Introduction: Eyelid surgery, blepharoplasty, is a procedure to remove fat, and usually excess skin and muscle, from the upper and lower eyelids. This surgery can correct drooping upper lids and puffy bags below your eyes, features that often make one look older and more tired, and may even interfere with proper vision. Blepharoplasty will not remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or browlift. Blepharoplasty is a popular procedure because we often first see the signs of aging around our eyes.

Candidates for Blepharoplasty: Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, think carefully about your expectations and discuss them with Dr. Shienbaum. The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

Surgical procedures: Blepharoplasty normally takes one to three hours to complete, depending on the extent of the procedure (upper or lower or both). The technique used for your surgery is dependent on your specific anatomy and the desired results.

Upper Blepharoplasty: During upper eyelid surgery, Dr. Shienbaum carefully removes excess tissues to sculpt and rejuvenate the appearance of the upper eyelid. Because the incision is hidden within the eyelid crease itself and is nearly invisible, a very natural appearance is possible. Occasionally, the excess skin in the upper eyelids is actually caused by sagging of the eyebrows, which then pushes the skin just below the brows onto the upper eyelids. In this case, a forehead or brow lift may be required rather than, or in addition to, an upper lid blepharoplasty.

Lower Blepharoplasty: During lower eyelid surgery, Dr. Shienbaum removes or repositions the fatty tissue that causes bags under the eyes. This can usually be performed through a small incision inside the lower eyelid that is completely hidden. Occasionally, a patient may have excess skin or muscle tissue that requires a small incision under the eyelashes.

Planning your surgery: Dr. Shienbaum and his staff at Brandon Plastic Surgery welcome you to a complementary initial consultation during which your desires will be discussed. In your initial consultation, you will visit with the professional staff that will take your medical history. The Doctor will evaluate your health, conduct an examination, and recommend the surgical technique, which is most appropriate for you. Dr. Shienbaum also will explain the anesthesia that will be used during your procedure. The staff will provide you with photos of previous patients so that you may better comprehend likely results. The facility where your surgery will be performed will be explained, as will the expenses involved. Insurance carriers generally do not cover blepharoplasty, since they generally deem it to not be medically necessary.

Upon your decision to proceed with this procedure, the staff will work with you to arrange a surgery date, review consent forms, and take photographs. Dr. Shienbaum uses an advanced digital imagery camera and storage on an automated imagery filer to immediately record photographs.

The staff will also provide you with instructions in preparation for your surgery. These will include guidance on eating, drinking, smoking, and the taking or avoidance of certain medications and vitamins. You will need to arrange for transportation from the facility and should have some assistance to help or to provide care following your surgery.

Where your surgery will occur: Dr. Shienbaum will perform your blepharoplasty in a local, fully accredited ambulatory surgical facility. While blepharoplasty is typically conducted in an outpatient facility, Doctor Shienbaum has privileges at area hospitals where he is recognized as a board-certified Plastic Surgeon and Otolarnygologist.

Your surgery and anesthesia: Upon your arrival for your surgery, the anesthetist will initiate an intravenous (IV) line. The IV will be used to provide your anesthesia and appropriate medications and hydration during the surgery and your recovery period. Depending on your case and the facility, either general anesthesia or a shallower 'sleep', known as IV sedation, are usually employed.

As previously mentioned, blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you're having all four eyelids done, Dr. Shienbaum will usually work on the upper lids first, then the lower ones. In a typical procedure, he makes incisions following the natural lines of your eyelids: in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend to the outer corners of your eyes. Working through these incisions, Dr. Shienbaum separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are closed with very fine sutures. Dr. Shienbaum will lubricate your eyes with ointment and may apply a bandage After completion, you will be moved to a recovery room or area.

While in recovery, a nurse will be constantly monitoring your vital signs and will ensure that you are comfortable. Recovery time is dependent on the anesthesia used and your individual physiology. A normal recovery stay of one to two hours should be expected. A member of Dr. Shienbaum�s nursing staff will contact you in the evening to check on your status. It is important that you provide the staff with a contact phone number.

After your surgery: You will likely feel light-headed the first 24 hours after your procedure. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication Dr. Shienbaum prescribes. You will keep your head elevated for several days, and use cold compresses to reduce swelling and bruising. Bruising varies for each patient, but normally reaches its peak during the first week and resolves within two weeks to a month. You'll be shown how to clean your eyes, and use the prescribed eye ointment, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing and sensitivity to light. Temporary changes in your eyesight, such as blurring or double vision, have been reported. Any complications noted should be immediately brought to the attention of Dr. Shienbaum.

You will be seen in our office on the day following your surgery. During this visit you will be evaluated and provided with further post-operative instructions, as needed. Dr. Shienbaum will follow your progress very closely and sutures normally will be removed within a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside.

You should expect to be up and around in 24 to 48 hours following your surgery. You should be able to read or watch television after two or three days, keeping activities minimal for three to five days, and conducting no strenuous activities for about three weeks. If you are a contact lens wearer, you won't be able to insert lenses for at least two weeks, and even then they may feel uncomfortable. Most patients are ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing and Dr. Shienbaum's instructions, makeup to hide remaining bruising may be applied. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a sunblock when you go outdoors. Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line.

Frequently asked questions: This section provides information in response to questions or subjects routinely posed by our patients:

1. Post-operative effects. The post-operative effects are minimal and temporary. Minor swelling, bruising and discomfort should disappear within two weeks. Cold compresses will help alleviate these side effects.

2. Wrinkles around eyes. The blepharoplasty procedure will not eradicate the wrinkles around the eyes (crow's feet) nor will it elevate droopy eyebrow. There are other procedures designed for these purposes.

3. Complications. All patients will experience some bruising and swelling for a few days after the surgery. In addition, a temporary problem with closure of the eyelids is usually seen. Some patients may have temporary blurring of their vision, usually due to the ointments applied to the incisions post operatively. The theoretical complications of any surgical procedure, such as bleeding, infection, wound disruption and heavy scarring are also possible, but extremely rare.

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