A forehead or brow lift is needed to restore the natural position of the brow, which can descend over time as we age. The brow is one of the more expressive areas of the face and with aging can give the chronic appearance of being sad, angry or tired. There are several approaches to addressing the brow that achieve varying levels of lift. These include the internal brow-pexy that can be performed through a blepharoplasty incision in the upper eyelid, the coronal lift in which the incision is hidden across the hairline, and the endoscopic lift in which tiny incisions are placed within the hairline and a thin tube with a camera is used to assist with visualization during surgery. The selection of procedure is customized to the degree of brow descent and patient’s desired appearance after surgery. Consultation with one of our skilled surgeons for evaluation will allow tailoring of a treatment plan.
An upper eyelid blepharoplasty is performed to address excess skin and fat protrusion that may occur as we age. The eyes are one of the most important features of our face and readily demonstrate the signs of aging, giving one a more tired and old appearance. The surgery is done through an incision that is hidden in the upper eyelid crease in which redundant skin is removed and sculpting of fat can be performed at the same time. Reshaping of the contour of the upper eyelid is thus achieved, restoring a more youthful appearance. For Asian patients wishing to have a more pronounced eyelid crease or “double eyelid surgery,” care is taken to be mindful of the subtle differences in eyelid anatomy. Our surgeons are well experienced with the nuances of blepharoplasty and will customize a surgical plan to the individual’s needs.
A lower eyelid blepharoplasty is performed to address puffiness or bags and/or dark circles beneath the eyes. These aging changes can give eyes an older, more tired appearance. Surgery can be performed several ways including with an incision on the inner aspect of the eyelid that is hidden from view. Alternatively, the incision can be placed just beneath the eyelash line should there be skin that needs to be addressed. The fat is sculpted and repositioned as necessary to restore a natural, rejuvenated contour to the lower lid as it transitions to the cheek. Lower blepharoplasty can be combined with other aesthetic surgery including upper blepharoplasty and midface lift. A careful evaluation with one of our surgeons can tailor a customized treatment plan.
A midface lift or a cheek lift is performed to restore a more youthful position to the cheek mound, providing more fullness to the cheek and lower eyelid area. As we age, there is decent and sagging of the soft tissues of the face that leads to hollowing beneath the eyes and a more prominent fold of skin adjacent to the mouth known as the nasolabial fold. By using well-concealed incisions around the lower lids or in the hairline over the temple area, the cheek fat pad is elevated and secured back to its original position. Results from a midface lift are more permanent than those achieved with soft tissue fillers. A midface lift can be combined with other aesthetic surgery including upper and lower blepharoplasty. Consultation with one of our surgeons will allow a tailored plan to meet the individual’s aesthetic needs.
Q. How much bruising and swelling will I experience?
A. There is a varying degree of bruising and swelling that can occur and depends on how much surgery is performed and also on the individual’s own healing process. Typically for eyelid surgery, 3-4 weeks of bruising and swelling can be expected, the worse of which is the first week and slowly dissipates with time. A longer recovery can be expected when combining additional surgeries, such as brow or midface lifting. Bruising can extend over the cheek and rarely down the face. Ice compresses immediately after surgery for the first several days can mitigate some of the after effects of surgery, as well as, sleeping with the head of the bed at a 30 to 40 degree angle. Your surgeon may also choose to prescribe you a steroid pack to reduce these effects if your health permits.
Q. Is there pain with surgery?
A. Pain during surgery is controlled with an IV line through which medications are administered. Local anesthetics are also injected into the surgical area. Post-operatively, for the most part eyelid and facial surgery is without significant pain or discomfort. In fact, most patients report that they do not need to take more than acetaminophen (Tylenol) after surgery. An oral analgesic for additional pain control may be prescribed.
Q. When can I bathe after surgery?
A. One may shower or bathe the day following surgery. It is okay for the scalp, face and eyelids to get wet. Direct spray onto the eyelids should be avoided, as well as, vigorous scrubbing of the face. The scalp can be gently shampooed and rinsed with care to not aggressively scrub these incisions if applicable. Submersing the head beneath the water is not advised.
Q. How long do I need to take off from work?
A. Most individuals choose to take one week off from work during the time when the most significant amount of bruising and swelling is experienced. Returning to work the week after surgery is fine, however, there will still be bruising and swelling that continues to resolve. Strenuous activities at work such as bending or lifting is not recommended in the first 2 weeks after surgery. It is advised when scheduling aesthetic surgery that at least 3 months’ leeway time is considered before any major life event such as a wedding, reunion, or retirement party to allow the surgical area to completely settle and heal.
Q. When can exercise be resumed after surgery?
A. It is recommended that heavy lifting, bending or straining including weight lifting, cycling and yoga be avoided for the first 2 weeks after surgery. Light activity such as walking is ok. In the third week, light exercise at half strength may be resumed followed by full strength routine by the 4th week. During exercise there is increased blood flow to the head and face, and as a result, swelling in the surgical area may worsen during the immediate post-operative peroid.
Q. When can makeup be used after eyelid surgery?
A. Makeup should be avoided for at least 2 weeks following surgery. This will prevent possible infection and also the introduction of the pigment beneath the skin which can permanently tattoo the area.
Q. What type of anesthesia is used for surgery and where is it performed?
A. Most surgery can be performed under conscious sedation or “twilight anesthesia.” For more involved procedures and/or for patient comfort, a general anesthesia is sometimes recommended. Surgery is performed on an outpatient basis at an ambulatory surgery center in San Francisco.
Q. When will I be seen after surgery?
A. A post-operative appointment will be scheduled the week following surgery. The next follow-up is typically scheduled a month later. Should there be any post-operative concerns or problems, the individual will be seen promptly and as frequently as necessary.
Q. Are there contraindications to surgery?
A. It is expected that individuals be of good health with any major medical issues such as hypertension and diabetes in good controlled. Smoking affects wound healing and is ideally discontinued one month before and after surgery. Preoperative clearance for surgery will be obtained from their general practitioner or primary care physician. Individuals with a positive outlook and realistic goals for improvement of their appearance are excellent candidates for aesthetic surgery.
Q. Are there risks to surgery?
A. The most common after effects following surgery are bruising, swelling, light sensitivity, blurry vision, eye tearing or discharge and dry eyes. The risks of aesthetic surgery to the eyelids and face are small but include bleeding, infection, scarring, numbness of the skin, difficulty closing the eyes, asymmetry of the eyes or face, hair loss for scalp incisions, and freezing of the muscles of facial expression. Precautions are taken during surgery to mitigate these potential risks. After surgery, it is expected that the individual rest and not perform any strenuous activity for 2 weeks’ time.
Q. Will I need surgery again in 10 or 15 years?
A. The effects of upper eyelid surgery can be maintained for many years to an entire lifetime. With lower eyelid blepharoplasty, rarely surgery needs to be repeated. The lifespan of forehead and midface lifting varies and depends on the type of lift, severity of correction and genetic and healing factors, as well as, adjunctive measures used to prolong the results of surgery such as Botox. Individuals will experience continued aging and the effects of the environment on the soft tissues of the face. Ideally surgeries would last a lifetime, but more typically the effects are sustained for 7 to 10 years depending on the previously mentioned variables.
Q. Is surgery covered by insurance?
A. Aesthetic surgery is not covered by insurance. Sometimes an upper blepharoplasty is deemed medically necessary after meeting the strict criteria of an insurance company and the surgical costs will be covered depending on the details of the insurance plan. If desired, it can be combined with other aesthetic surgeries. In addition to the aesthetic surgical fee, there would also be a facility fee and an anesthesia fee to consider in the overall cost of surgery.