Blepharoplasty, or eyelid surgery, is a surgical procedure with an extremely high patient satisfaction rate. Blepharoplasty can be performed on the upper and/or lower eyelids, depending on the needs of the particular patient, and is appropriate for both women and men.

Dr. Mehta’s philosophy on upper blepharoplasty is conservative, removing only the needed amount of skin and very little fat. This approach yields extremely natural and youthful results, avoiding the “hollowed-out” look of overly aggressive fat removal. Patients typically come in for a consultation reporting heaviness of their upper eyelids or difficulty applying eye makeup. Patients with severe excess upper eyelid skin may even notice a reduction in their visual field.

Lower blepharoplasty is a highly effective technique for reducing the “bags” under one’s eyes. Patients usually come in because they “look tired all of the time”. The bulging of this fat is typically related to aging, though many younger patients, in their 20’s and 30’s, have a genetic tendency to develop these bags. For the majority of his patients, Dr. Mehta utilizes a fat repositioning technique, in which the fat that is forming these bags is not removed, but rather moved down over the upper portion of the cheek bone. This technique can yield magnificent results, as it provides a smooth transition between the lower eyelid and the cheek by removing the bags and filling the hollows below them.

The Consultation

Your blepharoplasty consultation with Dr. Mehta will last approximately one hour. Dr. Mehta will begin by asking you what exactly bothers you about your eyes and what improvements you would like to achieve. There are numerous nonsurgical treatments that Dr. Mehta utilizes extensively, including Botox and Dysport, injectable fillers, lasers, intense pulsed light treatments, and peels. If you are a candidate for any of these treatments in lieu of or in addition to surgery, he will discuss these with you as well.

Dr. Mehta will then obtain a careful history, including medical conditions that may affect your ability to undergo and recover from surgery. Any history of adverse reactions to anesthesia or medications commonly given before, during, and after surgery is also determined. If you have a history of dry eyes or have undergone prior Lasik surgery, it is important to inform us during this visit.

This discussion is followed by a thorough examination of your eyes and eyelids. Dr. Mehta will assess the degree of excess skin and fat and determine if you are a good candidate for surgery. He will check your lower eyelid support and the extent of your hollows below the eyelids. If you have any ptosis, or drooping of your eyelids, Dr. Mehta will check this as well. Following the examination, Dr. Mehta will photograph your face and eyes from several different angles. The images are displayed on his computer, enabling both Dr. Mehta and you to inspect your eyelids in detail.

At this initial consultation, you will have the opportunity to meet Nadine, our Patient Care Coordinator, who will help guide you through the entire process, before and after surgery. She will also share with you several of Dr. Mehta’s before and after photos.

Preoperative Visit

After this initial consultation, you would return for a preoperative visit, two or three weeks before your surgery. During this visit, you will again meet with Nadine, the Patient Care Coordinator.

Dr. Mehta will again go over your list of medications and supplements, as it is usually necessary at this time to discontinue any products that can increase the risk of bleeding during or after the surgery. These include, but are not limited to, aspirin, ibuprofen, heparin, warfarin (Coumadin), Plavix, vitamin E, fish oil and numerous other supplements. The decision to stop any of these prescription or over-the-counter products is made in conjunction with your primary physician. Medical clearance and other tests may need to be obtained, depending on your age.

Dr. Mehta will give you prescriptions for your pain medication (or call your pharmacy) at this visit as well. This allows you to pick up these important medications prior to your surgery, so that postoperatively, you and your caretakers can rest and concentrate on your recovery. Dr. Mehta will advise you to pick up Arnica Montana and Bromelain, two homeopathic products which reduce bruising after surgery. These are taken as directed, beginning immediately after surgery. You will be given detailed preoperative and postoperative instruction pamphlets, to read prior to your surgery. It is important to minimize salt intake and avoid alcohol for three days leading up to your surgery.

Lastly, you will have the opportunity to spend time with the office manager/surgical coordinator to answer any logistical questions related to your surgery. Your final surgical fees are settled at this visit as well.

Surgery

On the day of surgery, you will arrive at the surgical center with a friend or family member who will drive you home and care for you after your surgery. It is imperative to come in on an empty stomach, not eating or drinking anything for at least 8 hours prior to your surgery. This includes water and chewing gum. You should wear loose and comfortable clothing, including a shirt that buttons in the front to avoid having to pull anything over your head after surgery. The operating room nurse will meet with you first to go over your instructions in detail.

The type of anesthesia required will depend on the type of surgery. For upper blepharoplasty alone, Dr. Mehta often utilizes moderate sedation, in which sedation is still administered intravenously but not to the same depth as twilight sedation. This form of anesthesia results in quicker recovery time afterwards and is extremely comfortable for the patients when used in conjunction with local anesthesia.

For lower eyelid blepharoplasty, Dr. Mehta and the team of anesthesiologists use “twilight” sedation, in which the patient is completely unconscious but breathing on his or her own throughout the surgery. This prevents the need for placement of a breathing tube, paralysis or use of a ventilator. Additionally, patients awaken more quickly after the surgery and have less nausea and “hangover” effect.

If “twilight” anesthesia is required, you will meet your anesthesiologist upon arrival to the surgery center. Prior to your meeting, the anesthesiologist will have carefully reviewed your medical and surgical history. You will have the opportunity to ask any questions you may have at this time. Following this, Dr. Mehta will meet you and your friends and family to answer any last minute questions as well.

After surgery, you will awaken in the recovery room, where your vital signs are carefully monitored by the anesthesiologist and recovery room nurse. Your eyesight may be blurry due to the use of lubricant ointment during the case. You will have small bandages, called Steri-Strips taped to your forehead or cheeks, depending on whether upper or lower blepharoplasty was performed.

After Surgery

After approximately two hours in the recovery room, you will be discharged home, in the care of a responsible adult for the first night. Your friend or family member will check your eyes, apply ice, assist with your pain medications, and help you with your normal daily activities. You will sleep with your head elevated at 30-45 degrees. At this time, you will begin taking your prescribed medications as well as the Arnica Montana and bromelain. Eating fruits such as pineapple and papaya are encouraged as well, as they are thought to help minimize bruising.

You will return to the office the following morning to be seen by Dr. Mehta. Over the subsequent 48 hours, you will develop bruising and swelling around the eyes though pain and discomfort are usually mild to moderate. By no means are you bedridden or debilitated during this recovery period. Often patients will work from home though most avoid work or social situations.

Your diet should be soft, mild in flavor and with minimal salt for the first 10-14 days after surgery. To minimize swelling and the risk of complications, you should avoid any vigorous activity or heavy lifting for this same period of time.

Your next visit will be 6-7 days after surgery, at which time your sutures are removed. The area around your eyes will be somewhat swollen and bruised at this time, though the majority of the swelling and bruising disappears over the subsequent 4-5 days. On average, patients return to work or school at 10-14 days after surgery though this certainly varies depending on one’s degree of bruising/swelling and comfort level.

The next visit will be at 3-6 weeks, to check your progress and recovery. This is followed by a 3-6 month visit, at which time the “after” photographs are often taken. Typically, your next visit will be at 12-18 months after surgery at which time, photographs may again be taken.

Conclusion

Upper and lower blepharoplasty can yield profound rejuvenating results and are well tolerated by most patients with a brief recovery period.

To schedule your own personal consultation or for more general information, please contact us.