Upper Eyelid Surgery

Upper Blepharoplasty

It has been said that your eyes offer a “window to our soul”.  If this is true then the upper eyelid is the most important window shade of your life!!  Eyelid and periorbital aesthetics are critically important to the overall appearance of your face. As a central feature of the human face and as an instrument that we use to define ourselves to the world, our eye appearance is one of the defining pillars of how we view ourselves (self-image), and how we portray ourselves to the world (aesthetics).

 

The ideal upper eyelid should provide a bright, youthful, and energetic look.  The eyelid and eye itself should have either an oval or almond shape.  In women, there should be a robust row of eyelashes on the upper and lower eyelid, but the upper eyelid is more noticeable.  There should be minimal excess skin in the upper eyelid, and surrounding the orbital area in general.  Crow’s feet should be minimized.  Lastly and most importantly, there should be a well defined cleft between the superior end of the upper eyelid and the inferior beginning of the lower brow.  This upper eyelid cleft is crucial to your overall appearance, as it provides definition between the upper eyelid and the brow.

 

During your consultation, there are 4 critical structures in the upper eyelid that must be evaluated to improve your overall aesthetics.

 

  1. Upper eyelid skin.
  2. Upper eyelid fat pads
  3. The Obicularis muscle & upper orbital septum
  4. Presence or absence of ptosis (aka eyelid droop)

Upper eyelid skin

 

As we age, our brow position tends to fall over time. We fight this brow descent by activating our Frontalis muscle (PICTURED), which lifts and elevates the brow position. By doing this, we create a tension on your upper eyelid.

These movements, which happen thousands of times a day will effectively stretch and elongate upper eyelid skin over the course of daces causing dermatochalasis, which is the term for having excess upper eyelid skin. The only truly effective treatment is upper eyelid blepharoplasty.

Fat pads

There are three fat/glandular components in the upper eyelid. The three components are the medial fat pad, the middle fat pad, and laterally the lacrimal gland (aka the tear gland). During upper eyelid surgery, we routinely reduce or remove the medial fat pad to emphasize the natural almond shape of the upper eyelid. However, we do not routinely reduce the middle fat pad as reduction or removal of this pad commonly creates a hollowed out appearance to your eye. Instead of reducing or removing the middle fat pad, we tighten this fat pad using a specific type of laser to create a revitalized appearance to the upper eyelids. Lastly, the lacrimal gland is left untouched to prevent disruption of tear flow and to maintain appropriate eye function.

We strongly advocate for defining the upper eyelid cleft during upper eyelid surgery. There is a natural elegance to a clearly defined upper eyelid and brow. If this cleft is obscured or absent, many patients will require a surgical brow lift or a chemical browlift to create the cleft. Conversely, in patients who have good overall brow position and merely have descent of upper eyelid, those patients can achieve outstanding results though reduction of the orbicularis muscle and removal of the excess upper eyelid skin and septum. By removing the septum and reducing the muscle, Dr. Durkin is able to recreate the natural upper eyelid cleft that you were born with. This specific maneuver that Dr. Durkin utilizes separates our upper eyelid results from our competitors.  By addressing the foundation tissue planes of the upper eyelid, we are able to create natural, youthful appearing eyes with lasting results.    Reduction of the orbicularis muscle and septum has no effect on eyelid function. It is an accessory function muscle and manipulation of the orbicularis does not alter your ability move your eyes.

Eyelid droop or ptosis

 

As we age, facial structures and landmarks tend to drift downwards.  When this happens in the upper eyelid, we call this ptosis.  Ptosis refers to the overall position of the upper eyelid in relation to the eye itself.  It does not indicate whether or not the eyelid has exta skin.  Rather, this refers to eyelid position overall.  This assessment is taken during your initial evaluation.  Repair of ptosis is traditionally done through manipulation of the Levator muscle, or another important muscle known as Muller’s muscle.  Ptosis repair can provide a dramatic improvement in facial appearance.  Dr. Durkin has extensive experience in regarding ptosis repair of the upper eyelid, and brow.  There are many causes of eyelid ptosis, and the repair of each type differs.  Ptosis evaluation is one of our cornerstones in eyelid surgery, as repair of upper eyelid droop is absolutely crucial towards overall outcome in upper eyelid surgery.

Frontalis Muscle

The Ocean Drive Upper Lid Blepharoplasty

As we age the upper eyelid skin tends to elongate and droop. Secondarily, it is common to have bulging eyepads, especially on the inner upper eyelid. On the outer lid, we tend to get extra skin. Taken together, these natural signs of eyelid aging can portray us as tired, fatigued or even sad. One of our most common requests is when patients come in and ask to look less tired. We commonly hear that people “don’t look the way they feel.”.  The tired appearance commonly involves both the eyes and the neck, and we firmly believe in a comprehensive, reductionistic approach to these issues with self image.  Upper eyelid rejuvenation begins with an evaluation of skin quality and volume, eyelash length, and presence or absence of excess fat. Upper  eyelid blepharoplasty is our second most common facial procedure overall and our most common procedure in men.  We like to undertake this procedure with minimal anesthesia so that patients recover quickly, and so that I can see them animate and move to ensure a natural result with removal of all excess skin.  Patient downtime is minimal.  Bruising is common, but resolves usually within 3-5 days.  Sutures are removed on postoperative day five.  Upper eyelid blepharoplasty is one of our most potent procedures, and offers a result that will last decades with minimal discomfort and very acceptable downtime.

 

We commonly employ up lid blepharoplasty (eyelid) with Botox® therapy and or Latisse® to get the maximum result possible. As well, all patients are evaluatied in terms of brow position.  Select patients who request up eyelid surgery may have an indication for brow lift as well, as not all patients are candidates for isolated upper eyelid surgery. Many will require brow lifting as well because their brow has fallen. This is very common in men and women. Upper eyelid evaluation is not complete unless your brow position is evaluated as well.  We will evaluate and discuss both issues with you at your consultation and define all surgical and nonsurgical options for you. We discuss this at length during your consultation and ensure all of your questions are answered before any procedure or intervention is decided upon.

Before Upper Blepharoplasty
Before Upper Blepharoplasty
After Upper Blepharoplasty
After Upper Blepharoplasty
Before Upper Blepharoplasty
Before Upper Blepharoplasty
After Upper Blepharoplasty
After Upper Blepharoplasty
Before Blepharoplasty
Before Blepharoplasty
After Blepharoplasty
After Blepharoplasty

Post Op Instructions

Care of the Surgical Site

You will not be able to shower until cleared by Dr. Durkin or Nurse. When cleared you may wash your
face gently cleansing the incisions with soap and water. Avoid “scrubbing” the incision sites. Use a gentle massage with your fingertips around the incisions. Wash the incision sites twice daily. Place the artificial tear ointment, which was given to you at your pre-op visit with the nurse, on the incisions after washing. Please do not wear any make-up while your incisions are healing.

An antibiotic has been given to you. This is begun the day after surgery and continued until gone.

 

Activity

Limit your activity over the first week following your surgery. We encourage walking, but AVOIDING bending over at the waist, or picking up heavy objects, or straining in any way. If you overexert yourself, bleeding may result. You may slowly resume your activities after the first week, but please avoid any strenuous activity until Dr. Durkin gives you the OK. If the activity involves being outside please use the appropriate protection from the sun (sunscreen, hat, etc.), even a mild sunburn may cause prolonged swelling and/or irritation of the incisions and skin.

 

Swelling

Every operation, no matter how minor, is accompanied by swelling of the surrounding tissues. The amount varies from minimal to extensive. Sometimes the swelling becomes a little greater 48 hours after your operation and will gradually decrease. Swelling is generally worse when you first get up in the morning. The swelling itself is not serious and is not an indication that something is going wrong with your operation. It may take several weeks for the swelling to diminish completely. After the swelling diminishes though, you may notice or feel some unevenness (lumpiness) under the skin; this will gradually disappear. The main thing to remember is the swelling eventually subsides; you can help in several ways:

1. STAY UP (sitting, standing, walking around) as much as possible on your first post-operative day. IMPORTANT, you should rest when you are tired.
2. AVOID BENDING OVER OR LIFTING heavy things for one week. Besides aggravating swelling,
this may raise the blood pressure and you could start bleeding.
3. AVOID HITTING OR BUMPING YOUR EYES. It is wise not to pick up small children and you should sleep alone for one week after your operation.
4. SLEEP WITH THE HEAD OF THE BED ELEVATED for 1-2 weeks after your operation. To accomplish this, place two or three pillows under the head of the mattress and one or two on top of it.

 

Discoloration

Discoloration and bruising are normal. Like the swelling, it may become more pronounced after the first day or so, but remember this is temporary.

 

Pain

There is usually little actual pain following a blepharoplasty, but you may experience a deep bruised sensation as a result of the swelling, and the eyes may seem heavy, this can seem worse at night. You will receive a prescribed pain medication and it can often cause sensations of light-headedness or sleepiness, particularly in the immediate post-operative period. If you choose to not take the pain medication prescribed you may try the application of cold compresses. Under no circumstances should ASPIRIN, IBUPROFEN,
or medications containing aspirin or salicylates or ibuprofen, be taken without first consulting us. If the pain is severe and the prescribed pain medication is not helping please do not increase the recommended dosage or supplement with your own medications. Notify our office and we will evaluate the next step in controlling your pain.

 

Returning to Work and Social Activities

When you should return to work depends on the amount of physical activity and public contact your job involves and also the amount of swelling and discoloration you develop; the average patient may return to work or go out socially 2-3 weeks after surgery when these factors are minimal, you will have to play this by ear! Do not drive if you’re taking the pain medication.

 

Diet

The night of your surgery you may feel nauseated. We have provided you with anti-nausea medication. You can take the medication and only take a few ounces of clear fluids until the nausea passes. There are no restrictions to what you can and can’t eat. Please no drinking of alcohol for the first 3 weeks and/or while taking the pain medication and the anti-anxiety medication. Alcohol may raise the blood pressure and initiate bleeding.

 

Depression

It is not unusual for an individual to go through a period of mild depression after cosmetic surgery because, no matter how much they wanted the operation beforehand and how much they were told about what to expect post-operatively, they
are shocked when they see their face swollen and, perhaps, discolored. Be realistic and realize that this is a very temporary condition which will subside shortly. The best “treatment” consists of busying one’s self with the details of post-operative care and trying to divert one’s attention to other thoughts. Do not compare your progress with that of other patient’s, everyone heals differently.

 

Daily Care

You may expect to feel some soreness, itchiness,
or bruising in the treated area. You may also have blurring or double vision. Your caregiver may ask you to do any of the following things to help you heal:

  1. At night, put a small amount of either lubricatingointment or if not available antibiotic ointment inthe eye to keep them moist.
  2. Use your eye medicines as ordered by yourcaregiver to ease red, itchy, and dry eyes. When placing an eye drop or ointment, do not let the tip of the bottle or tube touch your eye. This could scratch your eye or cause an infection. Wash your hands with soap and water before putting the medicine in your eye.
  3. You may shower when cleared by Dr. Durkin. When cleared be sure to use a gentle shampoo such as Johnson’s Baby Shampoo.
  4. Be sure to report immediately any signs of bleeding that persist after ten minutes of direct pressure, infection, redness, fever, unusual drainage, or pain.
  5. If any, Sutures will be removed at your one week post-op appointment.

 

Ice Compresses

Soft washcloths or the ice packs that we provide to you can be used. If you decide to use a soft cloth, dip in water with ice chips. They may be placed in a plastic wrapper such as a baggie to avoid wetting your clothing. Apply your preferred method across the eyes for twenty minutes several times daily during the first 3 days may help reduce swelling, discomfort, and discoloration.

 

Medication Instructions

Every post-op patient will receive the following four meds which may be adjusted due to medication allergies etc.
• Antibiotic to start the following day after surgery • Muscle relaxer typically this is Diazepan. Take

one tablet every 12 hours as needed. Please take this one hour apart from your pain medication. This can be sedative do not drive while taking.

• Pain medication to be taken with food you may start once you get home after surgery. We advise you to take a stool softner as your pain medication may cause constipation. You may alternatively take Tylenol if you chose. Do not take Ibuprofen or Asprin.

• You are given a packet of Ondansetron for nausea. this is to take only as needed. Once every 8 hours. If symptoms do not resolve contact office.

 

Finally

Remember these things:
1. You will need a responsible adult to drive you home and remain with you for 24 hours after your procedure. 2. You must wear your surgical garment at all times except when showering
3. Walk in a slightly bent position for the first few days and sleep with 2 pillows under your knees and 2 pillows under your back.
4. No driving until released to do so by Dr. Durkin
5. Restrict your activity to light walking for the first 2 weeks. Dr. Durkin will increase your activity level as you heal.
6. Report…

(a)Temperature elevation
(b) Sudden swelling or discoloration
(c) Discharge from wound or other evidence of infection (d) Bleeding
(e) Development of any drug reaction

• If you have any questions or concerns, please do not hesitate to contact the office at (772) 234.3700. If you have an emergency after regular office hours, please call 911 or go to your local emergency room.

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