Cosmetic Eyelid Surgery & Blepharoplasty

My primary concern is always safety. I think that is the most important thing as a doctor. So, there are a couple of risk factors for problems after eyelid surgery.

• Dry Eye – If you just have a little dry or sandy sensation in your eye occasionally, then I would have to examine you and have a personal conversation with you to determine if it is safe to have a blepharoplasty. But people who have a lot of irritation and discomfort and need to use several drops a day would need to have the dryness fully managed before undergoing surgery. 
• Patients recently diagnosed with a Thyroid condition – Believe it or not, the thyroid can have strange effects on the eyelids, so if you were recently diagnosed with any thyroid condition (in the past 18 months), I have to make sure things are stable before proceeding with surgery.
• Patients on blood thinners like Plavix, Clopidigrel, Baby Aspirin, Warfarin, or Pradaxa AND can’t stop it before surgery – If you can’t stop your blood thinner before surgery, I don’t recommend surgery. If the doctor who prescribed the medication allows you to hold it for a few days, then it’s worth having a discussion about how that will affect your risks.
• People with unreasonable expectations, uncontrolled depression, or PTSD – Depression is very common, and as long as it is well controlled and you have a support system and therapist or provider (psychiatrist/psychologist/primary care doc) taking care of you, it should be OK. Patients who recently went through a traumatic life event (death in the family, divorce, lost job) should wait a few months to make sure everything is stable.
• Prior Eyelid surgery & Trauma -These are two risk factors for having difficulty closing the eyelids after surgery. So, while I commonly perform Revisional Eyelid Surgery, these need to be evaluated in person.

For an eyelid lift, I make the incision in your natural lid crease. This is nice because it is hidden and heals really well. Unless you are closing your eye and looking for it, you usually don’t see it. It is also not under tension, so it heals really well. If you have a lot of hooding in the outside corners, then I have to extend the incision, but I do so in the natural crow’s feet that most people have. So, this, too, heals really nicely.

The skin on the eyelids is the thinnest on the body and is blessed to heal very well. The incision heals over the course of the year, and the big milestones are 3 months, 6 months, and 12 months. Some patients get little bumps on the incision line that usually fade by 3-6 months but can be enticed to go away sooner with a massage or, if they are really persnickety, with a steroid injection. The incision fades over the course of a year.
Some patients who have had keloids on other body parts and African Americans are understandably worried about keloids. But there have been no keloids reported in the literature after cosmetic eyelid surgery.

The procedure is surprisingly uneventful. I’m so amazed at the advances in surgery, to the point where I’m able to have someone come into my office, have surgery on their eyelids, and most patients either fall asleep or laugh at my singing. Honestly, I have at least one patient every week say, “It was so much easier than I thought it would be.” 

Afterward, I’ve never needed to call in narcotics. I tell patients to take Tylenol every 4 to 6 hours after surgery. Most patients will take Tylenol that night and the next day. Some patients might need it for a third day. But some patients don’t ever need any Tylenol!

Most people can get back to work about 5-7 days after an upper lid blepharoplasty. I’ve had one patient, an accountant, come in the morning for surgery, go to lunch, and then go to work that afternoon. I don’t recommend it, but she did it. I also operated on an ophthalmologist who went back to seeing patients 1 week later and operating on patients’ eyeballs 2 weeks later. If you can work remotely, you can probably get back a little sooner. If you have a very visually demanding job, like a bookkeeper, a nurse, a doctor, or an engineer, set aside a week and a few days just because your vision might be ever so slightly blurry, but it’s usually not a problem. 

I ask patients not to work out for 7 days after eyelid surgery. There are thousands of tiny little capillaries, and anything you do that gets your heart pumping can make the eyelids bleed more. After 7 days, you can work out. Just ease back into it so you don’t hurt yourself. 

I’m not very pushy about selling cosmetic procedures, so if the only thing that is bothering you is your upper eyelids, I’d tell you just do your eyelids, and you’ll feel great. That being said, the other surgeries I commonly perform at the same time as an upper lid blepharoplasty are ptosis surgery (for droopy lids) and lower lid blepharoplasty (for bags under the eyes). A really great thing to do at the same time as eyelid surgery is laser resurfacing because that really freshens up your skin in an amazing way, but the downtime is about 2 weeks, which overlaps with the downtime that you’ll have anyways. Either me or my nurse practitioner can also do fillers at the same time because there is some bruising with fillers, especially around the lips and mouth. 

The total cost of upper eyelid surgery in Northern New Jersey can be around $5000-$7000. It will depend on numerous factors. The three biggest fees are the surgeon’s fee, a facility fee, and the anesthesia fee. The surgeon’s fee is the cost of the actual procedure, and for my practice, this includes the preoperative consultation, the surgery itself, and the postoperative visits. If something needs to get tweaked, I also do not charge patients, as my goal is to get it as perfect as possible, and everyone heals differently. The facility fee is the cost of the supplies and the facility itself. Since the vast majority of my cases are done in my office, you’re just paying for the supplies and equipment since so much stuff is disposable, i.e., gauze, needles, sutures, etc. I also do most of my cases with local anesthesia and just an oral relaxing medication, so most people don’t need an anesthesiologist. If you’re very nervous, or we’re doing a revision or a lower lid blepharoplasty, then the anesthesiologist fee is to pay for a doctor to be there to provide “twilight” sedation. The following may not apply to everyone: some random fees that patients may have are History and Physical with Primary care doc, blood work, EKG, and erythromycin ointment medication (which costs $12.15 without insurance). 

I like to tell patients that when they do the procedure after age 42, it usually lasts them for most of their life. They shouldn’t need to repeat the procedure. I do see a lot more patients in their 30-40s, and those patients may need to repeat it in a few years because they typically just have much more loose and lax skin than the average person who didn’t need it until later on in life. I’m 44 and hope to be doing this for decades to come, so time will tell how long it really lasts.