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Blepharoplasty, or cosmetic eyelid surgery is a procedure to remove excess skin and fat from the upper and lower eyelids. Eyelid surgery can correct drooping upper lids and puffy bags below your eyes, which are features that make you look older and more tired than you feel. Blepharoplasty can be performed alone or in conjunction with other facial surgery procedures, such as a face-lift, laser resurfacing or brow-lift. Blepharoplasty can enhance your appearance and your self-confidence. The best candidates for eyelid surgery are patients who are physically healthy, psychologically stable, and realistic in their expectations. Before you decide to have surgery, think carefully about your expectations and discuss them frankly with Dr. Burt Greenberg. PLANNING YOUR SURGERYThe initial consultation with Dr. Burt Greenberg is very important. A complete medical and ophthalmologic history is reviewed in detail. Specific symptoms, such as: dry eyes, need for eye drops, family history of glaucoma, collagen vascular disease, thyroid, or endocrine problems, and allergies must be discussed. Dr. Burt Greenberg works closely with ophthalmologists who will be asked to evaluate your eyes, and perform a complete ophthalmologic examination, including that of a tear production test. Dr. Burt Greenberg will carefully discuss your goals and expectations. He will discuss the techniques available and those procedures indicated for you. THE SURGERYBlepharoplasty is performed in Dr. Burt Greenberg's plastic surgery facility, The Great Neck Cosmetic Surgery and Laser Facility, which is accredited at the highest level ("C" level) by the American Association of Ambulatory Surgical Facilities (AAAASF). General anesthesia or intravenous sedation is used and is provided by Board-certified Anesthesiologists who work exclusively with Dr. Burt Greenberg. Blepharoplasty usually takes one to two hours. Generally, the upper eyelid will require a surgical incision following the natural contour of the eye. The incision is discreetly placed within the crease, extending slightly to the outer corners of your eyelid within the crow's feet. Excess fat is teased out and the skin is trimmed from the underlying muscle of the upper eyelid. Incisions are closed with very fine sutures that are removed approximately three to four days following the procedure. There are two techniques to perform surgical blepharoplasty of the lower eyelid. If you have a pocket of fat beneath your lower eyelids, but do not need to have any skin removed, a transconjunctival blepharoplasty is performed. The fatty tissue is removed, as shown in figure 2, with fine forceps, but no skin is removed. In this procedure, the incision is made inside the lower eyelid leaving no visible scar. At this time, the lower skin may be tightened with Erbium or CO2 laser treatments to help improve fine rhytids (wrinkles). Laser treatments can also be used to improve the appearance of the crow's feet or laugh lines. (Figure 3). Alternatively, if the lower eyelid has excess skin, an open blepharoplasty will be performed. In this case, skin is removed as well as elimination of the fatty pockets. An incision along the lower eyelash lines will be made extending to the crow's foot similarly to the upper eyelid incision. Sutures are used to close the incision. AFTER YOUR SURGERYFollowing the procedure, Dr. Burt Greenberg will lubricate your eyelids with ophthalmic Bacitracin ointment. Your eyelids will feel tight, irritated and sore as the anesthesia wears off, but you can control any discomfort with Tylenol #3, Percocet, ophthalmic Bacitracin ointment, lacrilube, and contact lens eye drops. If there is any severe pain, Dr. Burt Greenberg should be called immediately. Your head must be elevated for several days and two pillows should be used for sleeping. For 24 hours, cold compresses or cold saline dressings should be used on the eyelid area to help reduce swelling and bruising. Bruising, which reaches its peak during the first week and generally lasts anywhere from two to three weeks, varies from person to person. In the first week, you may experience excessive tearing, sensitivity to light, temporary changes in your eyesight such as, blurring or double vision secondary to edema and from ophthalmic Bacitracin ointment. Dr. Burt Greenberg will remove your sutures approximately three to five days after the procedure. At that time, you should be able to read and watch television, but you will not be able to wear contact lenses for about two weeks. Most patients feel ready to resume normal activities in a week to ten days and wear make-up to hide the bruising. You may be sensitive to light and other irritants for several weeks, so you should wear sunglasses and use #30 sunblock. Healing is a gradual process and is
highly individual. The incisions, including the laser treated region,
may remain pink for several months or more after the procedure. Eventually,
the incision sites and laser areas will fade away. In the occasional
patient, the tear film layer is altered, which may prompt a refractory
alteration. Very commonly, Dr. Burt Greenberg will perform cosmetic
surgery of the eyelid with adjunctive procedures such as other types
of facial rejuvenation. |
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 Figure 1 Typical patient illustration demonstrating excess fat and skin in the upper eyelid, creating hooding and ptosis. The lowere eyelid shows excessive fat creating a "negative vector" convexity. |
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 Figure 3 |
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BURT GREENBERG,
MD. FACS
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