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Facial Plastic Surgeon / Procedures / Face / Eyelid Surgery

Eyelid Surgery

Eyelid Surgery San Francisco

Overview

Our San Francisco blepharoplasty, also known as an eyelid lift, is a surgical procedure performed on the upper and/or lower eyelids that involves some type of modification to the skin, muscle, and fat of the eyelids to produce a more youthful appearance. There are many techniques available to the surgeon who must tailor the surgery to the individual characteristics of each patient.

Eyelid Surgery San Francisco

Based on the American Society of Plastic Surgeons (ASPS) 2017 Plastic Surgery Statistics Report, blepharoplasty is the fourth most popular cosmetic surgery in the U.S., with 209,000 procedures performed in 2017. It is also one of the most difficult surgeries to perform, and one of Dr. Dino Elyssnia's specialties as a board-certified plastic surgeon.

Some typical signs of aging of the upper eyelids include the development of excess skin that can hang down and interfere with peripheral vision, and excess fat usually seen at the inner portion of the upper eyelid. The muscles and hence the wrinkles of the glabella (the area between the eyebrows commonly treated by BOTOX) can also be reached through an upper blepharoplasty incision and modified as in a brow lift.

Common findings with aging of the lower eyelid include sagging of the skin, lower lid bags, drooping of the eyelid margin, and the development of a distinct junction between the eyelid and cheek.

For the upper eyelid, the surgery involves an incision that lies inside the entire length of the fold of the lid, which allows for the removal of skin and fat. Through this incision, some surgeons like to modify the position of the brows and also modify the muscles that cause frowning to produce a more permanent affect as compared to BOTOX.

For the lower eyelid, an incision can be made either on the inside of the eyelid (transconjunctival) or on the outside (transcutaneous). The advantage of the inside incision is that the scar is better concealed but if there is excess skin, this cannot be treated. The outside incision allows access to any of the structures of the eyelid but does result in an external scar.

Through either incision, the fat pads of the eyelids can be removed or repositioned to treat bags and provide a more youthful, smooth transition from the lower eyelid to the cheek. A cheek lift can also be performed through this incision, however our facelift in San Francisco is much more effective at lifting the cheek.

Although both upper blepharoplasty and transcutaneous lower blepharoplasty result in scars, these usually heal very well and after several months are barely visible and rarely problematic. When the incision is placed on the inside of the lower eyelid, the scar is invisible.

Who are good candidates for eyelid lift surgery in San Francisco?

Blepharoplasty in San Francisco can improve your appearance and self-image but it can’t necessarily change your look to meet your ideal. It will likely make the area around your eyes look younger and more rested but it won’t make you look like a different person. When the results are excellent, those around you will notice that you look much better, but the reason won’t be clear to them.

The best candidates are healthy individuals usually in their 40’s to 60’s who have developed the typical signs of eyelid aging as discussed in the overview section. Younger patients who request a change in certain ethnic features of their eyelids may also be good candidates.

Patients with diseases of the eyes like excessive dryness, thyroid disease with involvement of the eyes, certain conditions of the eyelids or even recent lasik surgery are not good candidates for blepharoplasty.

Commonly patients request eyelid surgery in San Francisco to correct a certain problem when in fact another procedure is more appropriate. For instance, many patients need a browlift to improve the appearance of the upper eyelid and not blepharoplasty or both a browlift and blepharoplasty. In fact, most patients in their 50’s and 60’s who are good candidates for facial rejuvenation, usually have signs of aging throughout their face and obtain the most benefit from a more global approach with brow and/or eyelid surgery to treat the upper face and a facelift/necklift to treat the lower face.


Blepharoplasty San Francisco

What is my initial
consultation at Dr. Elyassnia's
office in San Francisco like?

During the first meeting, Dr. Elyassnia will determine if you are a good candidate for blepharoplasty surgery while at the same time you will decide if he is right for you. This starts with a full health history with a focus on previous eye problems and any major illnesses that can cause problems during your surgery like uncontrolled high blood pressure. It is important to tell your surgeon if you smoke or take any medications, supplements, or other drugs as these can have a big impact on your surgery. An example is aspirin or ibuprofen which can lead to bleeding after your procedure.

During the exam, your surgeon will do a thorough evaluation of your face and eyes with a focus on the specific features that are creating an appearance of aging. Various tests may also be done to evaluate the health of your eyes. Finally, photographs are taken of all patients; these assist with the planning and evaluation of your surgery. This results in some of the very best eyelid surgery San Francisco has to offer.

Based on this thorough assessment and a discussion of your goals, the surgeon will describe not only what approach is best for you but also the various alternatives and all of the risks and limitations associated with each of these.

It is very important to listen carefully to the various limitations of each approach and to openly discuss your expectations with your surgeon. Many times a poorly informed patient or surgeon is the direct cause of an unsatisfactory result even when there are no complications with surgery. The surgeon should also go over the details of the procedure including the type of anesthesia used, the facility where surgery will take place, and the costs involved.

At the end of the consultation you may decide to go ahead with surgery and schedule a date but if you are unsure or don’t feel fully informed don’t hesitate to ask your doctor any questions. A second meeting may be necessary and should always be available as an option.

What is the
day of my eyelid lift
surgery like?

You will need to begin fasting 8 hours prior to your procedure which means you cannot eat or drink anything at all during this period including chewing gum or water. If you have been instructed to take any medications in the morning this is permitted with a few sips of water.

Our blepharoplasty in San Francisco can usually be done with local anesthesia and sedation which means you are very sleepy but time to time you may be slightly aware of what is happening. When combined with a facelift, this may require general anesthesia. The surgery takes about 1 to 2 hours when done alone. You will likely have no dressing after surgery except antibiotic ointment and ice packs over your eyes. After surgery, you will stay in the recovery suite until you are ready to go home.

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How do I
prepare for
eyelid lift surgery?

Within 1 month of surgery, all patients greater than 50 years old or with medical problems should have a medical evaluation by their physician or a primary care provider. Depending on your health this may require blood tests, an EKG, etc. You will be given a list of medications, vitamins, and supplements to refrain from taking at least two weeks before and after surgery. You should also stop smoking for at least 1 month before and after surgery.

An upper and/or lower blepharoplasty alone is usually an outpatient procedure. When combined with other procedures like a facelift, many patients find it more comfortable staying in our overnight facility or hospital for one night. If you and your surgeon have decided that you will go home, you will need to arrange for someone to drive you. Your surgeon will give you a prescription for the medications you will need after surgery so these can be obtained ahead of time. If you are having other concurrent procedures please refer to the corresponding sections of this website.

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What is the
recovery process
for eyelid lift surgery?

You may feel some discomfort for a few days after surgery but this is well controlled with the medication prescribed by your surgeon. You will have some swelling and bruising around the eyes which will progress over 2-3 days then begin to improve. Due to the ointment and drops you may have some blurry vision.

Ice should be applied for 15-20 minutes every few hours for the first 48-72 hours. You should feel pretty good in 1-2 days but it is important to refrain from any strenuous activity for at least the first week after surgery. Patients are encouraged to begin showering 1-2 days after surgery. All sutures will usually be removed within a week after surgery. Initially, the swelling will distort the way you look but this will improve by the end of the second week.

The majority of people are able to return to work after 1 week but this depends on your job and may require some makeup to cover any remaining bruising. You will have to refrain from any exercise for 3 weeks but then you may steadily increase your activity.

It is important to follow up with your surgeon as directed so that any potential complications can be detected and treated early. For the most part these are rare and you will spend most of your time enjoying your new look!

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What are the
risks of eyelid
lift surgery?

All surgical procedures carry some uncertainty and risk and this operation is no different. Although there are many possible complications, the good news is that the combined risk of having any major complication is still rare as long as your surgeon is properly trained and the procedure is performed in a well-equipped facility. The following represents some of the major complications but is not meant to be comprehensive.

The most devastating complication that has been reported is blindness. This is extremely rare but has occurred. It is usually due to bleeding after eyelid surgery (which is also rare) that puts pressure on the eye and is not treated urgently.

Another rare complication is excessive scarring within the lower eyelid resulting in the lower eyelid being pulled down producing an unattractive appearance and/or dry eyes. This usually resolves on its own but may require more eyelid surgery to repair the problem.

Eyelid Surgery San Francisco

More commonly, patients may complain of temporary dry eyes after eyelid surgery for several days and or even weeks. This is treated with lubricating drops and ointments until the symptoms resolve.

Other complications such as infection, unsatisfactory scars, and healing problems are possible but rare.