Yesterday I saw a patient who was interested in improving her upper eyelids. She complained that her upper lids were heavy and were drooping down over her eyes, giving her a tired look. She told me that her mother had the same problem but much worse and that she did not want to have the same look later on.
We discussed eyelid surgery and she left. Patients are made aware that plastic surgeons can cut too much skin and the patient will not be able to close her eyes! I will tell you how I avoid that from happening.
Eyelid plastic surgery, blepharoplasty, plastic surgeon in Virginia, eye surgery

1. What is eyelid surgery, or blepharoplasty?

Eyelid surgery involves the removal of excess skin of the upper and lower eyelids and improvement of the associated pockets of fat that have herniated through (bags under eyes).

In our upper lids, there is always some skin to remove and usually some associated fat pockets, especially in the area closest to the nose. In our lower lids, skin removal may not be necessary; fat is either removed carefully or else pushed back into the eye socket so you don’t get a “hollowed out” look. The surgery can be done through the inside of the lids with no need for visible scarring or skin removal.

2. What type of anesthesia is used for blepharoplasty?

I always try to do these eyelid surgeries under local anesthesia for the simple reason that when awake, your muscles are active and you can move your lids up and down so we can be sure that you can CLOSE YOUR EYES!

Under general anesthesia, you have no muscle control and too much skin can be removed.

3. What else can you do to prevent too much skin removal?

I carefully measure the amount of skin to be left so as to ensure eyelid closure. It is not what is taken out but rather what is left behind that is important. I measure and ensure that you have at least 15 mm of skin between the eyebrow and eyelid and at least 8-10 mm of skin between your lashes and the crease of the eyelid. This ensures eyelid closure. Remember that some people have a slight opening of their eyes when they are asleep. This is normal for them.

4. What role does the brow have on the eyelid?

Drooping of the brow can have a dramatic effect on the amount of skin to be removed from the eyelids. Some eyelid heaviness can be improved solely by elevating the brow (a brow lift). Some patients need both a brow lift and eyelid surgery for best results.

5. What are possible occurrences after eyelid surgery?

– swelling and bruising
– dryness and itchiness
– increased wrinkling of skin that resolves without intervention
– drooping of the lower lids, which usually resolves itself without surgery

Not being able to close your eyes after eyelid surgery is very rare. I wouldn’t worry about it as long as you keep your eyes peeled for a good board-certified cosmetic plastic surgeon!

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