Upper Eyelid Surgery: Blepharoplasy & Brow Lift

California Skin & Laser Center offers two kinds of upper eyelid procedures: Blepharoplasty and Brow Lift.

Loose, drooping upper eyelid skin, which can occur on a hereditary basis or as a result of aging, can be cosmetically unappealing and can give one a tired look and make you look older than you feel. . At times the upper lid skin folds can be large enough to partially obstruct vision. Eyelid surgery can correct drooping upper lids, and the tissue that appears to be bags under the eyes can frequently be "corrected" without surgery, by the judicious use of filler. Neither of these procedures will remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. Dr. Bock has been repairing excess eyelid skin since 1988.

Our California Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your desires, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Bock.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery.

Risks

Generally blepharoplasty complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection, bleeding, scarring or a reaction to the anesthesia. You can reduce your risks by closely following the instructions you have been given, both before and after surgery.

The minor complications that occasionally follow blepharoplasty include temporary swelling and or bruising, and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; we can remove them easily with a very fine needle.

Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent.

Planning for surgery

The initial consultation with Dr. Bock is very important. Dr. Bock will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform us if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

In this consultation the nurse will test you for tear production.

Dr. Bock will explain the techniques and anesthesia to be used, the type of facility where the surgery will be performed, and the risks and costs involved.

Don't hesitate to ask any questions you may have, especially those regarding your expectations and concerns about the results.

Preparing for surgery

We will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly.

While you're making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.

Anesthesia

Eyelid surgery is performed under local anesthesia -- which numbs the area around your eyes -- sometimes along with oral sedatives. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.) .

The surgery

Blepharoplasty usually takes about one hour. In a typical procedure, Dr. Bock makes incisions following the natural lines of your eyelids; in the creases of your upper lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, we separate the skin from underlying fatty tissue and muscle, removes excess fat, and often trim sagging skin and muscle. The incisions are then closed with very fine sutures.

After your surgery

After surgery we will apply cool compresses and may apply a bandage. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication recommended. Usually there is minimal discomfort. If you feel any severe pain, call Dr. Bock immediately.

We would like you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from one to two weeks.) You'll be shown how to clean your eyes, which may be gummy for a week or so. We may recommend eyedrops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

Dr. Bock will follow your progress very closely for the first week. The stitches will be removed two days to a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.

Getting back to normal

You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in a week to 10 days. By then you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

We recommend that you to keep your activities to a minimum for three to five days, and to avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. You should avoid alcohol, since it causes fluid retention.

The final results

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line.

On the other hand, the positive results of your eyelid surgery -- the more alert and youthful look -- will last for years. For many people, these results are permanent.

A browlift is a procedure that restores a more youthful, refreshed look to the area above the eyes. It also frequently reduces the loose skin on the upper lids. It corrects low lying or drooping eyebrows, and improves the forehead lines and furrows that can give an angry, sad or tired appearance. The browlift is performed in the office under local anesthesia. An incision is made at, or in the hairline and enough skin and muscle is removed to properly position the eyebrows. The incision site is then closed. The procedure results in a more open appearance of the eyes, a smoother forehead and a more approachable, less angry facial expression. Of all the cosmetic surgical procedures, the browlift produces the most dramatic immediate results. Even as the patient leaves the office bandaged up, their friends and relatives often comment about how much better the patient looks.

A brow lift is often performed in conjunction with a MACS Lift to provide a smoother overall look to the face. Eyelid surgery (blepharoplasty) may also be performed at the same time as a brow lift, especially if a patient has significant skin overhang in the upper eyelids. Sometimes, patients who believe they need upper-eyelid surgery find that a brow lift better meets their surgical goals.

Remember, a brow lift can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your desires, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them in detail with Dr. Bock.

For a better understanding of how a brow lift might change your appearance, look into a mirror and place your fingers on your forehead, above your eyebrows. Gently draw the skin up to raise the brow and the forehead area. That is approximately what a forehead lift would do for you.

Complications are rare and usually minor, but the possibility of complications must be considered:

• In rare cases, the nerves that control eyebrow movement may be injured on one or both sides, resulting in a loss of ability to raise the eyebrows or wrinkle the forehead. Additional surgery may be required to correct the problem.
• Formation of a broad scar is also a rare complication. This may be treated surgically by removing the wide scar tissue so a new, thinner scar may result. Also, in some patients, hair loss may occur along the scar edges.
• Loss of sensation along or just beyond the incision line is common, especially with the classic forehead lift procedure. It is usually temporary, but may be permanent in some patients.
• Infection and bleeding are very rare, but are possibilities.

Where is the surgery performed?

Both the browlift and the upper eyelid surgery are performed in the office under local anesthesia accompanied by oral sedation. Should the patient desire it, these procedures can be performed in a certified outpatient surgery center under intravenous sedation or general anesthesia.

Preparing for your surgery

Dr. Bock will give you specific instructions to prepare for the procedure, including guidelines on eating and drinking, smoking, and taking and avoiding certain vitamins and medications. Carefully following these instructions will help your surgery and your recovery proceed more smoothly.

If your hair is very short, you may wish to let it grow out before surgery, so that it's long enough to hide the scars while they heal. You should arrange for someone to drive you home after your surgery, and to help you out for a day or two.

The surgery

Before the operation begins, your hair will be tied with rubber bands on either side of the incision line. Your head will not be shaved, but hair that is growing directly in front of the incision line may need to be trimmed.

For some patients, a coronal incision will be used. It follows a headphone-like pattern, starting at about ear level and running across the top of the forehead and down the other side of the head. The incision is usually made well behind the hairline so that the scar won't be visible.

If your forehead is broad, the incision may be placed just at the hairline, to avoid adding even more height to the forehead. By wearing your hair down on your forehead, most such scars become relatively inconspicuous. Special planning is sometimes necessary for concealing the scar in male patients, whose hairstyles often don't lend themselves as well to incision coverage.

Working through the incision, the skin of the forehead is carefully lifted so that the underlying tissue can be removed and the muscles of the forehead can be altered or released. The eyebrows may also be elevated and excess skin at the incision point will be trimmed away to help create a smoother, more youthful appearance.

The incision is then closed with stitches or clips. Your face and hair will be washed to prevent irritation and the rubber bands will be removed from your hair. Then the incision is covered with gauze padding and the head is wrapped in an elastic bandage.

After the surgery

After the brow lift you may experience some numbness and temporary discomfort around the incision, which can be controlled with prescription medication. People who are prone to headaches may be treated with an additional longer-acting local anesthesia during surgery as a preventive measure.

You may be told to keep your head elevated for two to three days following surgery to keep the swelling down. Swelling may also affect the cheeks and eyes-- however, this should begin to disappear in a week or so.

As the nerves heal, numbness on the top of your scalp may be replaced by itching. These sensations may take as long as six months to fully disappear. If bandages were used, they will be removed a day or two after surgery. Most stitches or clips will be removed within two weeks, sometimes in two stages.

Some of your hair around the incision may fall out and may temporarily be a bit thinner. Normal growth will usually resume within a few weeks or months. Permanent hair loss is rare.

Recovery

Although you should be up and about in a day or two, plan on taking it easy for at least the first week after surgery. You should be able to shower and shampoo your hair within two days, or as soon as the bandage is removed.

Most patients are back to work or school in a week to 10 days. Vigorous physical activity should limited for several weeks, including jogging, bending, heavy housework, sex, or any activity that increases your blood pressure. Prolonged exposure to heat or sun should be limited for several months.

Most of the visible signs of surgery should fade completely within about three weeks. Minor swelling and bruising can be concealed with special camouflage makeup. You may feel a bit tired and let down at first, but your energy level will increase as you begin to look and feel better.

If you are interested in eyelid or browlift surgery, what is the next step?

The next step is to call CSLC at 800-500-5842 and schedule an evaluation. At that time Dr. Bock will advise you whether you are a candidate for this procedure, and what other possibilities exist for improving your appearance.

Why should you choose California Skin & Laser Center for your upper eyelid procedure?

At California Skin & Laser Center, we want you to have an excellent outcome and to feel that your needs and concerns have been promptly addressed in a caring and sensitive fashion. We strive diligently to ensure your satisfaction, your comfort, your privacy, and your safety. All treatments are supervised or performed by a board-certified dermatologist with many years of successful experience in a large variety of cosmetic procedures. Many treatment modalities are available, and we can recommend the one or two that are most likely to meet your needs; we're here to meet your needs and help you realize your aspirations. At our clinic in Stockton, CA, we serve communities throughout San Joaquin County and the Central Valley, including Lodi, Sacramento, Tracy, Manteca, Modesto, Galt, and Valley Springs; many of our patients also come from the San Francisco Bay Area.