Plastic surgery restores form and function through reconstructive procedures, cosmetic enhancements, and body contouring.
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The consultation serves as the foundation for a successful surgical outcome. It begins with a comprehensive medical history and a detailed examination of the periorbital region. The surgeon evaluates not only the eyelids but also the entire upper face, including brow position, cheek projection, and skin quality.
During the exam, the surgeon assesses the amount of excess skin using forceps to pinch the lid. They evaluate the fat pads by gently pressing on the eye (retropulsion) to see where the fat bulges. The tone of the lower lid is tested using the “snap back” test to determine if muscle tightening is required.
The surgeon also checks for dry eye symptoms. This is critical because removing skin from the eyelids can temporarily affect closure. Patients with pre-existing dry eye may require a more conservative approach to prevent exacerbating the condition.
Modern consultations often use high-resolution photography and digital imaging software. Photos are taken from multiple angles front, oblique, and lateral both in neutral and upward gaze. These images serve as a medical record and a planning tool.
While digital simulation is more complex for eyelids than for noses, surgeons can use the photos to demonstrate the intended changes. They can show the patient the asymmetry that already exists (which everyone has) to manage expectations about post-surgical symmetry.
A thorough review of the patient’s medical history is mandatory. Conditions such as thyroid eye disease (Graves’ disease), high blood pressure, and bleeding disorders have direct implications for eyelid surgery. Thyroid disease, for instance, can cause bulging eyes, making surgery more complex.
The surgeon reviews all medications and supplements. Blood thinners, aspirin, ibuprofen, and supplements like fish oil or Vitamin E must be stopped before surgery to prevent hematoma and excessive bruising. Smoking status is also addressed, as nicotine impairs healing.
No two eyes are the same, and the surgical plan must be customized. The surgeon discusses whether the patient needs only skin removal, fat removal, or fat repositioning. For the upper lids, the crease position is discussed and marked.
The decision to combine procedures is made during this phase. Patients are often advised on whether a brow lift or facelift would complement the eyelid surgery. The goal is to create a harmonious plan that addresses the individual’s specific aging pattern.
For patients with functional visual obstruction, a visual field test may be required. This test documents the extent of vision loss caused by droopy eyelids. Insurance coverage is often required if the procedure is deemed medically necessary.
Patients with a history of glaucoma, a detached retina, or recent eye surgery (such as LASIK) may need clearance from their ophthalmologist. This collaborative approach ensures that the aesthetic procedure does not compromise ocular health.
The surgeon evaluates the patient’s motivations and expectations. Eyelid surgery changes the central feature of the face. Patients must be prepared for changes in their appearance and the recovery process, which may involve visible bruising and swelling.
Discussions include the concept of “improvement, not perfection.” Understanding that minor asymmetries may persist and that the healing process takes time is vital for psychological well-being during recovery.
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Patients receive detailed instructions to prepare for surgery. This includes stopping specific medications, arranging for transportation, and preparing the home environment. Patients are advised to have ice packs (frozen peas are popular), artificial tears, and antibiotic ointment ready.
Nutritional guidelines focus on reducing sodium intake to minimize swelling and staying hydrated. Avoiding alcohol for a few days before surgery is also recommended to reduce the risk of bleeding.
On the day of surgery, the patient meets with the surgeon again for final markings. These markings are done with the patient sitting upright, as gravity affects the position of the skin and fat. The surgeon marks the amount of skin to be removed and the location of the fat pads.
This marking process is the blueprint for the surgery. It requires the patient’s cooperation and the surgeon’s artistic eye. Once marked, the patient is prepared for anesthesia.
Eyelid surgery can be performed under local anesthesia alone, local with oral sedation, or IV sedation (twilight sleep). General anesthesia is rarely needed unless combined with other major facelifts.
The choice depends on the patient’s anxiety level and the complexity of the procedure. Local anesthesia allows the surgeon to check muscle movement during surgery, which can be beneficial. The surgeon and patient decide on the best option together.
Patients must arrange for a responsible adult to drive them home, as their vision will be blurry due to the ointment and swelling. It is also recommended to have someone stay with them for the first 24 hours to assist with ice application and medication.
Planning for time off work is essential. While desk work can often be resumed quickly, social engagements should be postponed until bruising subsides.
If you have a history of eye diseases such as glaucoma, dry eye, or a detached retina, yes. Your surgeon will require a clearance letter from your ophthalmologist to ensure your eyes are healthy enough for the procedure.
You cannot wear contact lenses during surgery. You will also need to wear glasses for about 2 weeks after surgery while the incisions heal and the swelling goes down. Inserting contacts can pull on the healing tissues.
Most patients take about 1 week off work. By day 7, sutures are usually removed, and most bruising can be covered with makeup or sunglasses. If your job involves heavy lifting, you may need 2 weeks.
If you take aspirin or other blood thinners within 2 weeks of surgery, you must tell your surgeon immediately. The surgery may need to be rescheduled because the risk of uncontrollable bleeding and hematoma (blood collection) is too high.
Most eyelid surgeries are done with “twilight” sedation. You are very relaxed and sleepy, and you won’t feel pain, but you breathe on your own. You won’t remember much of the procedure. General anesthesia is usually not required.
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