Announcer (00:01):
You are listening to Head On with your host, board certified plastic surgeon, Dr. Bahman Guyuron.

Dr. Guyuron (00:08):
And as I mentioned earlier, commonly patients have eyelid ptosis, which I correct that through an incision inside the lid. No cuts on the outside that we can see unless I'm doing a blepharoplasty at the same time, meaning removing upper eyelid redundant skin at the same time. And when we complete the surgery, the patients go to the recovery room and then go to home or hotel, depending on where they're from. We see them the next day. Usually they have a little bit of blurred vision for a period of time because of the medications in the eye, ointment in the eyes, meaning a day or two. And they may have some swelling, some bruising, and on the same day we ask them to put some cold compresses. And again, the vision could be slightly blurred because of the ointments that we use during the surgery and right after finishing the surgery. And the next day, again, they may have some blurred vision, but we want the patients to be somewhat mobile right after the surgery and the next day stay out of the bed, walk around as much as they can.

(01:28):
We advocate that actually walking and moving the ankles and legs just minimize to minimize the clot formation in the legs. And again, within two or three days, the vision becomes clear. They can do the computer work, but socially they'll be to some degree limited because of the bruising, swelling. But tinted glasses, they can go out for a dinner in a couple of nights. Again, those of us who are experienced enough have done enough surgery, as soon as we start making incision, we know how much the patient's going to bruise or bleed, and we may give the patients specific medications that are called tranexamic acid or D-D-A-V-P, which enhance the clot formation and reduce the potential for bruising and swelling. We don't see patients with really puffed eyes, they're blocked, they can't see for a period of time anymore, or it will be extremely, extremely rare. But most patients get some bruising, some swelling that will go away in a fairly reasonable time.

(02:39):
For the upper eyelid, that would mean within a week or so, most patients actually can resume their social and professional activities. And for patients, no strenuous activities, meaning playing tennis, jogging, swimming, golf for three weeks after the surgery, whether it's the upper eyelid or lower eyelid, that would be the case. The lower eyelid recovery is a little bit longer, may take 10 days to two weeks, and some patients will have some swelling in the conjunctiva that we have remedies for it and we implement. And regardless, most patients look pretty presentable within, again, 10 days, two weeks, and they can resume the activities except for strenuous activities. We tell the patients not to take any aspirin, aspirin type medications three weeks before and a week after the surgery to minimize the bruising and swelling that I referred to. And they can see there, many of these patients are very happy, gratified and look more energetic, looks less tired. As I said, if we do ptosis correction, they're going to have improvement in their vision.

(03:57):
Infection, bleeding can happen again, extremely rare. We minimize those. But we also, as I said, are absolutely precise about this surgery because this is not a forgiving surgery. The patients who wear contact lenses, we advise them not to wear the contact lenses for a week. They can wear glasses, but after that, after the first week, they can gently place the contact lenses. Patients have a dry eyes. They may have a little bit more dryness after the surgery, but that usually is temporary. There are techniques that actually can make the dryness worse. But again, those of us are experienced, we do not use those techniques. Or most of the time actually, the techniques that we utilize may actually improve the disbursement of the tears, thus reduce the dryness to some degree. Complications of the eyelid surgery include those that are going to be occurring during the operation, which is unfortunately of potential loss of vision.

(05:11):
Whenever we operate around the eyes, that is extremely, extremely rare. The patients can have excessive bruising, bleeding after the surgery. Again, we minimize that by making sure that the patient's blood pressure is controlled before the surgery and during the surgery after the surgery. Within a week or so, infection can happen, very rare after the eyelid surgery. Fillers in the lower eyelid can produce a good deal of improvement temporarily. But the things that can go wrong is obviously lumpiness meaning irregularities. The filler can get into the vessels, can cause blindness, but fortunately again, that's extremely, extremely rare. It can cause too much fullness, not needed amount of filling. And sometimes it does cause persistent swelling, but those are fortunately unlikely possiblities. On a long-term basis, the lid can get pulled down. If that occurs, it can be corrected. That usually means that either the skin was removed too much or the patient formed a scar tissue in the eyelids or one thing was missed, and that is the tone of the lower eyelid that I mentioned earlier.

(06:43):
Sometimes in conjunction with a lower eyelid surgery or often actually the in conjunction with the lower eyelid surgery, we tighten the tendon that holds the lid up, supports lower lid up, and it is connected to the bone and is like a sling going all across the lower lid and holding it up. We tighten that if it is loose to minimize the potential for the eyelid being pulled down. There are patients who are prone to having that kind of condition and we need to detect that. We need to be aware of it and we minimize, again, deterioration of the lower eyelid tone after the surgery. Those are the things that the patients can experience. Nobody should wake up not being able to see. Again, the vision will be blurred if there is a problem seeing the doctor should be informed immediately.

(07:43):
But fortunately that it is incredibly rare. And as I said, in 44 years that I've been doing this surgery, I've never seen one. Of the rejuvenation procedures that we carry out, eyelid surgery is the one that provides more lasting results, meaning it would be rare that the same patient may need upper eye surgery twice. Can it be done? Absolutely. If there's a redundant skin, the answer is yes. If there's a depleted fat, fat can be replaced, but it is unlikely. Most likely that patient who had upper eyelid surgery and now has redundant the skin is going to need a forehead lift rather than eyelid surgery. And the same for the lower eyelid, we can actually redo the lower eyelid surgery either for correction of the previous surgery that did not result in an optimal outcome, or a patient who has developed fat pads that were removed, but sometimes they come back.

(08:50):
But that would be, again, extremely unlikely. It is not like aging facelift that most patients would be a candidate for another operation. However, in either situation, a facelift or eyelid surgery, the rejuvenation, the changes that we occur is permanent. Meaning if we make the patient's eyelids to look 10, 15 years younger, that patient is going to always look 15, 10, 15 years younger because we are not stopping the gravity, we are not stopping the aging. Had we not done that surgery, that patient would've looked a lot worse. So the results that change that we occur are permanent. What we are not doing is stopping or halting the time element and gravity effect on the face or the eyelids. It is true about any plastic surgery procedure that if it is done properly and the patient heals properly, it should not be obvious that the patient had surgery.

(10:04):
And the reason is we strive to create natural looking, natural change on the eyelids or the face or the nose or even on the body contouring. And because of that, it should not be obvious that the patient had an operation no matter where the surgery is done, particularly the eyelid. On the other hand, if the eyelid surgery is not done properly, it doesn't heal properly, unfortunately, the reverse is true, the face will look different. And then the reason is when we look at people first, we look at their eyes. That's the first thing that we see and the changes that are drastic there that make the patient look different is going to be obvious to us immediately. So because of that, as I mentioned earlier, this is the most demanding and most precise surgery next to the nose operation. They are two procedures that are extremely demanding and require enormous experience, the nose operation, rhinoplasty and blepharoplasty. As indicated earlier, they're totally unforgiving. There's really no room for a minimal error.

(11:39):
We have a number of patients who have allowed us to use their pictures in my website, however, we have more pictures in my office because some patients only allow us to show their pictures to the other patients in the office setting. And we respect the patient's privacy rights and we do not ever show any pictures of patient to somebody else, even their friends or family members without the patient consent. For a consultation about blepharoplasty, you can call my office (440) 461-7999. Again, 4 4 0 4 6 1 7 9 9 9 or go to our website and that is DrBahmanGuyuron, one word .com, and we'd be happy to offer in person or virtual consultation. Overwhelming majority of my practice is from out of town, out of country patients.

Announcer (12:53):
Links to learn more about Dr. Guyuron and anything else mentioned on this podcast are available in the show notes. Head On is a production of The Axis, T-H-E-A-X-I-S.io.