What Are The Risks of Eyelid Surgery?
When patients get eyelid surgery they are often unsure what the normal expectations are for healing. How bruised am I expected to be? When will the swelling go away? When will I look "normal" again? This article is meant to give an honest account of what expectations should be after surgery. Most patients getting eyelid surgery in Denver, Colorado will be recieving an upper or lower eyelid blepharoplasty or both. That being said, many of my Colorado patients also have other procedures done at the same time such ptosis repair or canthoplasty.
It is important to understand, when you have eyelid surgery such as a blepharoplasty it is in fact real surgery. Regardless of whether an incision is being made with a blade, cautery needle or laser the skin is being cut and tissue is being manipulated. From your body's perspective it is no different than when you sustain an injury.That being said, eyelid surgery is performed in a controlled fashion. Swelling and bruising are normal after any procedure (even injectables) and more so after surgery where cutting, cauterization and suturing is performed. It is important to have realistic expectations of bruising and swelling after eyelid, tear duct and eye socket procedures.
Second, the eyelid more procedures you have done, the more swelling and bruising you can expect. So..if someone is getting an upper eyelid blepharoplasty they will have less bruising than someone who is getting an upper eyelid blepharoplasty, lower eyelid blepharoplasty, ptosis repair, midface lift at the same time. The more procedures, the more bruising. Makes sense right?
Finally, when your doctor tells you most people are back to normal in two weeks he or she means 75-85% of patients will be back to normal in two weeks, not everyone. The distribution of how people heal is under a bell curve. Most people follow a straightforward pattern but there are exceptions. I once did an eyelid lift on my technician and she was "back to normal" in three days. Now..she represents one edge of the curve. She healed very fast and very well. Not everyone is like that. Similarily, you can have someone who takes 6 months to heal. It is important to understand for blepharoplasty, eyelid surgery or facial surgery that each patient is different and responds differently to surgery. How one patient from Littleton heals could be totally different than their friend from Cherry Creek. Also, if you healed quickly from one procedure it serves as no prediction how you will heal from the next procedure.
There are several components of the healing process I will talk about: bruising, swelling, scar and incision healing, lid position, and herbal medicines.
After eyelid surgery expect to have some bruising. How variable can this be? Good question. Some people have a light amount of redness near the incision site. Others have redness covering the entire eyelids. Others have bruising that is on their cheeks or ever lower face or neck. During surgery small amounts of blood can track down with gravity. I have had patients who come in their first followup in Denver and ask "Doctor Thiagarajah, what did you do to my neck?" after they have had a blepharoplasty. The answer is that because blood tracks downward with gravity, blood under the skin from the eyelids can track down to the neck. Bruising usually takes about 2 weeks to go away. Sometimes it can take up to 2 months but that is very uncommon. The color may change to yellow and blue as the blood is being absorbed by the body. The good news is that the bruising always goes away.
Immediately after surgery, patients will have swelling in their eyelids or face. This is because the body is sending healing cells to heal the surgical area. The swelling is worse within the first 24-48 hours. If you have had a cut, you will notice that 30 seconds after you get the cut, the skin is flat and smooth except for the area of the cut. However, after a day or two, the area may get swollen as the body begins to heal the area. Any cosmetic or reconstructive eyelid surgery results in swelling in the eyelids. Within 2 weeks 90% of the swelling is usually gone. The remaining swelling (the last 10%) is usually gone within 2-3 months. Rare patients can have swelling for 6 months to 1 year. There are reported cases in the literature of patients having swelling permanently. These are rare exceptions. In my experience as a physician for over 10 years, I have never seen that occur personally.
Steroids and Swelling
Some cosmetic surgeons give patients steroid pills after surgery to reduce swelling. Steroids suppress the immune system and immune response and thus reduce swelling. Yes..this definitely decreases the swelling postoperatively compared to not giving steroids. However, there is a reason why I don't routinely do that. One, steroids do increase the risk of infection. Patients who are diabetic for example or who have an underlying low immune system could get a bad infection in a different part of their body or the surgical site. Also oral steroids increase the lifetime risk of avascular hip necrosis. Avascular hip necrosis is essentially when the hip bone fractures or dies because of lack of blood supply. There have been reported cases of patients getting one dose of 80 mg of steroid and then developing hip necrosis. As a result, most plastic surgeons do not routinely give this medicine out unless needed.
What can be done to minimize swelling? Two things work well. Icing the eyelids minimizes the fluid that is being drawn into the area and can reduce swelling very well. Also keeping the head above the heart helps by gravity to allow the fluid to drain down away from the eyelids. I ask patients sleep on pillows with their head elevated for the first week. For my Denver patients who are undergoing blepharoplasty, facelift or any other facial procedures, these steps are the most helpful to promote healing.
Scar and Incision healing
The red line of where the incision is may take some time to heal. In the upper eyelids after a blepharoplasty or fold this is in the eyelid crease. In the lower eyelid blepharoplasty, it is usually in the side corner near the lashes. The scar from the incision for most eyelid and facial surgeries often heal to an almost imperceptible manner. How long does it take after surgery? Though the scar and incision is 90% back to normal at two weeks, the redness is at their worse in 6 weeks. After six weeks they start to improve dramatically. Avoiding the sun helps the healing process for the incisions. Most patients and surgeons feel that at 8 weeks the incisions are non noticeable for many facial procedures For patients who undergo a blepharoplasty, this is often the case. That being said, microscopically, the incision is not 100% healed for 1 year.
The eyelid position can be altered by the swelling and bruising that occurs. This usually resolves within six weeks or so. In some patients you need the full six months to let things settle down. Eyelid malposition or asymmetry after eyelid surgery such as blepharoplasty or ptosis repair is almost impossible to correctly asses at 1 week. These patients are the exception as opposed to the rule.
Herbal medications such as bromelain, arnica montana and papain are show to speed recovery and healing. Those along with Vitamin C are also recommended to my patients in Denver Colorado. Sometimes the simple things are the best such as good nutrition. In Colorado there are many patients who take herbal medicines which may have been self prescribed or prescribed by a naturopathic doctor. I recommend that these herbal medicines should be stopped before surgery. Some herbal medicine can actually make bleeding worse and expose the patient to greater complications after eyelid or facial surgery. Ask your surgeon before taking any herbal medicines before surgery.