Upper and Lower Eyelid Surgery (Blepharoplasty)
A blepharoplasty (ie, eyelid surgery) is a procedure to rejuvenate the eyelids. Hooding upper eyelids and sagging bags under the eyes can be enhanced with this wonderful procedure.
The procedure typically takes between 30-45 minutes for the upper eyelids and 60-90 minutes for the lower lids. Patients come in the morning and leave by lunch time.
The anesthesia is minimal: Upper lids can be performed in the office with just local “Lidocaine”, though lower lids are typically performed with mild sedation (ie, Twilight Sedation). This is a very pleasant experience for the patient. You don’t have any anxiety or pain during the procedure, but as soon as the procedure is over, the sedation starts to wear off and you feel like your normal self. It is not general anesthesia and a breathing tube is not used. It is important to note, that this procedure has minimal discomfort. Dr. Landmann never prescribes pain medication – Tylenol is all that’s needed. Dr. Landmann works with an exceptional team of nurses and anesthesiologists all of whom are dedicated to making sure you have a safe and pleasant experience.
Bruising and swelling vary depending on a number of factors, but Dr. Landmann typically tells patients that everyone is bruised for the first 2 weeks. After that, make-up can be used to hide most residual black & blues. Swelling usually lingers for upto 6 to 8 weeks, so if you have a big event like a family wedding or TV appearance, make sure to schedule accordingly. The upper eyelid incision is hidden in the natural eyelid crease, so it is not noticeable unless you are closing your eyes and specifically looking for it. The lower lid incision can be made on the inside or outside of your eyelid, depending on your anatomy and desired outcome.
How Safe Is The Procedure
Safety is the sine qua non for everything that Dr. Landmann does. Safety is not only the First Step for every procedure, but also built into the entire procedure. That being said, the main risks for eyelid surgery are bleeding and infection. To minimize the risks for bleeding, Dr. Landmann will take a detailed medical history and coordinate with your primary care physician. He will personally go over your medications, vitamins and herbal supplements and advise you which need to be stopped prior to surgery. Infection is exceptionally rare, and Dr. Landmann has never seen it, but an antibiotic ointment is used to promote wound healing and prevent infection after the surgery.
The ultimate goal of the procedure is to restore your natural beauty. The biggest compliment Dr. Landmann gets is when a patient’s best friend from years ago says she looks more well rested, or less tired or more energetic, but doesn’t realize she had something done. Subtlety, fine enhancements, rejuvenation and refinement are words that encompass Dr. Landmann’s goal. A blepharoplasty should make you look and feel like happier and that you have more energy. But if you are looking to change who you are or look like a different person, than Dr. Landmann is not the right cosmetic surgeon for you.
Cosmetic Eyelid Surgery FAQ's
Dr. Landmann primarily performs cosmetic and reconstructive eyelid surgeries. The most common types of surgeries are:
- Upper lid blepharoplasty “Eyelid Lift” – to fix the hooding over the eyes.
- Lower lid blepharoplasty “For bags underneath the eyes” or when there is excess skin underneath the eyes.
- Ptosis repair – when the muscle that opens up the eyelid gets detached, patients are unable to keep their eyes open.
- Mohs reconstructions on the face – when a skin cancer on the face is removed, it must be repaired correctly or the eyelids won’t be able to open and close correctly.
- In addition, Dr. Landmann performs a multitude of other more complicated reconstructive surgical procedures. These include surgeries for eyelids that are turned-in or turned-out, removal of tumors behind the eyeball, trauma, issues related to excess tearing or dryness, thyroid related eye problems, as well as surgeries on the forehead, eyebrows and cheek.
These procedures primarily help with the signs of aging – namely when skin becomes too loose, muscles become lax and fat pooches forward. Patients often complain that the excess skin makes it difficult to apply makeup, so by removing the excess skin, patients have a larger lid platform on which to apply makeup. These procedures can also help with the bags underneath the eyes or on the inside corner of the upper eyelid.
On average, procedures performed on the upper eyelids usually take between 30 – 60 minutes and procedures on the lower eyelids take between 60 – 90 minutes.
Cosmetic eyelid procedures can be performed in the office or an outpatient surgery center. Regardless of where the procedure is performed, most patients come in the morning and leave by lunch time. Patients do not get admitted to the hospital nor need to stay overnight.
When performed in an office setting, local numbing medication is used on the eyelids. When a procedure is performed in an outpatient center, Monitored Anesthesia Care (MAC) is administered by an anesthesia team. Sometimes this is referred to as “Mild Sedation” or “Twilight”. The advantages of this type of anesthesia are:
- It is not General Anesthesia, so a breathing tube and breathing machine are not used.
- Patients recover and feel like their normal selves very quickly.
Ultimately, Dr. landmann will take into account your health and the proposed procedure to determine what type of anesthesia will be the safest and most comfortable in each specific situation.
Everyone’s perception of pain is different, so it is impossible to answer that directly. But to give you a framework, here are some key points.
- Dr. Landmann never prescribes prescription pain medications.
- He does recommend that everyone take over-the-counter Tylenol for the first few days after surgery.
- Most patients reported that they stopped using Tylenol after the 2nd or 3rd day.
Most patients will feel back to normal within a few days, but the patients who take it easy for the first week afterwards usually bruise the least and heal the fastest. It is generally recommended to avoid exercise, heavy lifting, strenuous or stressful activities for 7 days. Most patients go back to work after 6 -7 days. Some patients have the procedure done on Thursday and fly to the Caribbean for vacation on Saturday.
The main bruising will occur during the first two weeks. It usually looks like a ‘shiner’ or a ‘black & blue’ eye. After two weeks, patients can put makeup over the stitches and usually hide the bruising fairly well. Dr. Landmann always advises patients that if they have a big event (like a wedding, a family get together or a TV appearance) then they should schedule the procedure at least 6 weeks in advance. The entire healing process takes a full year, so there will continue to be improvements over the course of a year.
In the majority of cases, dissolvable stitches are used, so they do not even need to be removed.
For procedures on the upper eyelids, most incisions are made in the eyelid crease. This location is ideal because not only is it hidden, but it also heals incredibly well. During your consultation, Dr. Landmann will show you examples of suture lines in various stages of healing.
Dr. Landmann strongly feels that safety is the first step in any cosmetic or reconstructive procedure. So he will take a detailed history of your medications and medical conditions at the consultation. At that time, he will also go over which medications should be stopped before surgery – especially Baby Aspirin or any medication for joint aches or headaches. The most common medications to be aware of are: Advil, Motrin, Ibuprofen, Aleve or Naprosyn. Herbal supplements that need to be avoided are: Multivitamins, Flaxseed Oil, Fish Oil, Gingko and Vitamin E.
The best way to learn more about cosmetic eyelid and facial procedures is to schedule a consultation with Dr. Landmann. He will carefully listen to your goals and concerns. After performing a comprehensive evaluation, he will review various before and after pictures and together, you will come up with a personalized treatment plan. Prior to any procedure, it is important to have all your questions answered, so you will have ample opportunity to ask any question and discuss with Dr. Landmann. After every surgery, Dr. Landmann gives every patient his personal cell phone number so you will always have access to him.