Who is a candidate for an upper blepharoplasty?
The most common candidates for an upper eyelid lift are usually women and men over 35 who are in good overall health. Due to genetic traits, some patients display an apparent excess of skin at an earlier age. It is important to identify those patients who have markedly drooping eyebrows, since in these cases a blepharoplasty alone does not sufficiently lift the eyelid and a brow lift may be necessary as well. As with any cosmetic surgery procedure, it is important to maintain reasonable expectations for a blepharoplasty. In other words, this surgery will improve your appearance and can make you feel better about yourself, but it cannot achieve drastic changes in your appearance and its effect is limited to your upper eyelids. Any preexisting medical condition must be checked before this type of surgery, especially hypertension and diabetes. There is no medical condition that prevents this surgery from being performed, as long as the condition is well controlled. See more below.
What does an upper blepharoplasty involve?
From its origins until the present, an upper blepharoplasty has been considered a simple act of “removing skin, muscle and fat.” For a true blepharoplasty specialist, it is much more than that. There are several factors that determine the appearance of the upper eyelid, and the excess skin in the eyelid is not the only one. Others include the eyelid crease and the position of the brow, and the appropriate exploration of each one is what allows us to obtain the best possible result for each patient. Proper planning is the key to a successful upper blepharoplasty. A surgery that is too aggressive on the skin, muscle and fat of the upper eyelid causes “hollow” eyelids, sunken eyes, a sad look, and, in the worst-case scenario, difficulty closing the eyes. In addition to individual differences (no two patients are alike), there are important differences between men and women. For men, the surgery tends to be more conservative, since an overcorrected blepharoplasty can feminize a man. The micro incisions are imperceptible as of the first day after the surgery (with the eye open), since they are made in the eyelid’s natural crease. We make the incisions with a cold scalpel, an electrocautery scalpel or a laser, depending on the case, always aiming for the fastest possible recovery for the patient. The use of one or the other does not affect the final result. By means of these incisions, we are able to eliminate excess skin while simultaneously sculpting the fat and tightening the underlying muscle to obtain the desired final look. In patients with a low or poorly formed eyelid crease, it is important to reshape this crease at the end of the procedure. This detail, discarded by many surgeons because it requires profound knowledge of oculoplastic surgery, is crucial to achieving a satisfactory result in some cases. In the event that a patient requires eyelid ptosis repair (see drooping eyelid), this can be done using the same incision used in the blepharoplasty. Some patients have excess fat at the brow level, which appears as a thick and descended brow. In these cases, the fat can be sculpted and partially removed using the blepharoplasty incision. When the brow is considerably descended, it may be necessary to lift it during the same procedure (see brow lift).
Before a blepharoplastyPrior to a blepharoplasty, you will have a consultation with Dr. Nieto during which you will discuss the features of your eyelids, the possible options, and the goals you wish to achieve. This visit lasts between 30 and 45 minutes. Before the visit, we will ask you to complete a brief questionnaire about your health, ocular problems, and previous surgeries. It is important for us to know about preexisting medical problems, as well as allergies to medications and any medications you are currently taking. During the same visit, we will perform a complete eye exam in order to verify that you are in good ocular health. Dr. Nieto is an expert ophthalmologist, with training in the best hospitals in the country, which is why your ocular health is in good hands. It is especially important to detect dry eye problems (reduced tear production), since in these cases we usually perform more conservative surgeries to avoid aggravating this condition. If you have previously had laser, cataract, glaucoma, or retina surgery, this is not an impediment for undergoing this procedure, but it is important that these issues are controlled and stabilized prior to surgery. Before the procedure, you must undergo lab tests with a clotting analysis and an electrocardiogram, which you must bring with you on the day of your surgery and submit to the anesthesiologist. In special cases, a visit with the anesthesiologist may be necessary prior to surgery.
The day of your surgeryYou must come to,surgical centre accompanied by another person, about 30 minutes before the surgery, bringing the necessary documentation that we have requested from you, as well as the preoperative tests. Once you are in the operating room, the team of nurses will ensure that you are comfortable and relaxed.; The anesthesiologist will, check your vital signs, and give the go-ahead for the procedure to begin. In most cases, we perform this surgery with local anesthesia and sedation, although it can also be performed with only local anesthesia if necessary for medical reasons or preferred by the patient. The medications used for sedation nowadays are very quickly eliminated from the body, which is why recovery is very speedy and there is no subsequent “hangover.” The surgery is always done on an outpatient basis, without admittance. The surgery usually lasts approximately 30-45 minutes, but if performed along with a lower blepharoplasty or a brow lift, it can last up to 2-3 hours. In any event, thanks to sedation and local anesthesia, it is a painless surgery. After the surgery is finished, you will remain under observation for about an hour while we apply cold and anti-inflammatories to slow the initial swelling process.
Recovering from an upper blepharoplastyThe post-operative process following an upper blepharoplasty is painless – so much so that the vast majority of patients need no pain medication. Bruising and swelling occur to a greater or lesser degree in all patients; for the most part, these effects go away after the first week. After one week, recovery is not yet complete, but most patients do not have any problems resuming their “social” activities at this point. During the first days after surgery, it is important to refrain from vigorous physical activity in order to avoid possible bleeding and to shorten recovery. We recommend applying cold for the first 2-3 days and an antibiotic ointment to the wound twice a day. Using eye drops to lubricate the eye is also advisable, since symptoms of dry eyes may appear due to the fact that normal blinking is reduced in these early days. It is even common for the eyes to not completely close at night during the first 2-3 days, since the orbicularis oculi muscle (responsible for closing the eye) is recovering from the anesthesia and inflammation from the procedure. The first follow-up check is done one week after the procedure to remove the sutures. Before this first check-up, Dr. Nieto will personally contact you by phone to ask after your progress. Should any doubt or problem arise, you will always have direct contact with him. Recovery is usually complete one month after the procedure, when we conduct the second post-operative appointment. The scar will continue to fade during the first year until eventually becoming invisible when the eye is closed (with the eye open it is usually invisible after the first day). The skin of the upper eyelid is the thinnest in the body, which is why it heals very quickly and cases of hypertrophic scarring (keloids) are almost nonexistent. The results of an upper blepharoplasty are long-lasting. It is very uncommon for us to perform this surgery a second time on the same patient. It is true that, after many years, the patient may note a certain “fullness” in the upper eyelids again, but this is usually due more to the drooping of the brow than to excess skin in the upper eyelid. In the event that a patient underwent a blepharoplasty years before and once again has excess skin, there is no problem with performing another blepharoplasty.