Lower Eyelid (Lower Blepharoplasty)

Lower Eyelid Surgery (Lower Blepharoplasty)

What is lower eyelid surgery?
With age and genetics, the lower eyelid skin can become excessive, and the fat pads (“bags” under your eyes) can push out and become prominent causing a heavy and tired appearance. The initial consultation will determine whether the issue is the skin only, the fat pads or “bags” only, or a combination of the two. The strength of the eyelid is crucial in determining which surgical procedure is the best option.

Behind the lower eyelids are three fat pads that can bulge and become more prominent with age. This can also lead to a hollowing of the eyelid/cheek junction often called the tear trough.

Lower eyelid surgery (lower blepharoplasty) is a procedure performed under local anesthesia (you are awake) if only skin and the underlying muscle are being addressed (called a pinch blepharoplasty) but more often under general anesthesia (you are asleep) whenever the fat pads are to be addressed or the eyelid itself needs tightening (called a canthopexy).

Pre Surgery Instructions

Before the procedure
No aspirin or blood thinning medications for two weeks prior to surgery. For surgery under general anesthesia, fasting begins at midnight the night before surgery. Any medications that you take in the AM may be taken with a sip of water (except for blood thinning medications).

For surgery under local anesthesia, no fasting is needed and we encourage you to have your normal meals and fluids on the day of surgery. You may take your normal medications except for blood thinning medications, such as Aspirin, Coumadin, Eliquis, Pradaxa, Xarelto etc.). If you get ill prior to surgery please notify us.

The Surgery

During the procedure
Depending on the surgery, it takes between 1.5-2.5 hours. The incisions are well hidden just underneath the lower eyelashes. The only area that can be seen is a small extension into one of the crow’s feet creases at the outer corner of the eye. The scars typically fade very well and are not usually noticeable once completely healed.

After Your Surgery

Post procedure
You will need someone to drive you home as the eyes are swollen and bruised. Sunglasses are very effective at hiding the bruising for the first 10-14 days.

Keeping your head elevated on two to three pillows will lessen the initial swelling. Though the bruising and swelling is dramatically improved at 10-14 days, it will take a few months for the final swelling to resolve. Patients typically require 1-2 weeks of downtime (due to the bruising).

You will have been given a prescription for antibiotics that is started when you return home from surgery and is taken for 5 days. The topical antibiotics are put on the incision line with a Q-tip twice daily for 1 week.
First night
The swelling can cause complete closure of the eyes for the first night or two and antibiotic ointment is used to prevent any crusts from forming while sleeping. After a night or two, the eyes will typically open up as the swelling subsides.
Day 1
You should be up and walking, drinking fluids, taking your antibiotics and pain medication as described below. Increase activity as tolerated, but there is no heavy lifting for 3-4 weeks. Use saline eye drops as needed for dry eyes.
What do I take for pain?
If you have pain, you are encouraged to start with:

Two Tylenol extra strength (total of 1000 mg of Tylenol) and one Advil extra strength (400 mg of Advil) to be taken at the same time as they work by different mechanisms and work very well together.

You can take the above three pills (two Tylenol extra strength and one Advil extra strength) every 8 hours around the clock for the first day or two.

** Please be aware that with any medication and particularly Advil (a type of non-steroidal anti-inflammatory) there are risks of allergy, severe allergy, gastro-intestinal bleeding and stomach ulcers. Taking your medication with food can sometimes help with some of the stomach symptoms.

You may shower at any time as the incision lines and stitches can get wet. You can clean the incision line with soap and water and replace the antibiotic ointment twice daily.
First post-operative appointment
Your first visit to the office is at one week and the stitches are all removed.
Second post-operative appointment
The second appointment is 4-6 weeks after surgery

Post-operative swelling and bruising begins to subside after 7-10 days but can take up to 3-4 weeks for the initial 70% of swelling to resolve.

Swelling can persist for a few months and the scars take many months to fade to the point where they are hard to see.
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