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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.

facial plastic surgery - eyelid lift

Upper eyelid blepharoplasty

Facial plastic surgery: Does it make you look younger or more attractive?

A recent study in the Journal of the American Medical Association: Facial Plastic Surgery looked at how much younger people appeared after certain facial plastic surgery procedures.  It involved one rater looking at before pictures and guessing the patient’s age and rating their attractiveness. A different rater did the same with the after photos and the results were compared. On average, the patients looked 3.1 years younger and were slightly more attractive. The problem with the study was that the same person didn’t see the before and after photos together, which is typically where the most difference is noted and what would happen in real life with a patient’s acquaintances.  But it does highlight a question: Does plastic surgery make you look younger or more attractive, and is this actually the goal?

Expectations around facial plastic surgery

When discussing patients’ expectations before eyelid & brow surgery, I try and stress that I’m not trying to shave off years, just trying to improve their peripheral vision with the added benefit that they won’t look as tired or angry.  We all know that there is “good old” and “bad old” when it comes to how people age.  Some patients, although into their 70’s or 80’s, still stand up straight, show good muscle tone and weight, and carry themselves like much younger people. While many patients in their 40’s to 60’s are just the opposite: overweight, sedentary, with poor skin and poor diet.  Plastic surgery isn’t likely to make this second group significantly more attractive or youthful, given all the other factors making them look prematurely older.  A red flag that someone is going to be unhappy after surgery, no matter how good the outcome, is their expectation that changing this one small aspect of their appearance will solve their problem of not feeling young or attractive.  It just doesn’t work like that.

What I hope my patients can understand is that we are all aging chronologically at the same rate, which no one escapes. No one can expect to look younger than the calendar suggests if they aren’t taking the best care of their bodies. We can slow the feeling of inevitable degeneration by first living a healthful life and only addressing those aspects we can’t otherwise change, such as baggy eyelids or a sagging brow, with facial plastic surgery or other procedure.  Patient’s with these realistic expectations are nearly always satisfied with their outcomes and will radiate both youth and attractiveness to the people they know and love.

 

Our second day of lectures and surgery was much like the first, only the Vietnamese doctors were eager to get their hands into the work and apply what we were showing them. On day one, a certain doctor followed me closely, recording with his cell phone several of my procedures.  He stood so close with his phone that at times it blocked my view.  I could tell he was paying close attention because he would comment if I did something slightly differently than I had explained in our lectures.  I would explain that every case is a little different and there is a time for following the textbook and a time for customizing your surgery for the patient. He wanted to know what prompted my every decision and was clearly a very perceptive and intelligent man.  On this second day, when I returned to start a particular case after scrubbing, I found him in my chair at the head of the bed.  I asked him if he was ready to lead the case, which he said he was.  I let him at it and he did a marvelous job.  He clearly had some surgical experience as he handled the instruments with confidence.  He would clarify the surgical steps with me just to be sure, but it was amazing to me how fast these doctors picked up our techniques.  I have no doubt they’ll be able to continue performing many of the surgeries we taught them. 

Dr. Call giving instruction

 
Recovery
 

Dirty feet, happy patient

 Our last day in Dong Anh was spent doing a few extra surgeries in the morning.  We then left our hotel there and moved to downtown Hanoi.  On our way we met with a few other hospital administrators.  It seems once word gets out that you are willing to come to Vietnam and bring equipment with you, lots of hospitals want to convince you to come the them on your next trip.  The following day we travelled out to Ninh Binh, an outlying area with a large eye hospital.  We looked at their needs and assessed what we could do on a future trip.  They then took us to a few of their nearby tourist sites, which was very nice.  We saw a thousand year old Buddhist temple and a newly built, massive pagoda.  The country-side was beautiful the people were all very gracious.  We look forward to returning soon.

 

God of Ninh Binh

 

Big pagoda

Making the decision to have a cosmetic procedure is a big one, and one you shouldn’t take lightly. When weighing their options, many people get too focused on one particular aspect, such as cost or reputation of the surgeon, while overlooking other important details. The following can serve as a checklist to consider before making the decision to commit to a procedure and surgeon.

Patient and scalpel

  1. First and foremost, find a surgeon you are confident will do the right thing for you.  Selecting a good doctor is a process in itself that I covered a few weeks ago on this blog.  To summarize the highlights, you need to seek out a person with quality experience, board certification and fellowship training, which ensures their colleagues have seen their work and have given the stamp of approval.  It is easy to pay for a weekend course in a procedure and set up shop doing it, but there is little to no oversight in the learning process and the surgeon’s skills are an unknown. You will also hopefully like this doctor and feel they treat you with respect. If they are marginal in their manners before you have surgery, their manners are unlikely to improve once they have been paid.
  2. Ask the surgeon to explain all your options, including those that don’t require surgery.  There is rarely only one way to do things and often the best treatment is no treatment at all.  Be wary of someone who has a cookie-cutter approach to all patients, steering them into the procedure he/she is most comfortable with or is most lucrative. My patients are always surprised when I end up telling them I wouldn’t have surgery in their case.  They seem at first shocked, then appreciative that I would direct them away from something that I’m in the business of doing. For a careful surgeon, however, it is a no-brainer.  Surgery is complex and creates myriad problems that must be overcome before a good outcome can result.  Doing a procedure when it isn’t indicated or in the patient’s best interest is just a recipe for regret for all parties concerned.
  3. Don’t choose based on cost.  Choose based on outcomes.  A surgeon who is significantly cheaper than everyone else has often lowered his/her prices to attract clients that word-of-mouth referrals aren’t generating. In tough economic times you will find lower prices, but don’t let this mesmerize you into overlooking other potential negatives of the doctor or facility.
  4. Know the risks.  Every surgery, no matter how simple or how great it turned out for your best friend, has risks of complications.  For example, I perform ptosis eyelid surgery, which is notoriously unpredictable.  Correcting ptosis, or a drooping eyelid, involves isolating delicate muscles and adjusting them to move the eyelid to an exact level, symmetric with the other side. During surgery we make careful measurements and even have the patient open and close their eyes to ensure symmetry.  However, it is not uncommon to have everything look perfect in the post-op area, then a week later after swelling and scarring have taken their toll, have the eyelid be slightly off.  A difference of only 1 millimeter is often unacceptable to patients and may need a revision.  Most good surgeons will spell this out to the patient before surgery, but almost no patient seems to remember this when it actually happens to them. When you go in knowing there can be complications and directly ask about them, you are less likely to be surprised when things don’t go exactly as planned.
  5. Understand anesthesia and its limitations.  Many cosmetic procedures are performed under sedation, not general anesthesia. This means the patient is awake, but given medicine for relaxation and pain by IV infusion.  Depending on the procedure, this anesthesia can leave the patient completely aware of what is going on during surgery. Most people will see that avoiding general anesthesia is a plus as you recover much quicker immediately post-op, can leave the surgery center after as little as 30 minutes, have no sore throat from a breathing tube, and are less likely to have nausea from anesthetic gas.  For others, the thought of being aware of surgery is too much and will result in anxiety.  Talk to your surgeon about exactly what your level of awareness will be and if you are comfortable.
  6. Inquire about the site for your operation. Will it be in a hospital, an outpatient surgical center, in the doctor’s minor procedure room, or in a reclined exam chair.  Different procedures require different support and certain more involved surgeries need to be done where help exists if something goes wrong.  If a surgeon insists on doing a procedure in their office, ask if you could have it done in a surgery center if you chose. If the answer is no, there may be an issue with the doctor not having credentials to perform surgery in an accredited surgical center. This is commonly a problem with physicians operating outside of their formal training. If a family practice physician decides to start doing liposuction by getting trained at a weekend course, they will likely not be able to convince a reputable hospital of surgery center that they are proficient enough to perform the procedure. They will have to perform the lipo in a medi-spa or outpatient office where they alone would be liable in the event of a complication. A doctor maintaining privileges at one or many hospitals is a sign that he/she has been cleared by both peers and insurance adjusters to perform quality surgery.
  7. Avoid surgeons who claim to be the only one doing a procedure. This is a tough one.  We all want the latest and greatest technique, but if only one person is doing something, it may not yet be tested for general consumption, or it may be just different to entice early adopters. You want proven surgical techniques that are accepted by the majority of surgeons because of their good outcomes. Look at the history of facelift techniques and you’ll see lots of procedures that have come and gone, trying to simplify the procedure and lessen complications, but many of them gave poor outcomes and were abandoned.  Find someone doing a tried and true technique with long-term patient follow-up results.
  8. Ask about recovery time. This varies widely from patient to patient and procedure to procedure. The majority of facial cosmetic procedures will leave you looking like you’ve been in a fight for a week or two, sometimes more. As with complications, patient rarely seem to remember the conversations we have before surgery about how bad they will swell and bruise, and they tend to be shocked the next day by their appearance. Knowing that you will look pretty rough for a few weeks, and that it will get better, will help your patience to wait out the outcome you are expecting.
  9. Ask about long-term outcomes. Gravity and aging are constantly working against our desire to look young and vigorous. A great surgical result today doesn’t tell you anything about what you’ll look like in 1, 5 or 10 years.  Ask your surgeon how long they expect the results to last, and then remember, they don’t have a crystal ball and everyone ages at different rates. As cosmetic surgery is expensive, consider having a procedure done once the improvement will be more noticeable and less likely to need repeating. This will also prevent that buyer’s remorse commonly seen when people find the surgery didn’t make the life altering change they were expecting.
  10. Manage your expectations. We all want to look like we did in our youth, but there are limits to the effectiveness of surgery. As I’ve said before, the hardest part of my job is helping people understand before surgery what they can expect after surgery. Remember the older you are, the more wrinkles present, the more advanced your problem, the more difficult it will be to restore the past look. The patients I find are most pleased after surgery are those who say things like “I don’t want to look 18 again, I just don’t want to look tired all the time.”  These are reasonable expectations from cosmetic surgery.  Patients that focus on every crease and fold as if those are the key to why they don’t look like a teenager anymore are in for a potentially disappointing and expensive experience chasing youth.