Aspirin bottle

Aspirin should be avoided at surgery time

Bleeding and bruising are a part of any eyelid surgery. Knowing what blood thinners to stop and when to stop them is important to minimize bleeding complications with eyelid surgery.  Most people are started on blood thinners by their primary care doctor or their cardiologist.  These medicines reduce the risk of blood clotting inside of vessels, which can cause complications such as heart attack, stroke and pulmonary embolus.  It is important that you speak with your doctor about the safety of stopping blood thinners temporarily for surgery.

Common Blood Thinners

While there are hundreds of medications that affect how well your blood clots, a few are very commonly used. These fall into a few categories.

Aspirin and aspirin containing medicines

Aspirin, in my experience, is one of the most dangerous blood thinners when taken around surgery time.  Not only does it make stopping bleeding during surgery very difficult, it’s effects can last weeks from when you stop taking it.  Also, many of our patients don’t even mention aspirin when asked about the medications they are taking. They think it is so trivial, almost like a vitamin, that they don’t have to mention it.  Aspirin causes platelets to not stick together. Once taken, any platelets in your blood will be permanently affected. Thankfully, your bone marrow is always making platelets, but it takes 10-12 days to replace all of them. Thus, you need to be off aspirin for 10-12 days to completely remove its effect.  Watch out for medications that contain aspirin mixed with other drugs, such as Alka Seltzer and Excedrin.

NSAIDS

Many other common pain medications cause thinning of the blood.  Ibuprofen (Motrin, Advil) and naproxen (Aleve) are the most commonly used.  They are slightly less potent than aspirin with respect to thinning the blood, but work by a similar mechanism and need to be stopped for 10-12 days as well.  Like aspirin, NSAIDs can be found mixed with other medications.

Prescription Anticoagulants

Coumadin (Warfarin), Heparin and Plavix have been the staple prescription blood thinners for many years, but lots of new medications have come on the market in the past few years. Xarelto, Eliquis and Pradaxa are newer anticoagulants that also can cause serious bleeding complications during and after surgery.  If you are taking these medications, chances are you have a more serious condition and should always speak with your doctor prior to altering your dosage or stopping it.

Vitamins and Herbal Remedies

Many vitamins over-the-counter remedies, such as Vitamin E and fish oil, thin the blood and can cause surgical complications.  Some of these take up to 3 weeks to lose their effects.  Be sure and share all your medications with your doctor, including over-the-counter medications you may not think are important.

See this article for a list of medications to avoid at surgery, and speak with your surgeon and primary care doctor prior to stopping any medication.

Lower eyelid blepharoplasty is commonly performed along with an upper eyelid blepharoplasty (eyelid lift). Lower eyelid blepharoplasty helps to remove baggy lower eyelids and take away the shadows that make your eyes look tired.  Here are the most common questions, with answers, that we get from patients about the procedure.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: How is lower eyelid blepharoplasty performed?

Lower eyelid blepharoplasty is performed by making an incision through the inside of the lower eyelid (transconjunctival approach). Through this incision, the fat pads in the lower lids that form the bags are either removed or repositioned. This smoothes out the lower eyelids. Normally, skin is removed from the lower eyelid just below the eyelashes as well. This is closed with dissolvable stitches.

Question: What will I look like right after surgery?

Lower eyelid blepharoplasty normally causes some bruising and swelling of the lower eyelids, which can travel into the cheeks. The bruising lasts about 2 weeks. The swelling can take 2-6 weeks to completely resolve, depending on your age and the health of your skin.  I tell people they’ll look like they’ve been in a fight, but won’t have significant pain.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: What do I have to do after surgery so I heal properly?

The most important treatment for lower eyelid blepharoplasty is to use ice on the eyelids 20 minutes, on and off, for the first 48 hours after the procedure. This will reduce swelling and speed recovery. You’ll also use antibiotic ointment on the incisions 3-4 times daily for the first week.  Avoiding strenuous activity and not touching the incisions excessively is also important to allow healing.

Question: How long does healing take?

Lower eyelid blepharoplasty takes about 6 months to completely heal, but within 3-4 weeks, you’ll have a good idea of what your appearance will be like. You can conceal any of the mild redness with light makeup.

Upper and lower eyelid blepharoplasty

Upper and lower eyelid blepharoplasty, before and after

Question: How long does it last?

While your skin will keep changing after surgery, you can expect the lower lids to look great for many years. It is uncommon that we have to repeat lower eyelid blepharoplasty.

Question: How much does it cost?

Costs vary around the country and depending on if you have lower eyelid blepharoplasty along with other procedures.  As of March of 2016, when this article was written, we charge $2500 for the lower eyelids alone, when done in our office.  When done together with the upper eyelids, the cost is $4000. We also recommend having an anesthesia provider present, which costs around $300 extra.  When done in conjunction with other elective surgery in a surgery center, we charge $1500 for the lower eyelids, which doesn’t cover the extra facility and anesthesia charges.

Brow lift surgery, as mentioned in our last post, can be achieved by several different methods. We’ve already mentioned coronal and pre-trichial techniques. In this post, we’ll talk about endoscopic brow lift surgery, direct brow lift surgery, and the internal browpexy.

 

Endoscopic brow lift incisions

Endoscopic brow lift incisions

Endoscopic brow lift surgery

Endoscopic brow lift surgery is performed by making 2-3 small incisions just behind the hairline. Through these incisions, the forehead and brow skin and muscles are lifted off the bone, pulled up, and then held in place with either stitches or a fixation device. Like the other brow lift surgeries mentioned before, the head is wrapped for a few days afterward. Recovery is usually fast with minimal pain. Incisions are closed with staples, which are removed after about a week. Bruising tends to be minimal, unless paired also with an eyelid procedure. Pros: Less invasive than coronal or pre-trichial brow lift surgery due to the smaller incisions; scars are hidden within the hairline; it raises the forehead and brows giving a nice outcome. Cons: Because no tissue is removed, results can be temporary; may not be any more effective than browpexy, but has harbors more risk. My conclusion: Endoscopic brow lift surgery was once my surgery of choice for droopy brows. It seemed to offer the lowest risk of scarring and resulted in a nice looking brow elevation.  After performing dozens of these procedures and then watching patients long term, I found that the results just weren’t as compelling as I wanted. It seemed that most of the improvement came from the eyelid surgery done at the same time. I have almost completely stopped doing this procedure for this reason.

Internal browpexy

The internal browpexy is a way of lifting or supporting the brows using the same incision made to lift the eyelids. After excess eyelid skin is removed, further dissection is made under the eyebrows, which releases the muscles that hold them down, allowing them to rise. The brows are the stitched in a higher position. The eyelid surgery is then finished and the wound is closed. The eyelids are covered in antibiotic ointment. No bandages are needed.  Recovery is just like that of eyelid surgery, with some tenderness of the brows. The deep stitches take 6-8 weeks to fully dissolve, which can cause tenderness when the brows are touched.  Pros:  Least invasive of all the brow lifting techniques; can lift the brows 3-4 millimeters and prevent them from falling further; scars are well hidden. Cons: Because no skin is removed, it is likely to eventually fail as gravity and skin changes continue. My conclusion: I use browpexy on many patients who either don’t want or couldn’t tolerate a larger brow lift surgery. In many cases our goal is to simply keep the brows from falling further, which can happen after eyelid surgery. Browpexy does this well. I always explain that it isn’t a true brow lift and shouldn’t be expected to make a striking difference in their appearance. It is most helpful when the vision is being blocked by both the eyelids and brows and both need some attention.

As you can see, there are many ways to lift the brows. Brow lift surgery is well tolerated and most patient have great outcomes with better peripheral vision. If you have questions, feel free to call us at (801)264-4420.

Brow lift surgery is often necessary in patients with droopy eyelids. When the forehead and eyebrows descend, due to gravity and changes in skin, they push the eyelid skin down over the eyes, blocking vision.  With many patients I find that lifting the brows is the most important part of opening the eyelids back up. This is especially true in patients with a prominent brow bone and eyebrows that were low to begin with.  There are many options for brow lift surgery, all of which have pros and cons associated.  Here I will go through the most common techniques and explain what I do and don’t like about each.

Coronal brow lift

Coronal brow lift incision site

Coronal brow lift incision site

Coronal brow lift surgery is the “gold standard” for brow lifting, meaning it is often held and the most effective and long lasting surgery, to which all other techniques are compared. It involves making an large incision over the top of the head, from just above the ears on each side, meeting at the crown of the head (hence the name). With this technique, the entire scalp can be mobilized and moved, pulling the forehead and brows up and back. A large ellipse of scalp tissue is removed. The head is wrapped for several days and a surgical drain may need to be placed based on the amount of bleeding. Sutures are removed in 7-10 days. Coronal brow lift surgery is performed under general anesthesia. This technique works well for someone with a normal to small forehead. It will pull the hairline back and make the forehead appear slightly larger.  Pros: It is long lasting and very effective in pulling up the brows and smoothing the forehead; the incision can hide well in people with thick hair if created and closed properly. Cons: It requires a large incision with some shaving of the hair; it leaves a large scar, which can be noticeable if the adjacent hair doesn’t grow back or falls out; it moves the hairline back, making the forehead look bigger. My conclusion: coronal brow lift works well in a very select population, but is a much bigger surgery than most people need or want.

Pre-trichial brow lift

Pretrichial brow lift incision

Pretrichial brow lift incision

Pre-trichial brow lift surgery involves making an incision right along the hairline. The forehead and brows are then freed up and pulled upward. The extra skin is marked and removed and the incision is closed.  The head is wrapped for 2-3 days. Sutures are removed in 7-10 days. The brow lift surgery is also normally done under general anesthesia. Pre-trichial brow lift will shorten the forehead, which is good for patients with a normal or larger forehead who want to pull the hairline down, or don’t want it to move at all.  It is best suited to people who wear their hair forward, covering the hairline. The incision will be more visible, but fades over the first year and is faint by a year from surgery. It can be completely hidden with the right hairstyle.  Pros: Slightly less invasive than a coronal brow lift; it doesn’t move the hairline back and can be made to move it slightly forward; the dissection field is smaller and a drain is almost never used; it is long lasting. Cons: the visible scar must be hidden with the proper hairstyle; it is not suited to people with thin hair or a receding hairline. My conclusion: Although there are drawbacks, in the right patient, pre-trichial brow lift surgery gives excellent cosmetic outcomes and is a powerful, long-lasting way of lifting the eyebrows and smoothing the forehead.

In part 2 I will cover endoscopic brow lift surgery, direct brow lift surgery and the internal browpexy, which is becoming one of the most popular procedures combined with eyelid surgery to enhance the position of the brows without adding another incision.

Bumps on the lower eyelids

Syringomas are bumps on the lower eyelids, which I see at least a couple of times a day with various patients. They are benign tumors of the sweat glands, which form small, fleshy spots, usually around 2-3 millimeters in diameter.  Patients often ask if they can be treated or removed.  As they are cosmetic and don’t pose any risk to your vision, insurance won’t cover the cost of removal.  The treatments are fairly simple, however, and can be quite effective to get rid of them.

eyelid bumps called syringomas

Eyelid bumps called syringomas

eyelid bumps called syringomas

More eyelid syringomas

Treatments

Bumps on the lower eyelids (syringomas) can be treated most effectively with bichloroacetic acid (BCA). You may have heard of trichloroacetic acid (TCA) which is used for chemical facial peels. BCA is its cousin and works in a similar fashion. When applied to the center of the syringoma, it helps destroy the irregular tissue and allows the bumps to resolve without scarring.  Usually only one treatment is required, but sometimes multiple applications of the acid are needed to clear up larger growths.

Syringomas that don’t respond to BCA can be treated with electrocautery. The skin is numbed with an anesthetic injection and a thin electric probe is passed into the growth.  Typically one or two treatments are necessary to get rid of the lesion.  Electrocautery can cause some scarring or a visible depression.

Bumps on the lower eyelids can be safely treated in the office with good results.  Call our office at 801-264-4420 if this is a problem we can help you with.

imperfect doctorsAs a surgeon, one of the most difficult things I have to deal with is complications from surgery. Any surgeon that operates regularly will encounter complications. In most cases, these are unavoidable, resulting from the inadequacies of our current techniques and the unpredictable nature of the human body. They can also result from imperfect patients and imperfect doctors.

Imperfect Patients

We all like to think that we won’t be the one patient in 20 who’s surgery doesn’t work out as expected. I counsel patients before eyelid surgery that 5-10% of droopy eyelid surgeries fail. This is usually due to excessive swelling after surgery, post-operative bleeding, poor tissue strength and asymmetries that the surgery can’t address. Our bodies just don’t always respond to surgery exactly as we plan and knowing who will respond poorly isn’t always predictable. I’ve had patients from time to time get upset after surgery when an eyelid doesn’t stay where we put it.  This can almost always be fixed, but certain patients just refuse to accept that they have any responsibility for the surgery not coming out as planned. And by responsibility, I mean this in a rather indirect way. Our bodies are imperfect and don’t always heal or respond to the trauma of surgery as we’d hope. Some patients think that any medical problem they have can and will be fixed, on the first try, if they just do what the doctor has asked. Boy I wish this were true.  As doctors, we can only recommend the best course of action that works in the majority of patients, and then hope each individual responds to the treatment in a manner close to what we expect.

Imperfect Doctors

As doctors, we often get more credit than we deserve for “healing” a patient, but we also often get more criticism than we deserve when a treatment doesn’t work out. The truth is, we can only do our best, based on our training and experience. Often, though, this isn’t enough.  As imperfect people, we sometimes don’t figure out your problems on the first try. We also can’t always judge the perfect surgical technique to use, if such a thing exists.  I’ve seen patients with severe ptosis (droopy eyelids) who despite my best efforts, come back a few weeks later with one eyelid still drooping down.  Did I mess up the surgery? It’s possible, but as someone who has done thousands of eyelid surgeries I feel pretty comfortable that I always do my best given the circumstances I have to work under. That being said, some days surgery just seems harder than others and I know that not every surgery can be my best work.  My only recourse is that I never close up a patient until I’m satisfied I’ve done all I can. This leaves my imperfections in the hands of the patient to heal as best they can.

When you combine imperfect patients with imperfect doctors, you are bound to get surgical set-backs and complications from time to time. Understanding this, and having a surgeon willing to work with you to make things right once a problem occurs, is an important step in your preparation for any procedure.

Vanity mirror

VANITY AND COSMETIC SURGERY

We see all kinds of patients in our office from all different backgrounds, almost equal numbers of men and women. A common question or comment we get is “Am I being vain by wanting to do this?” when asking about an eyelid lift. Or others become immediately defensive stating “I’m not vain, but I think this needs to be done.” What is the best response for folks with these questions and concerns. Typically my answer is this: “Each day we get up and shower, comb our hair, possibly put on makeup, and do all kinds of things to make ourselves look presentable. Doing this type of surgery falls in that same vein. You want to look your best.” I firmly believe that many types of cosmetic surgery are just one other step in personal grooming. For some folks, who may be extremely bothered by a particular physical attribute, cosmetic surgery may be the best way to correct it. Does this constitute vanity? I think patients ask us this question for a couple of reasons.

The Costs of Vanity

The higher one-time costs of plastic surgery make many people think that it is some sort of luxury that they don’t deserve or they are spending way more than most people on their looks. Analyze the cost of an eyelid lift that may cost several thousand dollars versus the cost you spend each month or year on new clothing or makeup. When you look at the long term differences there isn’t much. Most of us spend on the order of a couple hundred to several thousand dollars per year on personal grooming. Over the course of just a couple of years the costs are almost the same. Most people would state that after plastic surgery they’ll have a very long term benefit from 10 or 20 years, possibly more. When thought about this way, it seems to be more of just a calculated expense.

What Others Think

Many are worried about what other people will think. This is probably the biggest hurdle to overcome. Many people feel that making a dramatic outward change tells other people that they are either very vain or just not comfortable with their body. The patients who I see get the most benefit psychologically and physically from plastic surgery are those that go in with realistic expectations. They have a certain aspect of their appearance that bothers them and that may also affect their daily living, such as heavy eyelids that restrict their vision. They don’t expect miracles but they do expect to look slightly better after surgery. They are focused more on how they personally feel about themselves and not what other people may think about them. These subtle changes after surgery thus bring them a lot more contentment.

Thinking of reasonable plastic surgery procedures as an investment in your long term personal appearance as well as analyzing your reasons behind doing it are important. If you can come to terms with these two thought processes, the question of vanity shouldn’t really enter the debate.

 

Natural eyelids: “Don’t make me look like Kenny”

(Part 2 of a series on eyelid surgery problems and how to deal with them)

Each day in my office, meeting with different patients who would like eyelid plastic surgery or upper facial surgery, the most common comment I get is “I just don’t want to look like Kenny Rogers.” I feel really bad about this, because I grew up listening to Kenny Rogers and watching the Gambler. I think Kenny Rogers has a lot of talent and it’s a shame he is constantly maligned. I started looking into what it is about his appearance that is so troubling to so many people. Kenny himself talked about his plastic surgery and how he feels it did not come out the way he wanted. This got me thinking about the conversation that patients need to have with their doctors before eyelid plastic surgery to ensure they’ll have natural eyelids when all is said and done.

Kenny Rogers before and after plastic surgery

Kenny Rogers: Before and after eyelid and brow lift

As I looked at Kenny Rogers’ before and after photos I noticed a couple of things. First of all, it appears that he has had a fairly aggressive brow lift and removal of fat. When you see his pictures from the mid 80’s, he has quite heavy brows and upper eyelids which gave him a distinctive look (i.e. natural eyelids). He was also a bit overweight, which filled in a lot of facial wrinkles. He was out of the limelight during his weight loss and surgery, so no one observed what was likely a gradual change. After surgery, he had a great reduction in the fat beneath his brows and a big change in the position of his eyebrows. His eyebrows are pulled much too high for what one would expect to see in a male brow (most male brows are flat and rest about at the edge of the upper eye socket). His new look gave him a startled look to the eyes. There was also a significant amount of upper eyelid fat that was removed during his eyelid plastic surgery, giving the eyelids a sunken in appearance. They almost appear to be stuck to his eyeballs. I’m sure that in his preoperative counseling with his doctor, this wasn’t perfectly communicated to him.

Strive for natural in eyelid plastic surgery

In my eyelid plastic surgery preoperative counseling, I try to discuss with my patients how to achieve a natural appearance. By deconstructing normal facial proportions, one can decide the ultimate look they are trying to achieve. For example, when looking at a teenage girl, in most cases the eyebrows will be high and arching. Over time, and with age, the eyebrows will become slightly more flat and will descend. If a woman in her 50’s or 60’s or older desires a brow lift, I would counsel her that the eyebrows should not be excessively high. This can result in a surprised look. The patient will look surprised for two reasons. One, the eyelids are so far open that they look startled. The second, one portion of the face looks overly rejuvenated while the rest of the face still maintains an aged appearance. Making more subtle changes, something some surgeons don’t seem able to do in many cases, will grant you much more metered and natural results.

Just the right amount of eyelid plastic surgery

Asking your surgeon to “do as much as they can” or “take out as much fat as possible” is a bad idea. The question you should be asking is that they take out just the right amount. This right amount should be discussed with your surgeon prior to eyelid plastic surgery and you should both be comfortable with it. It may even be preferable to do the surgery in two stages: starting out conservatively, with a second procedure only if necessary. I always tell patients that it is a lot easier to take more later than to put back what was already taken. Bottom line, it is important to have an honest discussion with your surgeon about realistic expectations and how your appearance will change. It’s my experience that most people don’t have a clear vision in their mind about how their appearance will change, and this is the most common reason why they are disappointed after surgery.

There is a lot of information on the web for and against having eyelid surgery. The few patients that have serious complications often stand out the most as they tend to be very vocal about what went wrong. One thing that often isn’t communicated well about eyelid surgery, however, is the roll that the patient played in some of these difficulties. There is no doubt some malpractice that goes on, but you as a patient can do a lot to avoid these problems by knowing a few things beforehand.

Understanding eyelid surgery risks

Most patients will take the time to understand the risk of their eyelid surgery, however, I am often surprised at how many patients never ask about what can go wrong in surgery. I try to take time with each patient and describe the most common problems that can happen, but there are always unanticipated set backs that can happen to anyone. Covering every one of these in our short time during a consultation isn’t always possible. Educating yourself and being comfortable with the risks are very important before agreeing to any surgery. For example, one of the most common complications or setbacks that we see in surgery is significant bleeding after surgery. This often happens because patients do not adequately educate themselves about the medicines they are taking that can cause their blood to be thinner that normal. Very often on the day of surgery, despite having had handouts and a lecture about the dangers of blood thinners, patients show up having not stopped any of the blood thinning medications and still wanting to proceed with eyelid surgery. It has become our policy to not proceed due to the possible complications. Very often, patients will not admit to using these medicines until after the surgery. One of the worst offenders is baby aspirin. For some reason, many people don’t even think of this a medication. Aspirin happens to be one of the most potent blood thinners people are taking and in my experience causes some of the most significant bleeding complications during eyelid surgery. Telling your doctor every medication you take, whether over the counter or prescription, no matter how insignificant you may think it is, is very important to having safe surgery.

“Perfection is the enemy of good”

This old adage is something many of us live by in plastic surgery. Too often, after surgery people will over analyze their appearance in the mirror and pick apart every small problem in detail that they feel the surgery did not correct. I have patients that come back week after week wanting every little bump attended to. Most of them when confronted with their pre-op photos can see the asymmetries and imperfections that we were dealing with. Imperfections and asymmetry are a natural part of our face and will not be completely corrected with surgery. Most of the true plastic surgery nightmares that I’ve heard about relate to people asking for repeat and revision procedures. The compounding problems that all of the scarring creates are generally what cause the most problems. Recently in the news, a patient was suing their doctor for not being able to close her eyes after eyelid surgery. The patient had multiple eyelid surgeries before and asked for another touch up for a small problem that she perceived. Unfortunately, the surgeon performed the procedure and I’m sure later regretted having acquiesced to the woman’s request. Trusting your surgeon when they say enough is enough is a good thing. They’ve seen a lot more bad outcomes than you could ever be aware of and their judgment should be heeded.

Patience is virtue after eyelid surgery

Lastly, patience is the most difficult part of any plastic surgical procedure. I find that when I see patients within a few days of surgery they tend to be much more tense than when I see them several weeks after surgery. Just seeing the improvement over time settles their worries more than any reassurance I can give them. True healing takes anywhere from 6 months to a year. Very few patients actually hear this when I explain it to them. After a few weeks they very often ask why they don’t look better, or if they’ll ever look normal again. Educating yourself on a realistic time frame of recovery after surgery can reduce postoperative anxiety. The take home message is educating yourself fully before taking the plunge into eyelid surgery. These are elective procedures and you need to be ready to accept the good results with the bad.

Posted by: Dr. Matheson Harris

Eyelid surgery pitfalls

Eyelid surgery, most often blepharoplasty or eyelid lifting, is one of the most common plastic surgeries done in America.  Most people have eyelid surgery due to excess skin hanging down over their eyes, which may block their vision.  Other times eyelid surgery is done to improve the appearance of the eyes.


Upper eyelid blepharoplasty

However, there are times when eyelid surgery is a bad idea, or must be done differently to achieve the best result.  Here are the most common reasons why eyelid surgery can go bad and what to do to avoid it.

Eyelid surgery pitfall #1: Droopy eyebrows

Some patients assume they need eyelid surgery when the eyelids appear heavy or full, but often the eyebrows are the bigger problem. As the forehead and brows descend, they push the eyelid skin down on the eyes. If a surgeon were to try and remove eyelid skin and fat without addressing the brows, they would end up shortening the eyebrow to eyelash distance, pulling down the brows further, and creating unusual facial dimensions. This can make the eyes appear worse and accentuate the problem.  Avoid this by comparing photos of you in your teens when the brows would have been in a normal position for you. If the brows look much lower, you need to discuss brow lifting along with any eyelid procedure with your doctor.

Eyelid surgery pitfall #2: Poor skin type

We all have different skin types, and some are better suited to healing after surgery than others. There are different scales based on both your skin color and how oily or dry you are. The one skin type I see the most problems with shows up in patients with thick, oily skin with large pores. Most commonly, this is seen in people who are overweight or obese. Unfortunately, being overweight is often associated with breathing issues including sleep apnea. These problems all conspire to make the skin heal very slowly. Swelling often lasts much longer.  In these patients, it is best to not do several procedures together, but rather space them out to not cause excessive swelling. Sleep apnea should be treated with CPAP or other appropriate therapy.

Eyelid surgery pitfall #3: Overly aggressive surgery

Sometimes surgeons get carried away with surgery, or don’t properly judge what a person’s tissues can handle.  This can lead to excessive removal of skin or fat, leading to problems with eyes closing or give the patient a hollow appearance.  Be aware of this possibility when you look at before and after photos and talk with the doctor about the specifics of what he/she is planning to do.  Don’t ask them to do “as much as possible”. They should be doing “just the right amount”, regardless.

Eyelid surgery pitfall #4: Unrealistic expectations

Any plastic surgeon’s most difficult job is managing patient expectations.  Patients often bring in photos of celebrities, asking to have their eyes look a certain way. Other times, they demand that surgery be as aggressive as possible to “just get rid of all those wrinkles”.  In both cases, patients don’t understand the art of knowing how much to do and when/if to do it.  I talk a lot more patients out of surgery these days then I ever thought I would when I first started.  A few things to consider. First, no one else has your anatomy and you can’t have someone else’s.  You are going to look how you will look after surgery. Don’t ask or expect to look like anyone else, even your sister. Second, as a facial plastic surgeon, I want all my patients to look their best after surgery. I wouldn’t intentionally do less just for kicks. If your surgeon recommends a conservative skin excision with your lower eyelid surgery, it is because he/she is worried about causing complications, not because they want to operate on you again in a year or two. A surgeon who is willing to do anything you ask for isn’t thinking critically about your needs.

Educating yourself about the potential pitfalls of eyelid surgery can spare you unnecessary grief later.  If you have any questions about eyelid surgery, you can email Dr. Harris at [email protected]