Before eyelid cosmetic surgery or blepharoplasty patients commonly ask me questions. In fact, I encourage it. The more questions patients ask, the better. As an oculoplastic surgeon in Denver, I want patients to be educated about their surgery, know what to expect afterwards and to understand the limitations of blepharoplasty surgery.
What is the recovery for blepharoplasty surgery?
Blepharoplasty recovery takes about two weeks. After surgery there is going to be swelling and bruising. This takes about two weeks to resolve. Sometimes bruising can take up to 6 weeks to resolve. Usually after a week, patients can use coverup to return to work and social functions. This applies in general to female patients. Male patients who are reluctant to use makeup may have bruising for several weeks after surgery. I explain to patients that bruising and swelling after surgery for patients is on a bell curve. Some patients heal quickly, others longer. Even the same patient who had a fast healing for one surgery years earlier may have longer healing several years later. Many factors play a role in healing such as age, health status, stress level, immune function, diet. These vary over time and can be very different from one person to another.
Common bruising and swelling that patients do not expect are often on the surface of the eye. The clear “skin” of the eye surface which is called the conjunctiva can become swollen and even red. There can be blood that deposits underneath the conjunctiva and the white of the eyes can appear red. This is called a subconjunctival hemorrhage. This is normal and will slowly go away with time.
I was informed the night before blepharoplasty surgery there should be no eating or drinking after midnight. What about taking my medications the next day?
The morning of surgery it is necessary to take ones medications in the morning with a small sip of water. This applies to all medications except blood thinners (see below). Your other medications are needed to keep your blood pressure, blood sugar, or any other medical conditions under control during the surgery.
Are there any medications that I should not take before surgery?
Any medications that are blood thinners specifically aspirin, coumadin, plavix, pradaxa, xarelto, elequis should be held before surgery. In order to weigh the risk of holding the blood thinner if someone has a medical condition necessitating it versus the benefit of hold it before surgery, this usually cleared by the patient's primary doctor or cardiologist. Below is a list of common length of times to hold these blood thinners. Blood thinners if not held can promote bleeding which can be catastrophic. Excessive bleeding can cause vision loss and blindness.
Aspirin 2 weeks
Coumadin 5 days
Plavix 1 week
Xarelto 1 week
Pradaxa 1 week
Elequis 1 week
There are herbal medications that can also thin the blood. It is best to hold all herbal medications for two weeks before surgery to prevent their interaction with anesthetic medications and also with blood clotting.
Why do I need a workup by my primary care before cosmetic eyelid surgery?
Any patient undergoing blepharoplasty surgery who will have anesthesia must be screened to make sure they are healthy enough for the procedure. Usually the primary care doctor for the patient can screen the patient to make sure that they are healthy to have anesthesia and undergo the oculoplastic procedure. Your primary care doctor will perform a medical exam and draw basic bloodwork to make sure you are healthy. It is very important. There is no point to get a cosmetic surgery if you are not physically capable of handling the surgery or have a more serious underlying medical illness. There are no exceptions for this because this is done in the best interest in the health and safety of the patient.
Why do I need someone to come with me on the day of blepharoplasty surgery?
There are several reasons for this. When one gets anesthesia (IV sedation or general), the medicine that is administered is analogous to giving someone a six pack of beer. Not only is it unsafe to drive but patients may find it difficult to ambulate (walk) up their stairs, get into their house etc. They generally need someone to be with them to get them to and from their procedure. It is required if one has general anesthesia that someone stay with them overnight as per medicare safety guidelines. In the car ride home after blepharoplasty, patients will hold ice packs on the ride home. It is pretty hard to drive holding ice packs so a driver is necessary.
Will my eye be patched after blepharoplasty?
The answer is no. I want you to monitor your vision for any changes after surgery. A patch will prevent this so no patching is done.
Can I “use” my eye after blepharoplasty?
There is no harm in using the eye by reading or watching tv after the procedure. Commonly, patients may feel their vision is blurry for a couple days especially if antibiotic ointment is used and gets in the eye. They may feel their vision is not great to read or drive but there is no “restriction” against reading, watching tv or using the eye.
Will I have pain after blepharoplasty?
It is possible for patients to have discomfort after the procedure. I always give a narcotic pain prescription is given after the procedure for the patient to use at home. Often for oculoplastics procedures such as blepharoplasty or other cosmetic eyelid procedures, patients feel that they did not need the narcotic pain prescription and that Tylenol alone will suffice. That is ok. The important thing is for the patient to NOT be in pain. Pain increases the blood pressure and increases the risk of bleeding which is bad after surgery. I let patients know that they should take the pain prescription if they are having discomfort but if they don’t have pain, they don’t need to take it.
Will my vision be blurry after Blepharoplasty?
The answer to this is yes. Often after blepharoplasty the eye itself gets irritated. Blood and fluid can rest on the eye surface and distort the vision. Antibiotic ointment which is often prescribed can get into the eye and distort the vision as well. If a patient has a sudden decrease in vision after the procedure, it is important for the patient to call immediately. This could mean that they are having a new onset sudden hemorrhage behind the eye.
Can I shower after Blepharoplasty?
Patients can shower after a procedure. It is usually recommended that they do not let the direct spray of water get on their face or stitches. Rubbing the eyelids is not a good idea either.
How do I care for my wound or stitches after my blepharoplasty?
It is possible to gently clean the stitches with a q-tip with hydrogen peroxide to clean the blood off the wound or stitches. Often less is more, so the less manipulation of the stitches the better. If there is dried blood on the face away from the stitches it is possible to clean them.
Antibiotic ointment is placed with a small qtip. A very small thin layer is all that is needed. Patients commonly feel the need to slather a large amount of antibiotic ointment on the wound which is wasteful and unnecessary.
The antibiotic got into my eye and my vision is blurry. What do I do?
When antibiotic ointment gets into the eye, it takes time for it to melt and dissolve. The vision will be blurry until that is done. It usually takes a hour for the ointment to wash out of the eye on its own. Often putting artificial tear drops in the eye will not be effective.
How do I sleep after oculoplastic surgery such as blepharoplasty?
The first night after surgery can be difficult. If patient sleeps on a couple pillows or in a chair to keep their head at a 30 degree angle, it can reduce bruising and swelling for the first week. The key is to keep the head above the heart.
What are my activity restrictions after blepharoplasty?
After surgery, it is important to rest and take it easy. Walking to the bathroom, or moving about the house is ok but there should be no heavy lifting, bending over or straining. Those activities increase the risk of bleeding behind the eye or causing a hemorrhage. Heavy lifting is defined as greater than 10 pounds. Certain tasks such as bending your head down over to wash ones hair or tying shoelaces are not recommended.
What about working out?
Working out and vigorous exercise should only begin 2 weeks after surgery. That reduces the risk of developing bleeding in the eyelids and vision loss.
When Can I wear contacts after Blepharoplasty?
After blepharoplasty surgery in Denver, I recommend to patients to restart contact use after 1 week. Before that, the eye surface is irritated and the patient will usually not tolerate the contact lenses very well.
Do I need to ice the eyelids? How often and How long do I do that?
Icing the eye is recommended 20 minutes on and 20 minutes off the wound site for the first 72 hours. Many patients use two frozen bags of peas. One bag is used on the wound site while the other stays in the freezer. It is not necessary to ice while sleeping. It is also important not to leave the ice on the wound for greater than 20 minutes. The reason is that the ice can freeze the skin which obviously can damage the tissue or eye.
Why do I have to come early for my blepharoplasty?
Before any surgery where anesthesia is going to be administered, there are certain things that done to check to make sure the patient is ok for the procedure. First, they will make sure the patient has had nothing to eat or drink 8 hours before the procedure. This is usually after midnight the night before for more patients. Secondly, the doctors and nurses will check the vital signs (blood pressure, heart rate, breathing) of the patient to make sure they are ok for the procedure. There are administrative things such as filling out the consent form and other paperwork that needs to be done. This takes time so the patient comes an hour or two hour before cosmetic eyelid surgery.
Common Questions after surgery
I had cosmetic eyelid surgery and one eyelid is more swollen than the other. What do I do?
After blepharoplasty, it is common for there to be asymmetry between the eyelids. This usually improves with time. Usually within the first week or so it is very difficult to assess how well the surgery went, how even things are etc because of the swelling and bruising after surgery. Asymmetry after surgery is normal. It takes time for things to settle down and swelling to reduce. After two weeks or so depending on the patient, the eyelids usually become more symmetrical.
When can I expect my stitches to be removed?
Most stitches after blepharoplasty are removed at one weeks time in my Denver office. This is done at the office and usually takes a few minutes. At that time I will examine the patient to make sure that things are ok and the surgical healing is going as planned.
In the morning I am getting crusting around my eyes. Is that an infection?
After blepharoplasty surgery there can be increased tear production from the irritation from surgery. It is not uncommon to have crusting in the mornings for several weeks to months after surgery. Generally, it gets better over time. A patient can clean it off with a tissue and it should subside with time.
I had surgery and I feel my eye is irritated. What do I do?
There will be a normal sensation of eye irritation after blepharoplasty. Any increase of pain out of proportion to normal especially if associated with vision loss is of concern and the patient should come in and be seen. If the eye irritation is minor the ointment given after surgery or artificial tear drops can be used to soothe the discomfort.
What is something to look out for after blepharoplasty?
The biggest risk or catastrophic complication we worry about after any surgery near the eye or face is vision loss. This is usually via a hemorrhage behind the eye or retrobulbar hemorrhage. A retrobulbar hemorrhage is usually characterized by sudden bleeding or bulging of the eye. There may or may not be vision loss at that time. Additionally, there is usually sudden strong pain that is different than the normal pain after eye surgery. This is an emergency and the patient should be seen immediately in the office or after hours.
My neighbor/sister/cousin had "amazing" results with you, Can I expect the same?
Blepharoplasty is a surgery. Like any surgery, results vary. Largely the surgery is done in a similar way by me every time. I use the same expertise, attention to detail and care. Every patient is capable of having a fair, good or great result but largely that depends on their individual anatomy, how their tissue heals, how responsive their tissue is to surgery and other variables. My goal is to give you the best eyelids after surgery that your tissue is capable of. Every patient is not going to get the same exact amazing results. If a surgeon you see tells you that they can deliver "amazing" results every time, I would run very very far. Cosmetic eyelid surgery involves honest discussion of what the realistic expectations are. Just because a family member recieved great results, does not necessarily mean your surgery will be a homerun. That is honest truth and I am ok losing patients who don't want to hear that truth.
I hope this article has been helpful. If you have a friend who is undergoing surgery or found this article useful, share it with friends on on facebook. It helps get the word out. A more knowledgeable patient is a happier patient!