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Blepharoplasties and related eyelid surgeries are among the top five most commonly performed surgical procedures across the United States, usually falling behind liposuction, breast augmentation/reduction, rhinoplasty (nose surgery), and brow lifts. Even so, according to the American Academy of Plastic Surgeons, the average, busy plastic surgeon performs 23 blepharoplasties each year, or roughly one every other week. Compare this experience to Dr. Lin’s, where he performs nearly 10 blepharoplasties each week, or some 500 / year, each procedure carefully customized to each individual’s needs.
Frequently asked questions about Blepharoplasty or Cosmetic Eyelid Surgery
1. Is eyelid surgery an out-patient procedure?
Yes, it is. The procedure is scheduled and you can go home after the procedure the same day.
2. What type of anesthesia is used to perform eyelid surgery?
Eyelid surgery can be performed with different types of anesthesia, and these include: local, local plus IV sedation, and general anesthesia. Dr. Lin Yang usually performs eyelid surgery using local anesthesia plus IV sedation for the patients comfort.
3. What is involved in recovery from eyelid surgery?
Recovery varies on the exact procedure performed and the individual patients. Generally, eyelid surgery results in bruising and swelling of the eyelids. We ask that patients plan on being at home on the day of surgery and two additional days. During these first days ice is applied to the eyelids to reduce bruising and swelling. After the third day most patients can drive a car and get about without much difficulty. We ask that patients avoid heavy lifting and strenuous exercise for two weeks after the procedure. Most patients will wear sunglasses for 2-3 weeks to hide bruising and swelling.
4. Is an incision made in the skin when performing upper eyelid blepharoplasty surgery?
Yes. In nearly all cases of upper eyelid blepharoplasty surgery there is excess skin in the upper eyelids. Removal of this excess skin is only possible with an incision in the upper eyelid. Fortunately the skin of the upper eyelid is some of the thinnest skin in the body and typically heals with little or no scarring. Furthermore, the incision site can be hidden in the fold of the upper eyelid allowing the incision to be hidden while healing.
5. How many days will I have my stitches?
Usually, the stitches are removed between 5 to 7 days, depending on the material utilized.
6. Can ptosis (droopiness) of the upper eyelid or droopy lower eyelids that cause eye irritation be addressed at the same time that cosmetic eyelid surgery is performed?
Yes. It is very common for patients to have surgery done to improve function at the same time that cosmetic surgery is done.
7. Is fat removed from the upper eyelids when upper eyelid blepharoplasty is performed?
The tendency is to leave as much fullness in the upper eyelids as possible. Removal of too much fat from the upper eyelids can give a hollow appearance that is not desirable. Often the fat pad in the upper eyelid adjacent to the nose is bulging forward and is reduced in size at the time of upper eyelid blepharoplasty surgery. This is done conservatively to get rid of the bulge without causing a hollow appearance.
8. Can the eyebrows be lifted or the lines between the eyebrows removed with upper eyelid blepharoplasty surgery?
Yes. Please discuss this option with Dr. Lin Yang, and he will be able to recommend the best option to address this issue.
9. If I have an upper eyelid blepharoplasty surgery will I be able to close my eyes afterwards?
The upper eyelids are central to form and to visual function. Removal of too much skin from the upper eyelids does not look natural and causes problems with lid closure. Dr. Lin Yang is an expert in both ophthalmology and plastic surgery around the eye which is why he is acutely aware of the need for the lids to look normal as well as function normally after cosmetic eyelid surgery.
10. Is an incision made through the skin of the lower eyelids when performing lower eyelid blepharoplasty surgery?
Typically not. Most patients with bags in the lower eyelid have little or no extra skin in the lower eyelids. The bags are typically caused by extra fat or fat that is positioned abnormally. If skin is removed from the lower eyelid when there is no extra skin to be removed it will pull down the lower lid so that the whites of the eyes show between the lower lid and the colored part of the eye. This is called lower eyelid retraction. Lower eyelid retraction is actually a sign of aging and creating this problem with surgery makes one look older. Lower eyelid retraction from removing skin from the lower eyelids during blepharoplasty surgery is probably the most common complication of facial plastic surgery.
11. Is removal of skin from the lower eyelids ever warranted?
It is done when there is so much excess skin in the lower eyelid.
12. I have not ever had eyelid surgery and I have droopy lower eyelids with white showing between the lower eyelid and the colored part of the eye. Can I still have cosmetic lower eyelid blepharoplasty surgery done?
This is a common situation. The lower lids become loose with age and in addition to removing the bags from the lower eyelid the lid can be horizontally tightened to reduce this droop of the lower eyelid.
13. Where is the incision made to correct bags in the lower eyelids?
The incision is made through the pink tissue on the back side of the lower eyelids. Using this incision site the surgeon can remove excess fat in the lower eyelids or reposition the lower eyelid fat into the dark circle in the lower eyelid. This incision is hidden behind the lower eyelid and is not visible when healing.
14. Does lower eyelid blepharoplasty surgery simply involve removing fat from the bulges in the lower lids?
It is often more complicated than that. Well done cosmetic eyelid surgery needs to correct all of the problems that have occurred with facial aging to make the lid look more youthful. Some patients only have extra fat in the lower eyelids. This is typically not an aging change as it is first noted as early as high school. This tendency to develop eyelid bags at a young age tends to run in families. In these patients fat removal alone can often correct the entire problem. However, most patients develop bags in the lower eyelids as a result of facial aging. In this situation the changes that need to be addressed are more complicated than simply removing fat from the lower eyelids. Simply removing fat from the lower eyelids of an aging face can cause a hollow appearance and hollow lower eyelids make one look older, not younger.
15. What is the relationship between dark circles in the lower eyelids, bags in the lower eyelids, and facial aging?
A number of changes may occur in the lower eyelid that causes bags and dark circles. A young normal lower eyelid is full, short, and has no dark circle under it. With aging of the face the fat from the cheek and the lower eyelid separate. This occurs because the cheek descends or droops with aging which makes the lower eyelid look longer and allows the eyelid fat to moves forward. This creates an empty space between the fat of the lower eyelids and the fat of the cheek just at the edge of the bone along the lower eyelid. The situation can be described as two mountains separated by a valley. The first mountain is the bulging lower eyelid fat. The second mountain is the drooping cheek fat. The valley lies between. We are normally in overhead lighting so that the bulging fat of the lower eyelid creates a shadow in the valley making it appear like a dark circle at the intersection of the cheek and lower eyelid. This can be tested by illuminating the lower eyelid with a flashlight while observing in a mirror. If the flashlight is pointed directly at the lower lid the dark circle nearly disappears in most Caucasian patients because the lower lid is no longer casting a shadow. In some patients of color there is a real deposition of pigment in this area that will still be observed when doing the flashlight test.
16. How can lower eyelid blepharoplasty surgery correct bags and dark circles?
The operation needs to be customized to the patient. In most patients the result is best if the drooping lower eyelid fat is transposed as apposed to removed. In some patients the result is even better if the drooping cheek or midface is also lifted.
17. What is fat transposition?
Fat transposition involves moving fat from the eyelid into the valley between the cheek and the eyelid. In other words, the fat from the lower eyelid is moved down to fill in the dark circle.
18. Where is the incision made to lift a drooping cheek?
This varies from patient to patient, but it may be made either in the upper eyelid, the lower eyelid, or behind the temporal hair line. You should discuss this with the doctor.
19. Can eyelid surgery cause complications?
Yes. All medical procedures have some risk. You should discuss the risk of complications with your doctor prior to surgery so you can make an informed decision on how to proceed. Many patients select Dr. Lin Yang for their surgery because they believe that the risk of complication with cosmetic eyelid surgery may be less when the procedure is performed by a surgeon with special training in plastic surgery of the eyelids who is experienced in performing these procedures.