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DONALD J. CAPUANO, M.D.
Plastic Surgeon

CONSULTATION

You may be interested in undergoing the surgical procedure for correction of excessive skin and or fat of the eyelids known as blepharoplasty. This surgical procedure can be done on the upper or lower lids, or both sets of lids, depending on the individual's personal preference.

In some cases SilkTouch LASER EYELID SURGERY may be able to be used.

Surgery usually involves removing excess skin and/or fat in the area of the lids. In some cases surgery may improve vision by allowing more light to come into the pupil area.

What 'needs to be done' certainly depends on your idea of what is 'wrong'. Some individuals are troubled by small amounts of skin while others will have significant amounts of skin and fat before it 'bothers' them. Our goal is to determine what can be done about your perceived lid problem.

Therapy depends on the condition. Some lids only need skin tightened (see LASER EYELID SURGERY). Some lids 'need' skin and or fat removal. Some lids need both skin and fat removed and muscle and ligament tightening and repositioning. Surgery may be more complex depending on the problem.

The placement of incisions will be outlined to you during your consultation. These will vary depending All surgical and non-surgical methods for lid surgery have potential problems and complications. These are relatively few and the vast majority of people are very satisfied with surgery.

Scars are the result of surgery. Usually lid surgery scars heal very well. Rare cases of persistent redness of scars and thickening have been reported but not seen. Usually the scars are very fine lines. Rarely do they need revisionary surgery.

Some problems are minor and rare. There may be temporary numbness in the area. Major problems such as bleeding, infection, and injury to the eye have been reported. They are rare but they do occur.

SPECIAL CONSIDERATIONS AND CONDITIONS

Some individuals have so much skin that their vision is blocked. In some cases insurance coverage (See also INSURANCE COVERAGE) may be available. Photos of your condition as well as a consultation from an ophthalmologist or optometrist will be needed to document your problem. Insurance companies look very closely at these requests for insurance coverage. Unless the condition is very clear they are very difficult to obtain.

Check the position of your eyebrows. Brow lifts elevate sagging of the eyebrows. Brow lifts are not usually needed.

Your eyelash position may reflect weakness of the muscle that raises the eyelid. If your eyelid has been weakened by time, excess skin and or fat, special attention may have to be given to the muscle that raises the lid. This is

If you have 'dry eyes' you need to call it to Dr C.'s attention. 'Dry eye' syndrome after surgery is possible, and has been temporary. Drops or ointment may be needed for varying lengths of time if 'dry eye' problems should occur. If the eye normally protrudes somewhat from the socket with white showing beneath the pupil, there is an increased chance of "dry eye" occurring. Thyroid disorders may be associated with protrusion of the eyes as mentioned.

If you plan to have surgery, you are advised to get an eye exam, especially if you are over 40 and or have not had an exam in the past two years.

ANESTHESIA FOR SURGERY

Eyelid surgery can be done with different kinds of anesthesia. It can be performed under local anesthesia with or without sedation, or it can be performed under a general anesthetic.

If your surgery is done under local anesthesia with intravenous sedation, you will be given medication through an intravenous. This will make you very groggy, sleepy or sleeping. You will not be aware of what is happening. Local anesthesia is then put into the area to numb it so you will feel no pain.

Oral medication is sometimes given before surgery. This is not as effective as intravenous medication. You will be aware of the surgery. The medication is used to make you less apprehensive and nervous, not to make you totally unaware. Only select individuals should plan to have surgery this way.

If you have a general anesthetic (totally asleep), you will have an opportunity to speak with the physician who will be 'giving' the anesthesia.

Being totally asleep may be advised if you have a very complex problem or if you plan to have other surgery such as a face lift or other cosmetic procedures. For most individuals, general anesthesia is very safe. With the many computer monitors used, the pulse, oxygen, blood pressure etc. are able to be checked minute by minute or second by second if needed. The chances of a major problem are less then driving on a 'bad weather day'.

BEFORE SURGERY CARE

If your surgery is done in the office, you will be given the time to arrive for surgery.

If your surgery is done as an out patient you will be mailed information from the out patient center at Park Ridge about any pre-surgery tests that are required, as well as a time to report for your surgery. You must not have anything to eat or drink from midnight the night before your surgery.

Please remove all, all, all makeup before surgery. This is necessary because if the makeup should get into a wound a permanent tattoo could result. After make up removal your face should be washed clean.

We ask that you refrain from taking aspirin or products containing aspirin for at least three weeks before your surgery. Do not eat a "lot" of apples (two or three per day), as they contain an aspirin-like substance. Don't eat a lot of garlic as this also 'thins' the blood. This may cause bleeding during and/or after surgery. IF YOU HAVE BEEN ADVISED TO TAKE ASPIRIN FOR A MEDICAL CONDITION, please let us know well before your surgery.

DURING SURGERY

Once you are given medication you will remember little if anything about your surgery. What you will miss is the cleaning of the area, the local anesthetic, the surgery, and the bandaging.

AFTER SURGERY CARE

You will need someone to drive you home. If you have had medication in a vein or a general anesthetic,you must have someone stay with you for at least twenty-four hours following your surgery.

WOUND HEALING AFTER SURGERY

Usually the wounds heal extremely well, and eventually become quite inconspicuous. There may be redness of the scars. Makeup can be used after the incisions have healed. You will be advised when you can use makeup. Dissolving sutures are used in most cases, and disappear five to seven days following surgery. The wounds may look irregular. These irregularities will smooth out with time and usually look very good within a few weeks. In a few cases a LASER 'touch up' of the wounds may be indicated.

ACTIVITY AFTER SURGERY

Following your surgery, you will have sutures (stitches) in place. You should avoid activity other than 'coffee and newspaper' type activities. Avoid stressful situations and activities. Try not to bend over (head down). Resume your usual medications if you take any (especially blood pressure meds). If you have questions about any activity, please ask BEFORE you have surgery !! And yes there is no jogging, swimming (ocean, lake, pool), horseback riding, tennis, golf, motorcycles, etc. until you get the 'o.k.' !!

Sun glasses should be worn when outdoors, and in the company of others for the first days to a week or two. This prevents comments and opinions that are unwarranted. Be wary of individuals who may be jealous of your choice to have surgery. They can cause you unnecessary concern and emotional distress especially immediately after surgery when the black and blue, and swelling may be at its worst. Remember that these individuals were not at your consultation before surgery and they do not know what was discussed. Ask them what medical school they went to and what Plastic surgery training program they graduated from. But remember, if you have a concern, please call us !!

MEDICATIONS AFTER SURGERY

You will be given prescriptions and asked to purchase some over the counter medications following surgery. Please follow the directions for these medications. Specific instructions will be given to you. Finish all medicines unless advised otherwise. If you have a problem with any medicine, please call the office.

CARE OF THE OPERATED AREA

For the first forty-eight (48) hours following surgery, keep cool compresses over the lids. Cover the compresses with an ice bag as much as possible to reduce swelling and bruising. "Black and blue", swelling and localized areas of discomfort can be expected after surgery. The majority of swelling and bruising should resolve within a week or two.

LOWER LID SURGERY

For lower lid surgery: As you know, the fat in the lower lids has most likely been protruding there for some time. Because of this constant pressure on the skin and muscle of the lower lid, these muscles are stretched and thin, like a rubber band that has been stretched constantly over time. Once the fat is removed from the area, even if surgery is done to tighten the lid, it will take your body some time to tighten this muscle again.

TIME AWAY FROM WORK

The estimated time away from work depends to a large degree upon the nature of your job. Under usual circumstances, one to two weeks is needed before swelling and "black and blue" diminishes. You may wish to wear sunglasses while at work. You should not bend over a great deal. Please discuss your job activities with the Doctor so you may obtain a better estimate of time away from work.

Dryness of the eye, especially associated with looseness of the lower lid, lack of tears, allergies, thyroid problems, allergies to medicines, undetected irritations, and so forth have occurred, but for the most part are not long term problems. You may notice a temporary change in your vision following surgery. In our experience this has not been a significant problem, and is not anticipated in the majority of patients. In most cases this is due to swelling, and should resolve. Dark circles under the eyes may be favorably influenced by surgery however this is not true in each and every case. If the only reason you wish to have surgery is to remove dark circles, you should think about it before undergoing surgery, as no guarantee can be given. The skin of the lid is remarkable in its ability to stretch. After lid surgery although the lids may feel 'tight' for a while, they loosen up and in most cases more skin folds or lines gradually return to some degree. It would be quite unusual for the condition to return to the before operation condition and this as yet has not been seen. Since the face is not symmetric or equal on both sides, the result of surgery will not be exactly equal. Minor differences are for the most part not detected. Rarely has a difference been obvious enough for anyone to choose to have further surgery. In some cases the position of the lid edge is hidden by the excessive skin or wrinkles. Unequal positions of the lid edge can be present and hidden.

Eyelid surgery may also make muscle weakness of the lids more obvious. Some people have weak lid muscles. When they become tired the lid can droop. If both lids droop then the problem is less obvious than if one lid is weak. Since muscle weakness comes and goes, it may not be present when you are examined. This has not been a significant problem for those who have such a condition but let us know if you have observed muscle weakness in one or both eye lids.

Most people do not realize that eyebrows have an important role in the way our eyes and faces look. The eyebrows (really a part of the forehead) can droop. Removal of eyelid skin alone does not help a drooping brow. Correction of eyelids may depend a lot on the condition of the eyebrows. 'Full' correction of excessive skin of the lids may not be possible without 'brow' surgery of some sort.

Please note that it is not reasonable to expect that all or most small wrinkles will be removed by the operation. Improvement is the key word. This is what one might anticipate.

Because of the nature of the healing process, because of unforeseen anatomy, weaknesses, after operation healing, medication allergies and so on, while a good result usually occurs, it cannot be guaranteed. Photographs will be taken before, possibly during and after your surgery. If photographs have not been taken, please let us know. You will not be identified in the photos except for our office records.

INFORMATION ABOUT
BLEPHAROPLASTY
(EYE LID SURGERY)

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