the truth about eyelid surgery

​When patients get eyelid surgery they are often unsure what the normal expectations for healing. How bruised am I expected to be? When will the swelling go away? When will I look "normal" again? This article is meant to give an honest account of what expectations should be after surgery.

Most patients getting eyelid surgery will be getting an upper or lower eyelid blepharoplasty or both. There are other procedures such as lateral canthal tightening, ptosis repair that can be also covered under this article.

Lets get some basics out of the way first. When you have eyelid surgery it is in fact surgery. Regardless of whether an incision is being made with a blade, cautery needle or laser the skin is being cut and tissue is being manipulated. From your body's perspective it is no different than when you sustain an injury. It's just that I am doing it in a controlled fashion. Swelling and bruising are normal after any procedure (even injectables) and more so after surgery. Second, the more procedures you have done, the more swelling and bruising you can expect. So..if someone is getting an upper eyelid lift, they will have less bruising than someone who is getting an upper eyelid lift, lower eyelid lift, ptosis repair, midface lift at the same time. Makes sense right? Finally, when your doctor tells you most people are back to normal in two weeks he or she means 75-85% of patients, not everyone. People heal under a bell curve. Most people follow a straightforward pattern but there are exceptions. I once did an eyelid lift on my technician and she was "back to normal" in three days. Now..she represents one edge of the curve. She healed very fast and very well. Not everyone is like that. Similarily, you can have someone who takes 6 months to heal.

There are several components of the healing process I will talk about: bruising, swelling, scar and incision healing, lid position, and herbal medicines.

Bruising  After eyelid surgery expect to have some bruising. How variable can this be? Good question. Some people have a light amount of redness near the incision site. Others have redness covering the entire eyelids. Others have bruising that is on their cheeks or ever lower face or neck. During surgery small amounts of blood can track down with gravity. I have had patients who come in their first followup and ask "Doctor Thiagarajah, what did you do to my neck" after they have had an eyelid lift. Nothing..but blood can drift down with gravity. Bruising usually takes about 2 weeks to go away. Sometimes it can take up to 2 months but that is uncommon. The color may change to yellow and blue as the blood is being absorbed by the body. The good news is that the bruising always goes away.

Swelling Immediately after surgery, patients will have swelling in their eyelids or face. This is because the body is sending cells to heal the surgical area. In fact, the swelling may get worse over the first couple days. If you have had a cut, you will notice that 30 seconds after you get the cut, the skin is flat and smooth except for the area of the cut. However, after a day or two, the area may get swollen as the body begins to heal the area. Any surgery results in swelling in the eyelids. Within 2 weeks 90% of the swelling is usually gone. The remaining swelling (the last 10%) is usually gone within 2-3 months. Rare patients can have swelling for 6 months to 1 year. There are reported cases of patients having swelling permanently. These are rare exceptions but it is a possibility.  

Steroids and Swelling Some surgeons give patients steroid pills after surgery to reduce swelling. Steroids suppress the immune system and immune response and thus reduce swelling. Yes..this definitely decreases the swelling postoperatively compared to not giving steroids. However, there are a couple risks with this. One, steroids do increase the risk of infection. Patients who are diabetic for example or who have an underlying low immune system could get a bad infection in a different part of their body or the surgical site. Also oral steroids increase the lifetime risk of avascular hip necrosis. There have been reported cases of patients getting one dose of 80 mg of prednisone and then developing hip necrosis. As a result, most plastic surgeons do not routinely give this medicine out unless needed.

Icing/Healing position What can be done to minimize swelling? Two things work well. Icing the eyelids minimizes the fluid that is being drawn into the area and can reduce swelling very well. Also keeping the head above the heart helps by gravity to allow the fluid to drain down away from the eyelids. I have patients sleep on pillows with their head elevated for the first week. If you dont ice or sleep with your head elevated it is not the end of the world. When they compare patients who ice with those who don't, in six months both groups look the same. It is only in the first couple weeks where the icing and head elevation will get you back to normal faster.

Scar and Incision healing The red line of where the incision is may take some time to heal. In the upper eyelids this is in the eyelid crease. In the lower eyelid if it is done, it is usually in the side corner near the lashes. These scars heal to an almost non noticeable level. How long does it take? The incisions can take up to 1 year to heal. That being said, they are at their worse in 6 weeks. After six weeks they start to improve dramatically. Avoiding the sun helps the healing process for the incisions. Most patients feel that at 8 weeks the incisions are non noticeable.

Lid Position The eyelid position can be altered by the swelling and bruising that occurs. This usually resolves within six weeks or so. In some patients you need the full six months to let things settle down. These patients are the exception as opposed to the rule.

Herbal medicines Herbal medications such as bromelain, arnica montana and papain are show to speed recovery and healing. They can be taken before surgery. Vitamin C is also a good healer. Other herbal medicines should be stopped and discussed with your surgeon. Some herbal medicine can actually make bleeding worse

I hope this summary gives you a good idea of what to expect from your surgery. 99% of patients I have treated are very happy that they had their eyelids done. Part of the healing process involves the patient constantly checking themselves in the mirror. You will notice things on your face you didn't see before. I tell patients that too much checking can actually be harmful as psychologically you will start noticing other things on your face that you don't like, you will notice small asymmetries between the eyelids that were there before. As long as there are not any glaring problems such as a broken stitch or excess bleeding I would try to minimize looking in the mirror for the first two to three weeks. I know that is easy to say and hard to do though. Good luck and enjoy your new eyelids.

What to expect after eyelid surgery - The Truth
WASHINGTON DC AND MARYLAND
An eyelid specialist serving D.C, Maryland and Northern Virginia
(301) 277-4844
Chris Thiagarajah M.D Oculoplastic Specialist