Northern Virginia, Fairfax and Manassas
By: George Bitar, M.D. and Larry Lickstein, M.D.
Board Certified Plastic Surgeons
The eyes are the windows to the soul. They are our most cherished feature of individualism, beauty, and self expression. Sadly, they are also the first target in the face that is attacked by the aging process. Eyelid lifts can offer a huge improvement in the general facial appearance when the eyes start showing their age. Moreover, removal of the excess skin of the upper eyelid improves the visual fields tremendously as well as “adds light” to the room.
Women apply eye shadow and mascara, so they may notice laxity of skin and excess fat around their eyes sooner than men. Women tend to have eyelid lifts as early as their twenties. In men, it is usually an operation that is sought as early as in their forties. By having upper and/or lower eyelid lifts, the look of “being tired” or having not had “enough sleep” is replaced with a refreshed look and that “just came back from vacation” appearance.
Preparing for Surgery
An initial consultation is set-up where we discuss the eyelid lift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. If you have any existing eye condition, such as dry eyes, lasik surgery, glaucoma, or cataracts, you will be asked to see your ophthalmologist as well for surgical clearance. You are asked to stop smoking, if you are a smoker, two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are always welcome to come back for follow-up, even years after your surgery, free of charge.
The Upper Eyelid Lift Procedure
People fall into three categories: Excess skin of the upper eyelid, excess fat of the upper eyelid, or both. The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this procedure, is given antibiotics, and anesthetized in the operating room. Local Anesthesia is used to anesthetize the eyelids and give post-operative relief. Next, the excess skin is excised and the excess fat is removed from the upper eyelid, as needed. The incision is closed, leaving a fine scar in the upper eyelid crease that is usually imperceptible with time. Care is taken not to remove too much fat and give a “hollow” look.
The Lower Eyelid Lift Procedure
People usually seek lower eyelid lifts to improve the look of “bags” under the eyes. These “bags” are usually pockets of fat. Lower eyelid lifts can be performed in one of two ways: Either fat removal alone, or fat and skin removal.
If fat alone needs to be removed, then the procedure is fairly straightforward. The patient is anesthetized and an incision is made on the inside of the lower eyelid. The fat is removed without leaving any scars on the eyelid skin.
The second procedure is performed on people who need both skin and fat removed. An incision is made under the eyelashes along the length of the eye. Excess skin is removed, and fat is excised from the lower lid. The scar usually heals very well, and is difficult to find. If the lower eyelid has laxity, then the outer corner of the eye is tightened in a canthopexy procedure.
Benefits of this Eyelid Lift Technique
This technique is simple, safe, effective and yields excellent results consistently with a very low complication rate. When people have eyelid lifts, they want their character to be preserved. They want to look natural, and not like somebody else. This technique does exactly that.
- This technique is performed under anesthesia and requires about a week off of work for the upper eyelids or the lower eyelids only. Two weeks may be required if both upper and lower eyelids are done simultaneously. The swelling and bruising usually is much decreased in a week, and the patient becomes socially presentable.
- A patient who has eyelid lifts may experience temporary dry eyes, blurry vision, excessive tearing, or other non-specific symptoms concerning vision. These usually resolve within a few days to a few weeks from the surgery. As a result, a patient who has eyelid lifts may not be able to wear contact lenses soon after the procedure. Very occasionally, if the symptoms mentioned above persist, the patient is referred to their ophthalmologist for an evaluation and treatment.
How We Minimize Complications of Eyelid Lifts:
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class hospital with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding with eyelids is a serious matter. There have been few reports in the plastic surgery literature of cases of bleeding leading to blindness in an eye. Fortunately it is extremely rare. Before surgery, our patients are tested to make sure they do not have any common bleeding disorders by their own physicians, and by lab tests. Furthermore, at the outset of the procedure, we inject the eyelids with a solution that will constrict the blood vessels and minimize the bleeding. The bleeding from this operation with this technique has been minimal, and has never gotten remotely close to blindness among our patients.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed a one-week course of antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after an eyelid lift is negligible.
Pulling Down of Lower Eyelid (ectropion)
A risk of this procedure is for the swelling, scarring, and perhaps aggressive skin removal to make the lower eyelids pull down giving a “sad puppy” look. In order to avoid this complication, we resect a conservative amount of skin from the lower eyelid and tighten the outer corner of the eye (a canthopexy) to counter the pull on the lower eyelid, thus having excellent results with lower eyelid lifts.
Inability to Close Eyes Completely
Due to swelling, scarring, and possible aggressive skin resection, especially when upper and lower eyelid lifts are performed simultaneously, the patient may be unable to close their eyes completely. To avoid this complication we perform a very judicious resection of upper and lower eyelid skin. Occasionally, we end up resecting more skin a year later to make a patient happy, but that is better than over-resecting skin during the initial operation.
Our office will provide you with a detailed post-operative instruction sheet that will be individualized to your needs. We usually see patients the day after surgery in one of our offices to make sure that everything is O.K., and that you are healing as planned. Multiple visits in the year after the procedure will ensure the best outcome possible.
For more information about this procedure call our office and speak to our friendly staff member at 703-206-0506.
Information on this web site is for information only. Do not use the information to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.