fine wrinkles of the lower eyelid.

Please inform Dr. Lee, at the time of your initial consultation, if you happen to have any one of the following medical conditions:

  • Eye disease, such as: glaucoma, dry eyes, or a detached retina
  • Thyroid disorders, such as: Graves’ disease and/or an under or overactive thyroid
  • Cardiovascular disease, diabetes, high blood pressure, or other circulatory disease

3. THE PROCEDURE

3.1. ANESTHESIA

  • The procedure is usually performed under local anesthesia with intravenous sedation, although, eyelid surgery can also be performed under general anesthesia.

3.2. TECHNIQUES

3.2.1. UPPER EYELID SURGERY

  • An incision is made in the natural crease of the upper eyelid.
  • Excess skin, and protruding fat if present, are removed and the incisions are closed meticulously.
  • The resultant scar is well hidden with the natural crease of the upper eyelid.
  • The procedure for both upper eyelids takes approximately 45 minutes to 1 hour to complete.

3.2.2. LOWER EYELID SURGERY

  • An incision is made just below the lower lash line. Excess skin can be removed through this incision.
  • Alternatively, the incision can be made on the inner surface of the lower eyelid to avoid any skin incisions (transconjunctival approach).
  • When indicated, excess fat is removed or redistributed.
  • Incisions are closed.
  • If the lower eyelids are lax, Dr. Lee may recommend tightening the lower lids in addition to removing skin and/or fat (canthopexy or canthoplasty).
  • The procedure for both lower eyelids takes approximately 1 hour to complete.
  • When surgery is performed on both upper and lower eyelids at the same time, the procedure takes approximately 2 hours to complete.

4. PREOPERATIVE CONSULTATION

 Dr. Lee will perform a thorough medical evaluation during your consultation to ensure that you are medically fit for surgery. He will also revise your medication list, as certain medications may need to be temporarily stopped before your surgery.

After carefully evaluating your eyelid and facial anatomy, and assessing your aesthetic goals, Dr. Lee will review your available options and help you choose the best treatment plan to achieve your desired outcomes.

Since smoking is known to be associated with poor/delayed wound healing, wound dehiscence, wound infections, and increased scarring postoperatively, smokers will be asked to stop smoking 4 weeks prior to surgery, and for at least 2 weeks postoperatively1.

Patients will also be scheduled for routine pre-operative blood testing and an electrocardiogram 1-2 weeks before surgery. If necessary, further recommendations will be made once the results of these tests have been reviewed.

5. RECOVERY

The operation is performed on an outpatient basis and most patients are permitted to go home a few hours after surgery.

You will have ointment applied to your eyes immediately following your surgery. There will also be small paper tape strips over your incisions. Head elevation, cold compresses, and rest are encouraged to minimize postoperative swelling and discomfort. Some bruising and swelling around the eyes is expected; however, this usually resolves in about 1-2 weeks. You may also be prescribed eye drops in order to keep your eyes moist, as well as pain medication, to help ensure your comfort throughout your recovery.

Before leaving our facilities, you will be given specific instructions that should be followed in order to ensure a smooth recovery. These include:

  • Use of cold compresses to minimize swelling – especially for the first 48 hours following surgery
  • Avoid wearing contact lenses for at least 72 hours
  • Avoid vigorous activity and get plenty of rest
  • Keep you head elevated when lying down

Most patients are able to return to work after a week of convalescence. Regular exercise and activities can be resumed after 4-6 weeks.

6. RISK AND COMPLICATIONS

 As with any surgery, there are risks associated with eyelid surgery. Smoking, diabetes, peripheral artery disease (poor circulation), as well as heart, lung, or liver disease may increase your risk of perioperative and/or post-operative complications.

Risks/complications include:

  • Risks associated with anesthesia
  • Bleeding from the incision lines
  • Dryness of the eyes
  • Temporary sensitivity to the sun or other bright light
  • Difficulty closing your eyes during the first few weeks following surgery
  • Ectropion (outward rolling of the lower eyelid)
  • Infection
  • Lid lag (a pulling up of the upper eyelid) may occur and is often temporary
  • Temporary or potentially permanent change in vision, and a very rare risk of blindness
  • Altered skin sensation
  • Poor wound healing
  • Scarring
  • Possible need for revision surgery

Post-operative scarring

Scars form as the body’s natural response heal tissues. As with any scar, the extent of post-surgical scarring depends on a number of modifiable factors (i.e. avoidance of UV light exposure, tension-free wound closure, appropriate wound care, etc.) and non-modifiable factors (i.e. patient age, comorbidities, skin type, genetics, etc.). While it is not possible to perform scar-free surgery, Dr. Lee makes every effort to minimize the appearance of your post-surgical scars through careful pre-operative planning, the use of meticulous surgical technique, and by ensuring appropriate wound care and follow-up post-operatively.

It is not unusual for scars to appear red and be slightly raised/firm for the first 4-6 weeks following surgery. Scars will flatten and become more pale over time, and can take up to 12 months before achieving their final appearance.

Dr. Lee will thoroughly discuss these risks (and possibly others) with you and answer any questions you might have prior to obtaining your consent for surgery.

Office of Dr. James Lee:

  • 2540 Daniel Johnson, Suite 905 Laval, QC,
  • Tel: 1(514) 664-2076

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