Upper Blepharoplasty (Upper Eyelid lift)

TRANSCRIPTION:

One of the single, best operations that we perform is what we call and upper blepharoplasty, or an upper eyelid procedure. When patients come to see me they often ask what can I do to look more refreshed, I feel tired, people are asking me when am I going on vacation and I just returned from vacation and when we look in the mirror, we look in each other’s eyes, the sycaic moments of our eyes, this is how we communicate. One of the single best things that we can do is rejuvenate the eye area so first we’re going to talk about the upper eyelid area. If there were only one procedure I could perform, that would help most patients over the age of let’s say over thirty look more refreshed, it would be the upper blepharoplasty, so let me explain what happens.

As we age there are two things that begin to occur in the upper eyelid. First is, we begin to lose elasticity, the eyelid tissue begins to thin and therefore begin to drop. The second thing that occurs in the upper eyelid is there is a partition called the orbital septum and some of our fat and some of the other contents of the eyelid sit behind that area. As times goes on, that orbital septum weakens and that fat begins to protrude and we start to see some heaviness over the eyelid. The bottom line is there is a very direct and very simple procedure that will help rejuvenate the upper eyelid. The upper blepharoplasty is a procedure that typically takes between fifteen to twenty minutes to perform. The upper eyelid procedure or the upper blepharoplasty is probably one of the single best procedures that we perform. This is an operation performed under local anesthesia, patients come in, we typically give them a cocktail, some Valium and some other medications so that they are very comfortable.

The most critical step is actually the first step, measuring and marking the eyelid tissue. In our eyelid we have a crease, it’s usually about eight to ten millimeters from our eyelash line. If one side measures ten millimeters and the other measures eight millimeters, we will make them both nine millimeters to start with. After that the left and the right eyelid are actually independent, our brows typically have hair on one side, there’s varying amounts of tissue from one side to the other so it’s not important what we’re removing, it’s important what we’re leaving behind, so we measure very carefully the amount of redundant or extra eyelid skin, when we’re through measuring and marking you have a little elliptical shape along the upper eyelid area. Then what we simply do is we localize the area and we numb it up, just like if you’d numbed up a little skin cancer or a mole, it’s a tiny little injection, one injection in each upper eyelid and then we wait. We wait a few minutes and when we’re ready to begin, all we do is follow the previously marked incision and remove the tissue. Often there is a lot of fatty tissue in the upper eyelid as well and we’ll shrink some of that tissue back to make sure the ultimate contour of the eyelid is very natural.

Once we’ve done that we use one suture, one stitch back and forth under the eyelid tissue and a little tiny piece will hang out the corner. Once we’ve completed one eye, we’ll head to the other eyelid and perform the same thing. That suture generally stays in place for about six days at which time we simply slide it out. The result from the upper blepharoplasty lasts probably fifteen to twenty years. This is probably one of the single best treatments that anyone can have performed. Following the upper blepharoplasty, the recovery is pretty straight forward. If there’s one disadvantage to the procedure it’s that people will be able to tell that you’ve had something done, now you can feel well, you can go shopping, you can go to the grocery store, you’ll probably want to wear sunglasses or glasses but it’s very easy to identify the swelling that’s left behind from the surgery.

While the upper blepharoplasty procedure typically takes about twenty minutes or so of actual operative time, the time spent measuring and marking takes another ten or fifteen minutes and the overall time at the office is about an hour to an hour and a half. Some patients are concerned that we’re going to perform an upper blepharoplasty under local anesthesia. I assure you this is a marvelous way to perform this operation, it does not require general anesthesia and it does not require IV sedation. Patients do exceptionally well with these treatments and love the fact that their recovery is so much faster and that they don’t have to recover from the effects of general anesthetic agents.

Some patients have concerns that they’re going to move during their upper eyelid procedure, and we tell patients it’s ok, if they need to cough, if they have post nasal drip, if they want to blink or move their head they can. We are in control of the situation, we are making an incision for just a couple of seconds anyway and the truth is all we’re doing is removing the excessive tissue outside of their eye, along the upper part of their eyelid. While we want patients to use common sense after all of these procedures, including an upper blepharoplasty, patients theoretically could be on their deck watering flowers, we don’t want you lifting heavy objects, we don’t want you bending over, we don’t want you doing things that generally increase your heart rate a lot, that being said, you feel well then you can go about your business mostly as usual.

Upper blepharoplasty is a very safe operation. Temporarily after the procedure, women may notice in the central portion of their lid, a little bit of numbness when they go to wear mascara, that’s a normal consequence that will resolve over several months. Outside of that, there aren’t really risks of nerve injury, we’re really just removing the skin and the fatty tissue from the upper eyelid area. A very common question that we have is about dry eyes and upper bleparoplasty. Many patients that we see have a pre-disposition and are already suffering from some dry eye syndrome already, those patients are still candidates for an upper blepharoplasty, sometimes we want to be more conservative and recognize the patient’s problems going into the operation. As long as an upper blepharoplasty is performed properly there really isn’t additional risk of dry eye syndrome. We all read articles and see situations where a doctor has excised or removed too much tissue from the upper eyelid, that should never happen. We want to measure and mark very carefully prior to making any incisions. As long as thing are performed properly by someone with experience we shouldn’t have any problems with creating dry eye problems.

Of all of the procedures that I perform, I would recommend eyelid rejuvenation and more specifically an upper blepharoplasty, to anybody that is a candidate. Most people over the age of thirty who have some extra tissue in their upper eyelid are candidates for an upper blepharoplasty. I feel very strongly that this is one of the best value procedures, this is one of the best treatments we can provide for patients and I would say that overwhelmingly, patients are thrilled after having their upper eyelids done, it’s not just a good procedure it’s a fantastic procedure. Patients who are seeking facial rejuvenation overall, the two most common procedures that we perform from a aging face standpoint, are the upper eyelid procedure, or the upper blepharoplasty and our advanced face lifting procedure, addressing the folds, jowls, jaw line and neck area. These are commonly performed at the same operation, most patients who are interested in having those areas rejuvenated would benefit from just a single recovery, by the end of six days all of the sutures are removed, patients are doing quite well and they are moving on with their lives

Fortunately, we work out of our own accredited surgery centers, so there’s no need to take patients to the hospital, the advantage of being in our center is we have people doing this day in and day out, multiple procedures every day, we have the same team, there’s some consistency with the care, the operation and the flow. Our surgery center is a more private environment where we have a great deal of expertise treating these sorts of conditions and performing these kinds of operations. During the pre operative period there is no need to obtain any additional lab work, EKG’s or chest x-rays. In the past, when we performed surgeiries in the hospital and when the surgeries were performed under general anesthesia, patients were required to undergo chest x-rays, EKG’s and a lot of lab work. Because these procedures are performed under local anesthesia and because they are performed in our accredited surgery center, you don’t require those exams any longer. The one exam that we still have patients undergo is an eye exam if you are undergoing an upper blepharoplasty. While this is not mandatory in many centers, and people can argue about whether or not it’s necessary, we feel it is safer to have a baseline understanding, what your eye exam looks like, before we do anything surgically.