Blepharoplasty

with Dr. Thomassen

What is a Blepharoplasty?

A blepharoplasty is procedure designed to improve the appearance of the upper eyelids, lower eyelids, or both. It gives a rejuvenated appearance to the surrounding area of your eyes, making you look more rested, less tired, and alert. Dr. Thomassen performs blepharoplasty procedures in his Fort Lauderdale Surgical Center.

Upper and Lower BlepharoplastyBy Dr. Thomassen

What are the different types of Blepharoplasties?

Upper Lid Blepharoplasty

Upper eyelid surgery removes excess skin mostly and sometimes excess fat from the upper eyelid. The fat can create a puffy appearing upper eyelid in the central or medial aspect. By removing this fat and excess skin, puffy eyes can look youthful again.

Upper Lid Blepharoplasty by Dr. Thomassen

Lower Lid Blepharoplasty

Lower eyelid blepharoplasty can remove excess skin that causes wrinkles in the lower eyelid. It also removes excess fat that causes bags.

Sometimes if only fat deposits is the concern with little excess skin, the procedure can be done with an incision inside the eyelid. This is called a Transconjunctival blepharoplasty. This avoids a scar on the skin. The benefit of a transconjunctival blepharoplasty is that since it does not violate the orbicularis muscle or septum because it approaches the lower lid fat pads from behind these structures, it causes less scarring and there is less risk of lower eyelid malposition or retraction.

Sometimes, a chemical peel applied to the lower eyelid skin at the time of a blepharoplasty can help eliminate fine wrinkles in the skin.

Lower Lid Blepharoplasty by Dr. Thomassen

What is a Quad Blepharoplasty?

Quad blepharoplasty is a combination of both upper and lower eyelids done at the same time. This allows for one recovery time and a more comprehensive rejuvenation.

Who is a Good Candidate for a Blepharoplasty?

Good candidates for a blepharoplasty are adult men and women of any age that are concerned about significant signs of aging around the eyes, including excess skin and bulging fat pads.

Preparing for your Blepharoplasty procedure

The key to a successful blepharoplasty surgery lies in a thorough preoperative evaluation. For your medical history, Dr. Thomassen will inquire about your ocular medical conditions, prior ocular procedures and medications taken. Any conditions that may pose a risk to a successful outcome will be addressed.

Medications

Any medications that may result in excess bleeding will need to be stopped 2 weeks before surgery. These include anticoagulants like aspirin or non-steroidal anti-inflammatory drugs like Ibuprofen. Tylenol is safe to take prior to surgery. You need to provide us with a list of homeopathic medications taken as these could have an adverse effect on wound healing and bleeding.

Smoking

A history of smoking or vaping is very important to report as this could adversely affect your wound healing as well. In general it is safest to stop smoking for 2 weeks before and 2 weeks after surgery.

Physical Exam

Dr. Thomassen will examine you to determine how best to undergo the surgery. Key examination information is the presence of any upper lid ptosis, scarring from prior procedures, lower lid lag, presence of herniated fat pads, and poor eyelid tone.

Preoperative Clearance

Dr. Thomassen will recommend the appropriate preoperative workup required according to your medical history. This workup usually involves an evaluation by a primary care doctor to ensure you are in an optimal state for surgery. This includes laboratory evaluation. If there are any abnormal findings from your workup, Dr. Thomassen will call you and discuss how to proceed.

Days before Surgery

Avoid strenuous exercise in the days leading up to your surgery. You should be well rested leading up to your surgery date. Also avoid excessive sun exposure.
Refrain from alcohol the week before surgery.
Stop using skin irritants on your face 1 week before surgery, including light peels, acne medication, and retinoic acid.
Pick up your prescriptions with plenty of time before your procedure. Set up a comfortable recovery area at home and plan your meals including a light clear liquid meal for the first night.
Plan for someone to be with you for 24 hours after surgery.
You will receive a call from our Operating Room Nurse a few days before your procedure to go over the consent and any preoperative details and instructions to make sure you are ready for surgery.
You will recieve a call from our Anesthesia Provider the day before surgery to go over your medications and discuss details about your anesthesia.
Use antibacterial soap when showering the day before surgery.
Remove any piercings or jewelry you may have before coming in for the procedure.

What to expect the day of surgery

The day of surgery you will arrive at our office at the appointed time. Wear something loose and comfortable that you can wear during the procedure.

You will meet the surgical team, including a preop nurse and anesthesia provider. Dr. Thomassen will answer any final questions you may have regarding the procedure and do some markings.

What Anesthesia is Used for a Blepharoplasty Procedure?

Most of these procedures are performed under local anesthesia in the office. An oral sedative is frequently administered as well to help relax you during the procedure. Oral sedation includes the use of oral Valium.

If the procedure is a lower lid blepharoplasty and/or combined with other procedures, IV sedation may be used. The IV sedation medications used include Versed, Propofol, and Fentanyl. Local anesthesia will ensure you are comfortable throughout the procedure. When you wake up after IV Sedation, you should feel comfortable, without the nausea that accompanies general anesthesia.

How long does a Blepharoplasty take?

An upper lid blepharoplasty takes approximately 30-45 minutes. A lower lid blepharoplasty takes about 1 hour to perform. Both procedures together take about 1 1/w hours to complete.

If done with IV sedation, when you wake up you should be comfortable. Cold compresses will be placed in the recovery area to diminish swelling and bruising post. You will be able to go home after you meet criteria for discharge. Dr. Thomassen will call you the evening of the surgery to ensure you are doing well.

What is the Recovery like for a Blepharoplasty?

After surgery you will recover comfortably at home. You will be given instructions on how to use cold compresses, ointments, and antibiotics. Dr. Thomassen will follow up with you by phone to ensure your recovery is as expected.

Your first follow up with Dr. Thomassen will be 1 week after surgery. Your incisions should be healed and Dr. Thomassen will remove any sutures.

You should not plan to undertake any strenuous exercise for at least 3 weeks after surgery. Light walking is fine the first week and you can gradually increase excercise as you feel better.

At 2 weeks, you will have another follow up to ensure your recovery is as expected. Your final eyelid surgery results will be evident at this time.

Common questions regarding facelifts

This varies significantly based on the complexity of the case, that is why it is best to evaluate patients before quoting a price. The price also varies depending on the anesthesia used, either local anesthesia with oral sedation or IV sedation. If the Blepharoplasty is done as part of another procedure, the price can be reduced as part of a comprehensive rejuvenation procedure. The average cost of cosmetic eyelid surgery is $4,120, according to the most recent statistics from the American Society of Plastic Surgeons.

Insurance may cover upper eyelid surgery if there is significant visual field impairment due to ptosis or pseudoptosis (when excess skin weighs down the eyelid). This has to be documented by a visual field test performed by an ophthalmologist showing significant obstruction. The insurance should provide a preauthorization to the surgeon stating that the procedure will be covered. Medicare does not provide preauthorizations for surgery so if the procedure is done and billed to Medicare, it is possible they will deny the claim.

Depends. An upper eyelid blepharoplasty only can be done under local anesthesia. However, the patient must be aware that they will be awake during the procedure. The pain will be well controlled by the local anesthesia but if they are very anxious, this may not be the best option. For lower eyelid blepharoplasties, since these are done via the transconjunctival approach, near the globe of the eye, it is best to perform under IV sedation for a comfortable experience. Simple lower eyelid skin only procedures can be done under local anesthesia alone.

There are scars after an upper and lower eyelid surgery, but if placed adequately they will hardly be noticeable. The upper eyelid scar should be placed right at the supratarsal crease. The lower eyelid surgery incision should be placed within a 1-2 mm from the lash line. In addition, eyelid skin is forgiving and usually forms very small scar burden. With appropriate suturing and surgical technique, the scars from this procedure are very acceptable.

See More Blepharoplasty Results by Dr. Thomassen

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If you’re considering plastic surgery, choosing the right plastic surgeon could not be more important. Dr. John Michael Thomassen has the training, experience, and caring to provide you with excellent care. We invite you to have a consultation about the procedure you need.

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