Am I a good candidate for eyelid surgery?
Any one or combination of the following conditions may indicate that you are a good candidate for eyelid surgery:
- excess skin obscuring the natural fold of the upper eyelids
- loose skin hanging down from the upper eyelids, perhaps impairing vision
- a puffy appearance to the upper eyelids, making the eyes look tired
- excess skin and fine, wrinkles of the lower eyelids
- bags and dark circles under the eyes, often with a depression along the bony border of the lower eyelids
droopiness of the lower eyelids, showing white below the iris (colored portion of the eye)
Aesthetic eyelid surgery can usually correct these problems, though other treatments may also need to be considered. For example, if the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift may be recommended. Smoothing of crow’s feet may require chemical peeling or laser resurfacing procedures. Circles beneath the eyes caused by dark pigmentation may be treated with a bleaching solution or chemical peel. Dr. Ruder can provide further information if you have an interest in any of these additional procedures.
How will Dr. Ruder evaluate me for aesthetic eyelid surgery? During the initial consultation, you may be asked to look in a mirror and point out exactly what you would like to see improved. This will help Dr. Ruder better understand your expectations and determine whether they can realistically be achieved. You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems or diabetes are among the medical conditions that may increase the risks associated with eyelid surgery. Dr. Ruder will want to know if you have allergies, especially if they affect your eyes. He may ask whether you have ever tried and were unable to wear contact lenses, you should bring them with you in case Dr. Ruder wants to test your vision. It will be necessary for Dr. Ruder to know if you were ever told by an ophthalmologist that you have a condition called “dry eye” or if you have any other problems with your eyes. One of several surgical techniques may be suggested to improve the appearance of your eyelids. The particular technique that Dr. Ruder recommends will depend on may factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids.
How is Dr. Ruder able to improve the appearance of my upper eyelids?
Because of individual factors, not everyone will achieve the same results from eyelid surgery. Dr. Ruder will select the surgical technique that he or she feels will obtain the best outcome for you. For upper eyelid surgery, generally an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases. Through this incision, excess skin and fatty tissue are removed. Because the incision follows the natural contour of the upper eyelid, it will be well camouflaged when healed.
How is my plastic surgeon able to improve the appearance of my upper eyelids?
For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed, or fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. As in upper eyelid surgery, the incision is well camouflaged by natural creases. In some cases, you and Dr. Ruder may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. A laser may sometimes be used in conjunction with this method to tighten the lower eyelid skin.
I understand that every surgical procedure has risks, but how will I learn more so that I can make an informed decision?
Fortunately, significant complications from aesthetic eyelid surgery are infrequent. Every year, many thousands of people undergo successful eyelid surgery, experience no major problems and are pleased with the results. The subject of risks and potential complications of surgery is best discussed on a personal basis between you and Dr. Ruder, or with a staff member in Dr. Ruder’s office. Some of the potential complications that may be discussed with you include hematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anesthesia. Following the surgery, there can be a feeling of dryness or irritation in the eye that requires treatment. There is a possibility of a temporary decrease in sensation of the eyelid skin or impaired eyelid function that sometimes may need to be corrected by additional surgery. You can help minimize certain risks by following the advice and instructions of Dr. Ruder, both before and after your eyelid surgery.
How should I prepare for surgery?
The goal of Dr. Ruder and the entire staff is to make your surgical experience as easy and comfortable for you as possible. If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery .Dr. Ruder will provide you with additional preoperative instructions. Aesthetic eyelid surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery
What will the day of surgery be like?
Your eyelid surgery may be performed in a hospital, free-standing ambulatory facility or office-based surgical suite. Medications are administered for your comfort during the surgical procedure. Frequently, local anesthesia and intravenous sedation are used for patients undergoing eyelid surgery, although general anesthesia may be desirable in some instances. For your safety during the operation, various monitors are used to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood. When surgery is completed, you will be taken into a recovery area where you will continue to be closely monitored. Your vision will be blurry as a result of ointment used to soothe and protect the eye during surgery as well as from the swelling that is a normal aftermath of eyelid procedures. There is surprisingly little discomfort, however, from the surgery. You probably will be permitted to go home after a few hours, although some patients may stay overnight in the hospital or surgical facility.
How will I look and feel initially?
It is important to realize that the amount of time it takes for recovery varies greatly among individuals. The first evening after surgery, you should rest quietly with your head elevated. Dr. Ruder may instruct you to apply cold compresses to your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications. Initially, you may feel a “tight” sensation around the eyes and some mild discomfort that can be controlled with oral medication. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. Some patients find that mild swelling persist for several weeks, while others may see swelling resolve in as little as one week. Bruising typically disappears within seven to ten days. Within the first week you will be permitted to use makeup, if desired, to conceal any discoloration. Stitches are usually removed within a week of surgery. Your vision may continue to be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. Some plastic surgeons recommend eye drops to help relieve any burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation.
When can I resume my normal activities?
Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Although you might feel like going back to work just a few days after surgery, your vision may still be slightly blurry which could make reading or other paperwork more difficult. You should not wear contact lenses for a week or two.
How long will the results last?
Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Since the healing process is gradual, you should expect to wait at least several weeks to get an accurate picture of the results of your eyelid surgery. Incisions will fade over a number of months until they become barely visible. The results of aesthetic eyelid surgery are long-lasting, but they may be affected by your heredity and lifestyle factors. Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows which mimics a recurrence of drooping upper eyelids. if this happens, correction may require a forehead lift or a secondary eyelid procedure. Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time. Maintaining a Relationship with Dr. Ruder You will return to Dr. Ruder’s office for follow-up care at prescribed intervals, at which time your progress will be evaluated. Please remember that the relationship with Dr. Ruder does not end when you leave the operating room. If you have questions or concerns during your recovery, or need additional information at a later time, you should contact Dr. Ruder.
The effects of aging are inevitable, and, often, the brow and forehead area show the first signs. The skin begins to lose its elasticity. Sun, wind, and the pull of gravity all affect the face, resulting in frown lines, wrinkling across the forehead, and an increasing heaviness of the eyebrows. Even people in their thirties may have faces that look older than their years. Your tired, angry, or sad expression may not reflect how you actually feel. As a result, many people have opted for a procedure known as the forehead lift. Based on variations in how men and women age and on new advances in medical technology, different methods are used to perform this procedure.
As with all elective surgery, good health and realistic expectations are prerequisites. When a surgeon tightens loose skin and removes the excess, forehead wrinkling and drooping brows are modified. The procedure is called a forehead lift or brow lift. If necessary, the surgeon removes part of the muscle that causes vertical frown lines between the brows. The result can be a smoother brow and a more youthful expression. To see what a forehead lift can do for your face, put your hands above your brows and outside the edges of your eyes and gently raise the skin upwards. Forehead lifts are an option if you have a sagging brow or deep furrows between the eyes. This procedure is usually done between age forty and sixty-five, although it may be necessary at an earlier age.
Incisions can be placed at the hairline, behind the hairline, or in some cases, above the brow or in the mid-forehead. Your surgeon can help you select the best technique suited to your particular situation.
The main difference among the various options for forehead lifting consists of the placement of the incision.
The original technique is the coronal incision, which is made slightly behind the natural hairline. An alternative is the pre-trichial incision. This is similar to the coronal incision except that the mid-portion of the incision is made directly at the hairline. This incision generally heals favorably and has the advantage of lowering the hairline. The disadvantage could be noticeable scarring. An option is to place the incision within the midforehead creases. This is primarily used in men with deep pre-existing forehead lines.
The newest apporach is endoscopic surgery. Several small one-half-inch to one-inch incisions are placed just behind the hairline. Althought this technique may require more surgery time, it is less invasive and results in a smaller chance of temporary scalp numbness.
This procedure takes between one to two hours to perform. It is most commonly performed under IV sedation or twilight anesthesia.
You will experience a certain amount of swelling and bruising in the 10-day period following surgery. In some patients, this condition may include the cheek and eye area as well as the forehead. You will be advised to keep your head elevated in order to reduce swelling. Cold compresses may further reduce swelling. As the incisions heal, you may experience some numbness as well as itching, both of which will diminish with time. The sutures are usually removed within seven to 10 days following surgery. If bandages have been used, they are removed in one to three days. It is important to follow the advice of your surgeon on resuming normal activities. For most patients, the recovery time will not exceed two weeks, but patients may still be advised to avoid strenuous activities for longer periods. Any prolonged bruising can be camouflaged with standard make-up techniques.
Not infrequently, a brow lift is combined with Blepharoplasty (an eyelid tuck) or face lift to provide a harmonious rejuvenation.