Blefaroplasty and aftercare

(Eyelid Surgery)

Arnoldo Fournier M.D., F.A.C.S. ©

If you wish to decrease the tired, wrinkled, and swollen appearance manifested by the excessive lines in your eyelids, you are a candidate for a Blefaroplasty or an Eyelid Surgery. These lines are the result of excessive skin, and bags of fat which result in bulging filled with retained water. Some of these pouches of fat might have suffered some kind of herniation which is noticeable within the skin of the eyelids. Some fat is removed and other is repositioned. This procedure also broadens the visual field (approximately one millimeter or a twentieth of an inch) from the top to the bottom, and it improves the contour of the superior and inferior eyelids.

The fat removed form the upper and lower eyelids never grow again. The scars are hidden in the upper crease of the eyelid or just below the eyelashes in the lower eyelid. After the surgery, your eyes will seem more alive, and vivid.

The surgery is normally done under local anesthesia and sedation. The patient may remain at Hospital Santa Rita several hours, on an outpatient basis or stay over night if recommended by Dr. Fournier. This surgery can be done simultaneously with other plastic surgery procedures such as facial remodeling, liposculpture or breast surgery.

BEFORE THE SURGERY EVERY PATIENT MUST:

  • Schedule an appointment with Dr. Fournier at his office. During this visit you can ask him any questions you might have about the surgery.
  • Have a complete medical check up, an electrocardiogram and laboratory blood and urine tests; including a complete whole blood count, partial tromboplastin time, prothrombin time, platelets, and HIV. If you are over forty five years old, a lipid blood profile is also needed with total Cholesterol, HDL and LDL, their ratio, and triglycerides. Tests are valid for three months prior surgery
  • Take antibiotics such as Augmentin 500mg, (one capsule three times a day with each meal) Cipro or Ceclor 500mg (one capsule twice a day with a full breakfast and dinner); two days before surgery, the day of the surgery, and seven more days after the surgery.
  • Inform Dr. Fournier your daily vitamin and medication intake.
  • Notify Dr. Fournier if you have developed a cold or the flu a week prior your surgery date.
  • Please avoid: aspirin, more than 500mg of Vitamin E, ginkobiloba, ginseng, or any blood thinners two weeks prior your surgery. Also avoid alcohol intake, and passive or active smoking for one month before and one month after the surgery. Remember that nicotine and alcohol delays and might even complicate your healing processes. Six weeks before surgery suspend and AVOID estrogen or progesterone derivatives or any female hormones.

THE DAY OF SURGERY

  • Please brush your teeth, but do not eat or drink coffee or tea.
  • Please do not wear make-up, remove your contact lenses or dentures before the surgery. Do not put any moisturizer on your eyes or face.
  • Please remove your nail polish and contact lenses.
  • The evening and the morning prior your surgery, clean the operative area with soap and water.
  • Please do not bring any jewelry or valuables to the Hospital.
  • Please wear a robe, housecoat or warm up suit that buttons or zips in the front and flat shoes after the surgery. No tight-fitting clothes.
  • Someone must drive you home, to your Hotel, or to the Recovery Home you choose to stay at.

* Postoperative instructions regarding activity, medications and office visits will be given following your surgery.

AFTER THE SURGERY:

  1. Place ice cubes or crushed ice into a plastic bag, covered within a towel (to avoid the burning on the skin) on your eyes immediately after the surgery for at least an hour or two. This relieves the pain and helps diminish the post-operatory swelling.
  2. Artificial Tears are used 2 drops every 3-4 hours during daytime for six weeks. Genteal or Vidisic lubricant will avoid the drying of the cornea caused by the opened eyes during sleeping time, please use a bit in the inner corner of your eye before going to sleep for 4 weeks.
  3. Always wear dark glasses (polarized and containing UV protection) after surgery during the daytime; this helps preventing acute conjunctivitis. In case the person develops conjunctivitis the medicines some ophthalmologists prescribe are antibiotics without cortisone like: Tobramicina drops, 1 or 2 drops every 2 hours during daytime and Tobramicina ophthalmic cream at night time. They should be applied near the lachrymal area on each eyeball.
  4. On the third week after surgery, apply Lacri-Lube or Duo-Lube, (In the USA you can buy it over the counter at any drugstore) and use it for six weeks or more as needed.
  5. The oral antibiotics Azitromicina (Zithromax) 500mg (once a day) or Augmentin 500mg, Ceclor 500mg or Ciproxina 500mg, (twice a day) should be taken with sweet juice at breakfast and dinner time. Start taking those two days before surgery and for 8 more days after surgery.
  6. In case of pain, take Tylenol or Winasorb every 4-6 hours.
  7. Please open and close your eyes (squinting) 200times. Please do it stronger each day to obtain normal movements and to decrease the swelling of the eyelids. During the first two to three months you might feel your eyes do not function properly, this is a normal recovery phase. After six months to twelve months all eye movements will be back to normal.
Please AVOID:
  • Stress and anxiety after surgery
  • Do not bend over, nor put pressure on the head or neck
  • Avoid alcohol, smoking or being around smokers, aspirins, exercising , motrim, alka seltzer, and Vitamin E for one month after the surgery.
  • Avoid visiting the sauna, and showering or bathing with hot water for one month after the surgery

All of these will prevent the Hematomas (collection of blood under skin). The Hematomas delay the healing process and will show in the lower eyelids. When there is an excess of Hematoma with a lot of contraction, the lower eyelid can be pulled down for four to six months, also known as transient ectropion.

What to expect after surgery:
  • An excess of bleeding normally occurs during the first 72 hours
  • Infections are unusual because of the use of drops, antibiotics and creams prescribed by the surgeon. If an infection occurs, please contact Dr. Fournier immediately
  • The eyelids open completely six weeks after surgery
  • The eyelid might not close completely during your sleep
  • Some asymmetry during the healing process is normal after surgery; one eyelid can be drop more than the other or heal faster than the other. If this occurs, three weeks after the surgery you can massage them gently during nighttime.
  • The skin in lower eyelids (sometimes as far as the cheek bones) might darken during the first six months after surgery
  • After the first 6 weeks after surgery, some people might develop an excess of tears, redness, burning sensation in the eyeballs, pus or drainage. Doctors call this acute conjunctivitis. The reason is the exposure to the dirt in the air, smog or bacteria.
  • In some cases, the movement of the eyelids needs to be restored, so the patients must squint the eyes (open/close movements) several times (200 times) everyday after the procedure.