What is a “Transconjunctival” blepharoplasty?
I am glad you asked that question. A blepharoplasty is an operation that is used to resect the extra skin around the eyes and to reshape and redrape the residual tissues. For example, in some patients, the upper eyelids seem to sag. This in many cases causes so much sag that the patient complains that they cannot full see. The patient finds himself/herself subconsciously lifting their forehead to see. This can be seen when patients seem to look surprised when they want to look forward. The excess that is causing this visual blockage needs to be resected so that the patient can see properly. This is done rather easily. It needs to be done in the controlled setting of the operating room. However, it tends to take only about an hour. After the operation, the vision is slightly blurred but returns to normal by the time you leave the post-operative area. I have to also mention here that along with the skin we tend to take some of the underlying tissue and some of the bulging fat. The amount of tissue and bulging fat taken out really depends on how much needs to be resected. This is determined by pushing on the eye and seeing how much of the fat around the eye seems to “bulge” out.
The “transconjuctival” approach to the blepharoplasty procedure allows us to go through the tissues at the inside aspect of the lower eyelid. This allows us to forego placing any incisions around the eyes at all. For this same reason, there is a much less chance of having complications with scarring. When a transconjuctival approach is used, the fatty pockets are approached easily and resected. In many cases, this approach is complemented with the use of a laser treatment to tighten the skin. Let me explain. When the fat is resected, then the pocket becomes somewhat hollow. The worst situation would be is to leave the area hollowed out giving a deeper, older look to the eyes. To prevent this, in many cases, we then use the lasers to treat the skin of the lower eyelid and make them fresher looking and tighter. This gives a better more appealing look to the eyelids and
How painful is the procedure?
Like any surgical procedure, there is pain involved. Most patients comment that they have a mild to moderate amount of pain. Most of the pain seen with blepharoplasties is due to the actual incision or the swelling involved. In fact most complain more about the soreness
and aching sensation than actual pain. To help with the pain, we regularly give patients oral and intravenous pain medicines in the
post-operative period. Upon their discharge from the hospital, we supplement this with oral pain medication. It must be noted here that at the time of the surgery, the incisions are infiltrated with local anesthetic medication that lasts six hours, in an effort to help with
How long do I have to take off from work?
Great question. Most often I suggest to patients that they consider taking about 1 to 2 weeks from work. Let me elaborate. Once a blepharoplasty is done, the area around the eyes becomes swollen and in some cases becomes black and blue, ecchymotic as we call it. For a few patients, there is significant swelling to the point that the eyes are swollen shut. This only lasts a few days. After the first few days the swelling begins to settle and the ecchymosis starts to resolve. By the first week, a patient can easily return to their normal activities.
If they have light duty or an office job, they can return to it without difficulty. Patient may be on some pain medicines. This may complicate
the return to work. However, most patients are only on Tylenol by the end of the first week. By the end of the first week, the sutures usually come out. By the end of the second week, most of the swelling has resolved and the patient is back at work fully. The patient continues to stay out of the sun and to apply the anti-bacterial ointment to the wound every 6 hours. Rarely do patients stay inflamed past the third week post surgery.
What are the possible complications?
I am glad you asked that question. Like any operation, a blepharoplasty has a host of possible complications. These include infection, dehiscence, bleeding, contour irregularity, and blindness. Of these, the most concerning are bleeding, and blindness. We will discuss each. First, bleeding. Bleeding can occur with any operation. However, in the controlled operative setting, we are able to minimize any chance of excess bleeding and maximize the best overall result. As for bleeding however, the patient plays the most important role. Bleeding can best be prevented by the patient. Patients need to be off of any type of blood thinners such as coumadin, aspirin, plavix, and must also be off of vitamins and additives for at least three weeks. It may sound strange but many of the bleeding complications seen are due to the use of vitamins. So the patient by being diligent and thoughtful can be the best asset. Blindness can occur due to actual insult to the eye or due to the surgery, either by actual burn injury or bleeding behind the eye. This is best managed by a careful observation of the surgical field. The eye is protected with a shield throughout the procedure. If following the surgery, the eye is swollen, the surgeon will investigate as to the reason why. If there is a blood clot developing behind the eye, the wound needs to be simply opened and the area decompressed. This can easily be done without any permanent damage to the eye. For this reason, following surgery, if the patient is having any visual problems, they need to contact the surgeon immediately and let him know.
Can I combine this procedure with any other procedure?
Yes and no. Like any surgical procedure, there are limits
to what can be done and what is safe. As for the yes, it can
be combined with some other procedures. For example, I routinely
do this procedure with a facelit. In fact for a full face
lift, the eyelids have to be assessed and adjusted. It can
be done with a facial peel, dermabrasion, Botox, neck lift,
or a browlift. Any procedure that may be too long or too arduous
and place the patient at risk for significant bleeding or
significant anesthetic exposure would have to be deferred
and done in two stages. Please understand I say this without
knowing exactly what you, the patient, may have in mind. I
can only speak from my experience.
Am I a good candidate?
Plastic surgery is not for everyone. It involves certain risks like any operative procedure. As long as you are aware of this fact, you can be considered for the procedure. However, in every case, the patient is best served by a thorough evaluation of their history, their body and
their overall expectations. You as the patient have to be realistic and cognizant of what is possible and what is reasonable. Trust me I am from Beverly Hills and I have had the privilege of working with many of the famous groups of plastic surgeons in LA. I can simply tell you there is no magic. We offer an opportunity to help you with surgical procedures in correcting what you may think is abnormal about your body. Also please understand that for many patients no surgery is needed; just a friendly word of encouragement and confidence from the local plastic surgeon.