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Blepharoplasty (Eyelid Surgery)

Restore Your Youthful Appearance With Eyelid Surgery (Blepharoplasty)

Cosmetic eyelid surgery, or blepharoplasty is the surgical removal of excess skin and fat of the upper and/or lower eyelid. By removing excess skin of the eyelids and getting rid of the “bags” around the eyes, a refreshed, well-rested, and younger appearance is created. It is the most comprehensive and definitive way of treating wrinkles, excess skin of the eyelids, and puffiness around the eyes seen in aging and is performed regularly by the plastic surgeons at Hill Country Plastic Surgery.

In San Antonio, fellowship-trained plastic surgeons Dr. Scott Farber and Dr. Amita Shah are industry leaders experienced in facial plastic surgery, with years of extensive and intense training. Dr. Farber specializes in facial aesthetic surgery, drawing on his extensive experience and training to restore contours that look both youthful and natural.

They recognize that each face requires an individualized approach to restore the appearance of youth and use a wide variety and combination of techniques to achieve this goal. In the end, you will have the most natural-looking results that celebrate your true beauty.

Because blepharoplasty surgery can create such dramatic results, it is important to work only with a plastic surgeon who has experience with the specific procedure and who has a thorough knowledge and understanding of facial anatomy.

What Makes Me a Good Candidate for Eyelid Surgery (Blepharoplasty)?

  • Excess fat in the upper eyelid giving a “puffy” appearance

  • Loose and crepey skin that hangs down and disturbs the youthful contour of your upper eyelid. It may even affect your vision

  • Excess skin and wrinkling of the lower eyelid

  • Sagging of the lower eyelid

  • Bags or puffiness around the lower eyelids

What can Eyelid Surgery (Blepharoplasty) Do?

A blepharoplasty is ideal for anyone looking to refresh and enhance their eye shape. It can correct hooded and sagging skin, puffy eyes, and create an ideal double upper eyelid shape. Eyelid surgery removes excess skin around the eyes, recontouring and refreshing the appearance of the upper and lower eyelids. By removing or replacing fat, tired looking eyes that have dark circles or bags can be rejuvenated to a well-rested appearance that can make patients look much more youthful. The plastic surgeons at Hill Country Plastic Surgery use advanced techniques to preserve distinct ethnic anatomical features to provide a more alert and rejuvenated post-operative appearance without altering the fundamental characteristics that contribute to your unique look and identity.

How is an Eyelid Lift (Blepharoplasty) Performed?

An eyelid lift, or blepharoplasty can be performed under general anesthesia or with light sedation and local anesthesia. Either the upper or the lower eyelids can be treated individually or they can be treated all together in order to address the signs of aging. Dr. Farber or Dr. Shah will help you determine which option will be the best to achieve your goals. The incisions are placed in the natural creases and lines, where they are well concealed once they heal. Some patients may be candidates for a transconjunctival approach, which allows the surgeon to access the fat without a skin incision at all. The incision is made inside the eyelid. In certain cases, an eyelid tightening procedure may be necessary if the lower eyelids are loose or sagging. The length of the procedure can vary, based on the extent of the correction needed, but it generally takes between one to two hours to complete. Blepharoplasty can be performed in conjunction with other facial procedures as well, such as a facelift or brow lift.

What Should I Expect During the Recovery Period?

You should not experience much pain following surgery, but it is normal to experience some bruising and swelling. Using an icepack will help reduce the swelling and bruising. Most people can resume normal activities within a few days, begin to wear makeup after one week, and can resume social activities in two weeks. We recommend waiting one week before performing any activities which may strain your eyes such as reading or focusing on a screen. It is normal to have some blurriness or visual changes, and that may take a few days to subside.

Why Should You Choose the Surgeons at Hill Country Plastic Surgery?

Both Dr. Farber and Dr. Shah were fellowship-trained at the most prestigious institutions and their techniques for delivering patient results and satisfaction set the standard for plastic surgeons in the field. They use the most advanced techniques and consistently achieve superior results. Their warm demeanor, genuine care, and dedication to their patients are second to none. Ultimately however, patients choose Dr. Farber and Dr. Shah for the results. Their patients look and feel their best, and so can you. Discover the difference here in San Antonio!

What to Expect During Your Consultation Visit

During the initial consultation with your surgeon at Hill Country Plastic Surgery, we will discuss your concerns and goals before recommending treatment options that are tailored specifically to your needs. Prior to your consultation, we recommend that you review the procedures on our website so you are familiar with the terms we will be using during our discussion.

Once we identify your concerns and surgical goals, we will discuss all of the treatment options that are available to you. Every patient is unique and we will develop a tailored surgical plan that addresses your specific goals. In addition, we will thoroughly review your medical history, surgical history, medications, allergies, family medical history, and other important details. It is very important that we obtain accurate information in all of these areas as it may impact the outcome of your surgery.

While discussing different treatment options, we will perform a physical exam and take measurements that are necessary for planning for your surgery. Pre-operative (before surgery) photos will be taken either at your initial consultation, or during your pre-operative visit.

After your consultation, you will receive access to your notes on the patient portal in addition to information about your specific surgery. If you have not activated your patient portal, this can be done at your appointment by asking any of our staff to assist you. If you have questions after your appointment, you can contact our office or message us through the patient portal. Some patients will require medical clearance from their primary care physician or a specialist or additional tests before undergoing surgery.

Once you have determined that you would like to have surgery and have completed any clearances and tests that were requested, contact our office at (210) 658-3555 to schedule a pre-operative appointment with one of our surgeons.

Pre-operative Appointment

On the day of your pre-operative appointment, we will review your procedure in detail and go over the surgical plan with you. We will also address any questions and concerns you may have. Please read over the procedure consent prior to this appointment and have any questions ready so we can discuss them.

During your pre-operative visit, we will provide you with all of the after-care instructions as well as necessary medication prescriptions. You will also be provided with a post-operative appointment for follow up after your surgery.

Before the Day of Surgery

Please do not smoke (cigarettes, vape, or pipe) or use any nicotine products 4 weeks prior to and after your surgery. Smoking and nicotine greatly impair healing, which can cause increased risk for infection and complications, such as delayed incisional healing or wound opening which lead to worse scarring. Please stay away from second hand smoke as well, as this can also cause wound healing problems. If you use nicotine products, you will need to stop 4 weeks prior to surgery and then you will need to undergo a cotinine test prior to surgery to ensure that the nicotine is out of your system.

Please do not drink alcohol before or after your surgery (until cleared by your surgeon). In addition, please do not drink alcohol while taking pain medication, as this can have serious, and life threatening side effects.

Please leave all valuables at home. If you have body piercings, kindly remove them prior to surgery.

Please have someone available to drive you home. Due to the lasting effects of the general anesthesia, you will be unable to operate a car after surgery. A taxi or car service is not adequate either. You will need a family member or friend who can assist you.

You may have been asked to obtain pre-operative tests at a lab facility or your primary care physician. Your pre-operative tests (labs, X-rays, EKG, etc) need to be completed at least three days before your surgery. If you have them done at your doctor’s office, the results will need to be faxed to (210) 362-1582.

The surgery facility will call you the day before your surgery to let you know what time and where you should arrive.

Shower the morning of or the night before your surgery with your normal soap and water. Do not use deodorant, lotion, cream, perfume, aftershave, oils, or makeup after bathing.

Do not take Advil, Aleve, Naproxen, Fish Oil, Garlic, CoQ10, Omega 3,6, Motrin, Excedrin, Ibuprofen, Aspirin, medications for arthritis or any medication that contains these medications for ten days prior to your surgery and two weeks after.

Do not eat or drink anything after midnight the night before your surgery.

Please call our office if you have an infection of any kind prior to your surgery.

Day of Surgery

On the day of surgery do not take the following blood pressure medications before your surgery:

Medications with generic names that end in “-pril”, “-sartan”. If you are on metformin, you will be asked to not take it on the day of surgery.

On the day of surgery, your plastic surgeon will meet you in the pre-operative area to go over any last minute questions or concerns you may have. Your plastic surgeon will make some preoperative markings and will perform extensive checks with careful attention to detail, ensuring high quality care and safety. You will meet the anesthesiologist and their team, as well as the members of our plastic surgery operative team.

During the plastic surgery procedure, our plastic surgeons pay meticulous attention to detail and work as a highly experienced team to ensure a great result. Your family will be updated of your status periodically and will be able to talk with the plastic surgeon in person after the procedure is completed. The incisions will be placed in a dressing or a compression bandage. Instructions for care on these will be given to you in your preoperative paperwork.

Aftercare

In order to make your recovery faster and more comfortable, we recommend that you prepare before your surgery. Things you can do are:

  • Prepare a sleeping area that is easy to get to. For example, set up a couch downstairs instead having to walk up to an upstairs bedroom. Keep your toiletries close by and prepare food ahead of time. Arrange for someone to be with you the first night after surgery.
  • You may receive your post-operative medications at your pre-operative appointment. You should pick up these medications prior to your surgery.
  • If you’re having an outpatient same-day procedure you will be released to go home the same day and will need someone to drive you home.
  • Review your post-surgery instructions given to you at your pre-operative appointment

If you have a history of nausea or vomiting after anesthesia, please let us and your anesthesia provider know. We can prescribe anti-nausea medications and take extra steps to prevent nausea and vomiting after surgery.

When undergoing general anesthesia, you will need to have someone drive you home. You will not be allowed to undergo surgery if there is no confirmed designated driver.

Medications:

After surgery you will have discomfort and the goal of pain medications is to reduce pain, but it will not completely remove all pain. A good measure for if you need more pain control is that you should be able to take a deep breath without severe pain. Do not wait until your pain is unbearable to take the next dose of pain medication because it will take longer to get your pain under control again.

You may resume your home medications after surgery except blood thinners and as determined by your surgeon. We will give you a prescription for a pain medication. If you are prescribed medications that contain acetaminophen (tylenol) it is important that you not exceed 3500 milligrams of acetaminophen (tylenol) per day.. Do not drive, operate heavy machinery or make important decisions while taking narcotic pain medications.

Narcotic medications may cause constipation. Ensure you have adequate (>25 grams/day) of fiber in your diet and drink at least 64 oz. of water daily. You may also wish to take an over the counter stool softener such as Miralax or Colace once or twice daily.

You can alternate your narcotic medication with Ibuprofen 600mg every 6 hours and/or Gabapentin 300mg three times a day. Take ibuprofen with food to protect your stomach from irritation.

If you have a history of nausea or vomiting after anesthesia, you may be prescribed an anti-nausea medication (Ondansetron) which can be taken as needed.

Before prescribing any narcotic medications, we are required to check the Texas controlled substance history database (Texas Prescription Monitoring Program). If you currently have a pain medication contract with another physician or are currently on narcotic medications, we will have to coordinate your medications with that physician.

We will prescribe pain medications for recovery after surgery, but do not prescribe long-term pain medications and do not do more than one refill for any pain medications. If you have pain that is beyond what is usually anticipated for your surgery and there is no surgical reason that can be found, we will help by referring you to one of the many pain management specialists that we work with.

Surgical Site Care:

You may shower 48 hours after your surgery. Do not scrub the incisions, just let the water run over them and gently dab them dry afterwards. Apply gauze or ointment over the surgical site daily as needed for light drainage. Do not immerse your incisions in baths or hot tubs until at least 2 weeks after surgery. More specific instructions will be provided during your pre-operative visit.

Drain Care:

Sometimes it is necessary to place a drain after surgery. The purpose of a drain is to remove excess fluid from the surgical area. Empty the bulbs and measure the output whenever the bulbs are half full or at least twice a day. You will be given a sheet to record how much is coming out of the drains. Bring this sheet to your follow-up appointment. In general, drains remain in place until there is less than 30mL (1oz) out of the drain for two days in a row.

Please Call Immediately if:

Please call if you have the following signs/symptoms:

  • temperature greater than 100.5 F
  • bleeding or pus draining from the wound site. If you have bleeding, apply direct pressure to the area for 20 minutes
  • increasing pain that is not controlled on oral pain medications
  • increasing redness or size at the surgical site
  • your drain is not holding suction
  • if your incisions come apart
  • Any other concerns

For non-emergency questions:

During business hours (8 AM – 4:30 PM): call (210) 658-3555.

After hours and on weekends/holidays: call (210) 658-3555 and you will be forwarded to the on call surgeon.

If you are having any serious problems or symptoms such as difficulty breathing or chest pain, call 911 or proceed to your nearest emergency room.

Activity restrictions:

No vigorous activity: no pushing, pulling, bouncing, housecleaning, yoga, running, heavy lifting greater than 5 lbs until your follow up appointment. Avoid activities that raise your blood pressure or heart rate. You are encouraged to walk around and you can climb stairs after surgery. You should not lay in bed and not move.

Clinic appointment:

Your clinic appointment will be scheduled at your pre-operative appointment before surgery. If you need to change your appointment time or date, please contact our clinic at (210) 658-3555.

The surgeon may adjust any of the above guidelines and instructions based on the patient and type of surgery performed.

Eyelid Surgery (Blepharoplasty) FAQs

An upper blepharoplasty or eyelid lift is a procedure to rejuvenate the upper eyelid by restoring the natural contours of youth. The procedure removes extra skin and fat in the upper eyelid region.

A lower blepharoplasty or eyelid lift is a surgical procedure that removes extra fat and skin from the lower eyelids. This can refresh the “tired” puffy eyes that typically are a result of aging.

The results will last a long time, however aging still occurs and you may need a repeat of the procedure years down the road. This all varies patient to patient.

The bags under the eyes are caused by your normal fat that bulges out with age. The procedure can either remove or reposition the fat to restore a smooth, youthful contour.

Patients with severe dry eye are not recommended to undergo elective eyelid surgery because the condition may worsen. For mild amounts of dry eye, patients are advised to use artificial tears or eye drops frequently after surgery.

Patients can wear glasses right away as long as they do not rub against suture lines or affect the incisions. We recommend 1 week before resuming contact lens use.

Interested?

Are you interested in learning more about this procedure? To schedule a consultation, please contact us. Hill Country Plastic Surgery is the premier plastic surgery center in the San Antonio area, and our friendly team members are here to help you and will reach out promptly.

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