After being in practice now for 12 years, I have seen a lot of patients, performed 1000s of eyelid surgeries and seen many second opinions after blepharoplasty or eyelifting. In my practice in Denver, I often am amazed by how little patients know about eyelid surgery before they get the procedure. Often there are many misconceptions and misunderstandings about what the procedure can do for someone. One of the most important things is to know what exactly a blepharoplasty is going to do for you. I perform eyelid surgery in Denver almost every day and there are important things to know before proceeding with the procedure. These are the top three things for patients to think about before getting eyelid surgery or blepharoplasty with me (or anyone for that matter).
First, not everyone is a candidate for the procedure. What does that exactly mean? Well there are two components of whether someone is a candidate for blepharoplasty. First off are you physically a candidate? And upper eyelid blepharoplasty primarily involves removing skin and fat from the upper eyelids. Sometimes it also includes a ptosis repair which is raising the height of the eyelid or opening the eyes. In order to be a good candidate for upper eyelid blepharoplasty you have to have excess skin and fat on your upper eyelids. Some patients may just have mild wrinkling of the skin. These patients may be better served by filler. Alternatively if you have crows feet or wrinkling on the side of your face Botox may be the best treatment.
In the lower eyelid one needs to have extra fat causing bags. Some people come to my office wanting a lower eyelid blepharoplasty but just have lower eyelid hollows without extra fat. Blepharoplasty will not serve these patients well and they may be served better with filler. Alternatively I have patients come in who don’t like the wrinkles on their lower eyelids that are formed when they smile. This is caused by the bunching up of skin as the facial muscles elevate during a smile. When these patients are not smiling they feel they look fine. Blepharoplasty is not gonna serve this person well. Additionally, there are other procedures such as mid face lifting which may be better.
On the third note some patients have an extremely mild amount of loose skin or fat. I approach these patients with caution because if someone has a barely noticeable issue the chance that they will feel they had a good improvement from the surgery is very small. Most often they feel "the doctor didn't do anything". I often talk to patients about realistic expectations at length add an informed them if they have a small problem they will be undergoing the same amount of risk as a person who has a big problem if they undergo surgery. They have to decide if it is worth it.
Finally, sometimes some issues with the eyelid are not really due to simply aging but medical diseases such as floppy eyelids syndrome Graves’ disease or ptosis of the eyelid can mimic aging of the eyelid patients,. Patients may just interprete it as aging overtime but really what’s happening is they have a medical problem that is going on. This is something that only an oculofacial plastic surgeon is really going to be able to identify. As a result they will be able to fix the problem in regard to their medical issue along with improving the patient cosmetically. In some patients the problem that they’re having is not cosmetic at all but really an underlying serious issue such as a tumor or autoimmune condition that is making the eyelids not look great. The real true treatment is directed at the medical problem and not a cosmetic blepharoplasty. Only an expert can identify that and the take-home is see an oculoplastic surgeon (preferably one certified by the American Society of Ophthalmic Plastic Surgeons not a self proclaimed "eyelid specialist").
Secondly it is important to understand if you are psychologically capable and ready to handle an eyelid surgery. Eyelid surgery is not magic. Patients often think that within a couple days they will be back to normal and looking “amazing”. It is important as a patient to really understand what the healing process is and what realistic expectations are.
Blepharoplasty is designed to create an improvement not perfection. The surgery is simply removing skin, fat and repositioning fat. Even if you look at my before and after photos or my colleagues before and after photo online you will see many patients who have a great deal of improvement. That being said you’ll find very few patients who are “perfect” afterwards. I think patients who expect perfection are set up for major disappointment. The patients I perform surgery on get a great deal of improvement and most are extremely happy. I would be very gun shy of operating on someone wanting perfection.
The psychological component of healing after blepharoplasty is something that should not be ignored. During the healing process there will be emotional highs and lows. I tell patients after surgery they will look at themselves in the mirror the next day and say “God what have I done”. That is the truth that most surgeons won't tell you. Yes, every day gets better and every day things slowly heal. Full disclosure: Full healing from blepharoplasty takes six months. It is true that within a couple weeks you’ll be feeling largely back to normal but you definitely will not look 100% normal. Sometimes incision redness can take months to get better. How you feel during that process? There’s a small percentage of patients who also may need a small adjustment or revision procedure after surgery. If you were part of that group how are you emotionally going to respond? Some of my colleagues have sent me patients for second opinions who have been depressed after their eyelid surgery. When I look at these patients eyelids they in fact look great! What I think the real problem is that the patient did not have the emotional or psychological preparation for the procedure. Additionally often these patients have completely unrealistic expectations for what a blepharoplasty can provide physically and the emotional process. I know that many people who write or talk about blepharoplasty on their website will not mention this but I think it is critically important for patients to be aware of. As someone who has now performed thousands of these surgeries I want patients who are fully prepared to undergo the procedure. Some surgeons who are not as busy or experienced will try to lure patients into surgery by claiming how simple or easy it is. I sometimes see these patients for second opinions and it is not pretty.
Second not everyone is getting the surgery for the right reasons. I’ve turned away many patients in my career because they are desiring eyelid surgery to fix some thing that has nothing to do with their eyelids. I have some great examples. Some patients such as a man I saw recently wanted to get eyelid surgery because his wife had left him for her Hurt tennis instructor. If you think about it, that really isn’t the right reasons to get eyelid surgery. He probably was feeling hurt and insecure because his wife left him for a younger man. As a result he jumped towards cosmetic procedures to try to “solve the problem”. I recommended that he first see a psychologist to get over his marital separation before returning for eyelid surgery. He came back several months later for something else and thanked him for steering him away from something he didn't inherently want.I believe that there are many surgeons who would’ve would’ve performed the surgery on him. The truth is, I perform plenty of eyelid surgery and I am not interested in that. What would have happened is an unhappy person would’ve gone through the process of eyelid surgery healing and recovery only to be hurt and unhappy by his wife leaving him still after the surgery
Another example I had was a female patient who was being encouraged to say the least by her husband to get surgery. He felt as though she had aged over the years and wanted her to upgrade. She felt completely happy with her parents however she wanted to make her husband happy. I recommended that this patient wait several months and come back to evaluate whether really it was her who wants the eyelid surgery or she is doing it for all the wrong reasons. She never returned and I heard through a patient who was sent by her that she was separated from her husband.
Finally the third example is a patient who I operated on. In life you learn through mistakes. I counseled this patient as normal and performed surgery. He was very unhappy afterwards. Though the blepharoplasty was performed flawlessly and he looked 15 years younger he felt that the surgery was not “good enough”. He then explained to me that he felt "in his community if you are not attractive you are worthless". Because of that it was important to him to try to look like a Ken doll. Because he did have bags that were severe and aging skin on the upper eyelids I thought he had enough physical characteristics that made him a good candidate. I didn't vet his psychological preparation. I tried to discuss afterwards with him the limitations of the surgery again and that he had a great outcome. Too late. He didn’t care. He wrote several reviews online trashing me as a surgeon (and basically as a person). Because he wasn’t getting the social outcome he wanted he felt the results were terrible. As you can see the happiness after eyelid surgery for some patient is not related to the actual surgical outcome but a myriad of other factors not related to the surgery. In fact I’ve had very few rare bad reviews online but the vast majority of them were due to the fact that I operated on patients who had completely unrealistic expectations or were doing the surgery for the wrong reasons. As I’ve gained experience I’ve gotten better at identifying those patients and steering them away from the operating room. It has let me sleep better and feel better that I am operating on people who are the best candidates.
Third is not everyone is prepared for the work involved in getting a blepharoplasty. What do I mean by that? I write a book called "So You Want To Get Your Eyelids Done".
You can buy it on Amazon. I give it to every patient so they have realistic expectations of what to expect before, during and after surgery. I also include in the book healing, alternative to surgery, common questions, misconceptions and before and after photos. I believe that patients are happiest when they know realistically what to expect. The more the patient knows, the better. I am not interested in tricking anyone into surgery. Frankly I make enough money and I have to sleep at night. What I do want is somebody who is a good candidate and who is willing to do the basic work required for surgery. The basics of what that involves include getting a pre-surgical physical to make sure that someone is in the health where they can get the surgery. Also they have to be able to do the aftercare which involves resting and icing and letting it heal. Additionally they have to mentally prepare for the healing process and returning for follow-up exams. This involves reading the book. If someone thinks getting a blepharoplasty or eyelid lift is the same as picking up a cheeseburger from McDonald’s they’re in for a surprise. Part of the experience of eyelid surgery is understanding with the journey will be, not just a final destination. If you were ill prepared for the recovery period even if your surgery turned out fantastic, you will feel it’s was bad experience. When patient reads the book I feel they are much more comfortable and happy. They are able to tolerate the healing process in a much calmer fashion. But in order to get there there has to be some preparation and work on their end.
A critical thing to understand is eyelid surgery is a two-way process between the surgeon and the patient. I want patients to understand what a realistic expectations for the surgery as well as realistic healing times. This involves work on the part of the patient to being open to listening to me to understand what can and can’t be done with cosmetic eyelid surgery or blepharoplasty. You are unfortunately not going to look like a Ken doll. The healing takes time. Each patient is capable of a great good or fair result depending on their surgeon but also their healing and DNA. If a patient is not willing to do the work to be open to that they are really not ready for the surgery.
If you were interested in learning more about blepharoplasty after reading this article the best thing to do is come in for a consultation with me. I can honestly tell you if you were a good candidate for a physical standpoint and what to realistically expect. Alternatively you can order the book I’ve written on Amazon to read about the surgery and understand what to look for in a surgeon as well as the process of surgery and recovery. The fact that you’re reading an article as long as this on the subject tells me that you have a thoughtful and careful approach to the procedure. You are already several steps ahead of most patients. That is great. Eyelid surgery is a wonderful cosmetic surgery for patients and the vast majority of patients are extremely happy they underwent a procedure and very happy with the results. Like any surgery or procedure I think it is something that you want to think of carefully for yourself. Best of luck in 2022 with your eyelids. Thanks - Dr T