Blepharoplasty (Eyelid Surgery)

Before Surgery

Our staff will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and medications. If you smoke, we will ask you to quit for at least two weeks before and after your surgery, since smoking may have an effect on how well you heal. You must stop all anticoagulant medications or herbal preparations such as aspirin, ibuprofen, vitamin E, St. John's Wart, gingko, garlic or ginseng 10 days prior to surgery. You may be required to take antibiotics to prevent infection.

For an upper eyelid blepharoplasty, Dr. Bentkover will carefully mark your upper eyelids prior to surgery with a temporary marker. An incision is made in the natural crease of the upper lid. Once healed, it is usually not noticeable when the eye is open. An appropriate amount of skin can be removed through this incision. For the lower eyelid blepharoplasty. Dr. Bentkover usually uses a transconjunctival approach. This technique for lower lid blepharoplasty involves an incision inside the lower lid so that there is no visible scar. It can also help prevent a drooping of the lower eyelid (excessive scleral show or ectropion) sometimes seen with external incisions. He may make some temporary marks on your skin to outline the lower eyelid fat pads.

The Surgery

A youthful lower eyelid has somewhat of a convex appearance on profile. In patients with excess fat that has moved forward with aging (commonly called "bags") the convexity has often become excessive and can even cause shadows on the eyelid that make it look darker. The operation for this condition consists primarily of a tightening of the fat and the membrane holding it (the orbital septum) and/or a removal of some of the excess fat. Laser resurfacing or Portrait PSR³ Plasma Skin Rejuvenation often further enhances the appearance of the eyelid by tightening the eyelid, restoring a more youthful appearance to the skin. The goal is a tighter but not overly flattened eyelid. In patients with a loss of volume in the lower eyelid that causes a hollow appearance or a deep "tear trough", the lower eyelid blepharoplasty is designed to restore the slight youthful convexity by adding volume. Common techniques include moving part of the fat pad into the "tear trough" (fat transposition) or moving upper cheek fat into the horizontal hollow of the lower eyelid (SOOF lift). As with the fat removal/tightening techniques, here too the skin may need to be tightened with a skin resurfacing technique. Also, various techniques may be used on one eyelid or another, depending on what is needed to achieve your goals.

Upper eyelid surgery is often performed with just local anesthesia in our office operating room. The discomfort is usually minimal, basically only the discomfort of the very brief anesthetic injection. If you wish, we can also give some oral medication prior to the procedure to help your relax. For safety reasons, we generally recommend intravenous sedation or general anesthesia for lower eyelid surgery.

Surgery performed under local anesthesia may be performed in our office operating room in our suite at Worcester Medical Center, Worcester, MA or in our office in Stoneham, MA, whichever is more convenient for you. Procedures requiring intravenous sedation or general anesthesia are usually performed in the Day Surgery Unit at Saint Vincent Hospital in Worcester Medical Center, Worcester, MA or at the Massachusetts Eye and Ear Infirmary in Boston.  We are confident you will find all of these facilities to be state-of-the-art, comfortable and very patient friendly

Recovery: What to Expect

The area surrounding the eyes will remain swollen in the days following the surgery. With conscientious application of ice packs, it should begin to subside after the second or third day. Application of ice packs is important to minimize the swelling and temporary discoloration. Some temporary blurring of vision is normal. Sutures are necessary only in the upper eyelid incision and usually dissolve in a week. Noticeable swelling and bruising will persist for about 10 days or so, but usually you can begin wearing makeup in a week. You may expect to resume normal activity within a week to 10 days, except for strenuous exercise, and start enjoying your new look within approximately 14-21 days. You may resume strenuous exercise in about 3 weeks. You can go for walks or get on a slow treadmill or elliptical machine at 10 days. It may take about 6 months for the upper lid scars to fade to their final appearance and can take up to 3 months for slight to moderate residual swelling to subside. The scars generally hide nicely in a crease and or can be easily hidden with eye makeup. In the lower eyelids, skin treated by resurfacing is "new skin" and yours to protect from the sun.  With smart skin care, second resurfacing procedures may be desired but are unusual. Also, it is unlikely that the "bags" will recur as bad as they were, because fat has been removed. Revision surgery for the upper or lower eyelids might be desired 8-15 years later or never.

Complications are uncommon in Dr. Bentkover's experience. However, complications can occur with any surgery and may include bleeding, excessive swelling, delayed wound healing, infection, drooping of upper or lower eyelid, asymmetry, double vision and dry eyes. Yes, blindness is a risk and an extremely rare complication of any eyelid operation done by any surgeon; it is generally related to excessive bleeding. As already stated above, you must stop all anticoagulant medications or herbal preparations at least 10 days prior to surgery. This includes aspirin, ibuprofen, vitamin E, gingko, garlic pills, ginseng and St. John's Wart. Smokers also have more bleeding, do not heal as well as non-smokers, and stay swollen longer. To help this situation as much as possible, you will be asked to stop smoking two weeks before surgery and not resume until 1 month after sugery (a good time to just stop smoking for good).