What to Expect After Lower Eyelid Surgery
The results of lower eyelid surgery are rewarding, taking years of aging off the face. Despite knowing what surgery can do to rejuvenate the eyes, most people are often hesitant to pursue eyelid surgery. The reasons include a concern for changes in vision, change to your overall look, longer than expected recovery making it hard to hide from the public, and dealing with any unexpected consequences after surgery. One of the most common questions I receive in consultation about surgery is what changes to expect.
So what can you expect after lower eyelid surgery?
First, the healing process depends on the type of approach that is used.
Inside Lower Eyelid Approach
The inside lower eyelid approach (Trans-conjunctival Blepharoplasty) removes eye bags using an incision made through the conjunctiva. The conjunctiva is the pink moist layer inside the lower eyelid that is visible when you pull the eyelid down. Removing eye bags through the conjunctiva eliminates visible scarring on the outside of the eyelid. The incision is hidden and bruising and swelling is usually minimized compared to the outside technique.
Outside Lower Eyelid Technique
The outside lower eyelid technique removes eye bags with an incision beneath the eyelashes of the lower eyelid. This technique usually leaves a slightly visible scar beneath the eyelashes; however, as time passes, these scars frequently become nearly invisible. This technique allows better visualization of the eye bags or fat pockets which can often be repositioned to treat any hollowing under the eyes. However, this approach also creates more swelling which often takes 2 weeks to resolve.
Whether the inside or outside technique is used depends on the type of problem you are experiencing. Some of these include:
- Loose Skin – outside approach which may be combined with laser resurfacing
- Prominent Fat Deposits – inside approach
- Excessive Amount of Loose Skin and Prominent Fat Deposits – outside approach or inside approach with pinch of the outside skin combined with laser resurfacing
Lower eyelid surgery may be combined with fat transfer
Lower eyelid surgery may be combined with fat transfer to address hollowing under the eyelids. If there is a small amount of hollowing, the fat from the eye bags can often be preserved and moved down to fill in the hollowing. However, deeper depressions often require more fat than is available from the lower eye bags. In this case, fat may need to be transferred from another part of the body to use like a “filler” to fill in the hollowing in the cheeks and tear trough or orbital rim. This procedure is called “Autologous Fat Transfer” or “Fat Grafting” and is a safe and reliable procedure. The fat that is transferred here is living and remains a permanent part of your face. The fat will fluctuate with weight gain or loss like anywhere else in the body and you can expect the results to last up to 5 years. However, aging will continue to deplete fat from the face and eyes and the procedure may need to be repeated in 5 years.
Common Changes After Surgery
Whether an inside or outside approach is used or autologous fat transfer is combined with the procedure there are some common changes that can happen after surgery. These include:
1. Blurry vision
Blurry vision is common for a short time following your lower eyelid surgery. The swelling that occurs can cause a temporary distortion of the cornea, which leads to blurred vision; in addition, ointments used during the surgical procedure or those prescribed for use at night can cause blurriness.
Another common cause of blurry vision is dryness due to the inability of the eyelids to close because of swelling. The swelling makes it difficult for your eyelids to distribute the tear film evenly across your eye, which causes this distortion. Sometimes you may notice additional tearing, but your eyes remain dry, this should resolve over time.
2. Contact Lenses
If you wear contacts, you need to wear your glasses for at least 10 days. When your eyelid swells, the eye can become temporarily distorted; thus, causing a misshapen cornea. Your optometrist prescribes the contact lenses that perfectly fit your corneas; therefore, if your corneas swell after your eyelid surgery your contacts will not fit properly.
You will have swelling immediately following your lower eyelid surgery. This happens as the body sends cells to heal the surgical site. You may even experience additional swelling over the first few days. For most patients, the swelling subsides within 2 weeks’ time.
Bruising is also common following your lower eyelid surgery especially if the surgery is combined with upper eyelid surgery or autologous fat transfer (fat grafting). Some people experience a very light red discoloration whereas; others have discoloration that covers the entire eyelids. Some patients will experience bruising on their cheeks and even their lower face and/or neck. This bruising can occur when small amounts of blood are pulled down by gravity during the procedure. Bruise colors change throughout the healing process; within 1-2 days, the bruise will appear purple or blue, eventually turning green and then yellow at the final stage of healing.
To reduce swelling, you can apply ice compresses that are made of gauze sponges for 20 minutes every hour during the initial 48 hours following your surgical procedure.
5. Short-term changes in the shape of the eye
Short-term changes in the shape of the eye can occur. The position of the eyelid can temporarily change due to the bruising and swelling associated with eyelid surgery. For the majority of patients, this issue usually resolves itself within approximately 6 weeks.
Asymmetry is another common occurrence following eyelid surgery. This is temporary and is usually caused by the variances in swelling in each of the eyes. In addition, most asymmetries are present before eyelid surgery and become more obvious after eyelid surgery. We are naturally born with some asymmetry between the two sides of the face and it is not uncommon to have eyelid asymmetry before surgery.
7. Numbness of lower eyelid skin
Numbness of the lower eyelid skin is common. Any numbness associated with the lower eyelid surgery is usually temporary. The numbness generally begins to dissipate within 4-6 weeks; disappearing altogether within 2-3 months. The sensation may be awkward the first time you apply mascara and/or eye makeup after surgery.