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Eyelift (blepharoplasty)

UPPER AND LOWER EYELID SURGERY

Do your eyes make you look more tired than you really feel? If the answer is "yes", you may be able to benefit from blepharoplasty, a procedure commonly performed to remove excess, unwanted tissue from your upper or lower eyelids.

People who look at you usually notice your eyes before any other facial feature. Aging, heredity, and sunlight often become manifest in your eyelid skin. These changes may either consist of baggy, excess skin on the upper lids, or of 'tired bags' (fat pads) on the lower lids. These changes may make you look tired, sad, or older than you actually feel, especially earlier in the morning. However, eyelid surgery can be a very satisfying facial cosmetic procedure, since, in many cases, these problems can be corrected with pleasing aesthetic results. Your self confidence may indeed improve as your eyes look brighter, younger, and more awake.

AM I A GOOD CANDIDATE FOR EYELID SURGERY?

The following are conditions that frequently respond to this procedure:

* FULLNESS OF THE UPPER EYELIDS: This condition, characterized by upper eyelid 'bags', is commonly found in both men and women. Surgery for this condition can result in dramatic improvement, especially in women. The procedure can be performed at any time after the age of 18. Unlike drooping skin secondary to aging, this condition will not recur once repaired. This surgery, for fullness of the upper eyelids, is probably the most widely performed and effective of all eyelid operations. Oriental women who wish to enhance their upper eyelid fold, as well as removing bulk from their eyelids, are often good candidates.

FOR WOMEN: Removal of these upper lid bags will accentuate your normal eyelid crease and permit better use of your eye makeup, as well as providing notable improvement. In fashion magazine models, the ideal, attractive upper lid is generated by the presence of a deep elevated upper eyelid fold. In contrast, in men, removal of the excess tissue will produce a more subtle, but effective, improvement.

* EXCESS SKIN OF THE UPPER EYELID: This skin laxity is generally related to aging and/or prior sun exposure. On occasion, the skin may sag enough to partially obstruct vision. This condition also lends itself well to surgical correction, which removes the sagging, tired skin, and restores a more youthful, rested appearance. In addition, eye makeup can also be worn more effectively. Women who have both upper lid bags and excess skin are also good candidates for this corrective procedure. The removal of excess skin will produce a cleaner appearance to the upper eyelid crease.

* LOWER EYELID FULLNESS OR BAGGINESS: This problem may gradually develop with age, or it may be a familial, inherited characteristic. Both men and women can achieve considerable improvement with this procedure, which can be performed at an early age if desired. A newer procedure, called a "transconjunctival blepharoplasty" avoids an external scar. This operation, developed by Beverly Hills cosmetic surgeons for their celebrity patients, has been performed by Dr. Swinehart for three years. This procedure effectively removes the tired, sagging, 'bags' from under the lower lids.

* EYELID FULLNESS IN MEN: Male patients benefit most from reduction of the lower eyelid bags that produce that tired, aging, overworked look. Upper eyelid surgery is, of course, effective, especially in the elderly, where vision is obstructed. For younger men, the results are moderate and subtle; the "surgical look" is avoided.

* SAGGING OR DROOPING EYEBROWS: These conditions can be corrected by elevating the eyebrows via a brow lift (excess skin removed from the forehead) or coronal lift (entire forehead lifted by removing excess skin from the scalp), in which the scar is hidden by your hair. These are separate operations, but may be performed at the same time as a blepharoplasty.

HOW IS THE PROCEDURE PERFORMED?

Upper and lower lid blepharoplasties are separate procedures, but are frequently performed simultaneously. On the upper eyelids, a small, fine incision is made with precision in a carefully-marked area, designed to be eventually hidden in the new eyelid crease. Excess skin, as well as bulging fatty tissue, are removed as needed. Fine stitches (sutures) are placed in the skin; these disappear or are removed in one week. In most instances, the small scar practically disappears in two to three months (Fig. 1).

Lower eyelid surgery is often performed through an incision hidden inside the eyelid, so that a scar does not result. On occasion, however, it may be made under the eyelashes. The excess fatty tissue that produces your 'tired bags' is then trimmed and removed. Occasionally, if your lower eyelid sags, it can be corrected by a "tightening" procedure (Fig. 2).

IS IT PAINFUL? WILL I BE ASLEEP OR AWAKE?

Your procedure will be performed under 'twilight sleep', accompanied by very effective local anesthesia. You will be awake enough to respond to commands during the operation, but probably will not remember much of this. With the local anesthesia, you will feel no pain during the procedure. Any postoperative discomfort is generally short-lived and easily controlled with analgesics.

WHAT ARE THE AFTER EFFECTS?

Since you will have been given relaxing medication, someone will need to drive you home after your eyelift. You will want to rest at home as much as possible during the first day or two, eating light meals, and applying ice to minimize swelling. We will want to see you in the office the day after your surgery. Stitches will either dissolve or be removed in five to seven days.

WHEN CAN I RETURN TO WORK?

Some swelling and bruising are natural, and generally last 7-10 days. Contact lenses can be generally restarted after this time. Eye makeup can be restarted when sutures are gone and most crusting has resolved. In general, however, you can work prior to this time if you would wish to.

WHAT ARE THE RISKS? IS IT SAFE?

With the numerous refinements added to these procedures in the recent past, side effects and complications are relatively uncommon. During the procedure, the eyeball is carefully protected from the surgical instruments. Visual impairment is extremely rare, occurring in approximately one in 50,000 cases. The other occasional risks can be discussed with you prior to the procedure.

WILL IT BE SYMMETRICAL AND EVEN?

Great care is taken prior to the procedure to locate, measure, and mark the exact amounts of skin and fat to be removed. Immediately after we have finished, we will have you sit up to examine you again for any irregularity. On occasion, a "touch-up" may be desirable if changes becomes apparent after the eyelift.

AFTER THE BAGS ARE GONE, WILL ANY WRINKLES OR DARK CIRCLES REMAIN?

Upper eyelid wrinkles are generally considerably improved by upper lid blepharoplasty. However, 'crows' feet' or lower lid wrinkles are generally not improved by lower lid blepharoplasty, although they usually will not worsen even after the bags have been removed. These lower lid wrinkles and lines are generally best treated by chemical peeling. Additionally, 'dark circles' under the eyes that are not caused by shadows from the bags will not disappear, and must be treated by chemical peeling, Retin-A, or hydroquinone (fading cream), or laser techniques.

CAN BLEPHAROPLASTY BE COMBINED WITH OTHER PROCEDURES?

Brow lifting, coronal lifts, and face lifts can, and often are, combined with upper and lower lid blepharoplasty. However, chemical peeling is never performed at the same time as an eyelift; it must be delayed until several months after your healing is complete.

WHAT IS THE COST? WILL IT BE COVERED BY INSURANCE?

The cost has been considerably lowered in recent years by performing the procedure in the office surgical suite rather than in the hospital (albeit with full monitoring and care from trained registered nurses). Upper lid blepharoplasty may occasionally be covered by insurance or Medicare if vision is obstructed by overhanging lids. Lower lid blepharoplasty, however, is always considered cosmetic. The Denver Dermatology Center now has financing plans available for patients contemplating eyelid contouring.

HOW LONG HAS THE DOCTOR BEEN DOING THE PROCEDURE?

Dr. Swinehart received blepharoplasty training at the Jules Stein Eye Institute at UCLA in 1988, and has performed the procedure since that date. He has also studied this procedure with a number of prominent cosmetic surgeons and ophthalmologists in Atlanta, Newport Beach, Los Angeles, and Beverly Hills. He completed his dermatology residency at the University of Colorado Health Sciences Center (1975 through 1978). He has been board-certified in Dermatology and Dermatologic Surgery since 1978. Dr. Swinehart is currently President of the Colorado Society for Dermatologic Surgery, and is President-elect of the Colorado Dermatologic Society.

WHAT DO I NEED TO DO TO SCHEDULE A PROCEDURE?

At the time of the initial consultation, Dr. Swinehart will carefully evaluate you and determine your needs, problems, and types of corrective procedures that may be possible. Before and after photographs and patient references are available in the office. You will also need a detailed eye exam performed by your eye doctor.

Two weeks before the procedure, a preoperative visit will be scheduled. At this time, an extensive exam will generally be performed, and photos will be taken. Lab work will be obtained, and your prescriptions will be discussed with you. Your signed consent will be obtained, and preoperative and postoperative instructions will be discussed in detail.

Please feel free to write or call with any further questions that you may have. Our fulfillment depends on your eventual satisfaction.

We are here to help you!
James M. Swinehart, M.D.

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