New York facial plastic surgeon Lee Ann M. Klausner, MD says many people put off eyelid procedures longer than they should, as in some cases, an upper and lower blepharoplasty can be done in the comfort of your surgeon’s office under local anesthesia. “In some cases, upper eyelid surgery and superficial lower eyelid surgery can be done under local anesthesia which is great for people who are trying to avoid the hospital,” she says. “Patients who are medically cleared for this procedure under local anesthesia will receive oral medication to relax, and then small injections of local anesthesia in the office. In most cases, people are pleasantly surprised that it is a relatively easy procedure to undergo and recover from.”

Here, Dr. Klausner shares when to know it’s time for surgery and when to graduate from noninvasive eye procedures like neurotoxins, fillers, non-invasive skin tightening and lasers.

How Do You Know It’s Time?

“I would say if your eyes look like they’ve aged significantly or they look smaller and there’s extra skin on the upper eyelid. Perhaps it’s difficult to apply eye makeup the way you used to. Or perhaps people think you look tired all the time. Those may be signs that you need upper eyelid surgery. Some people are bothered by dark circles under the eyes, puffiness below the lower lid, or extra crepey skin involving the lower eyelids. So, you may be evaluated for lower eyelid surgery for those reasons.”

What Does an Upper Blepharoplasty Improve?

“Upper blepharoplasty removes the extra skin involving the upper eyelid and when indicated a small amount of fat which may be protruding above the inner corner of the upper eyelid. By removing the excess upper eyelid skin and protruding fat, the eyes appear a little bit more open as a result.”

What Does Lower Blepharoplasty Improve?

“It can do one of two things: Some people have a lot of wrinkles under their eyes when they smile, but they don’t have puffiness. In those cases, we can just remove a pinch of skin under local anesthesia. The sutures come out in five days and it’s a relatively easy procedure to heal from which takes care of the problem.

“If there is bulging fat and excess skin involving the lower eyelid, the procedure is performed under IV sedation. There are tiny blood vessels within the fat that need to be carefully sealed as the fat is removed. With the patient under IV sedation there is more control as the blood pressure is monitored by the anesthesiologist and the patient is sleeping during the procedure.”

How Do You Know When It’s a Good Time to Graduate from Nonsurgical Treatments?

“Well, one way is that your doctor is going to tell you what can and cannot be accomplished with minimally invasive treatments and that surgery may be indicated if it will better treat what bothers you. If you’re not currently under the care of a plastic surgeon, it might be that you’ve had some different treatments done and you didn’t really get what you wanted. Or it might be that you seek a consultation with a plastic surgeon to learn more. It’s very helpful to have a plastic surgeon evaluate you because he or she is trained to do both the surgical and the nonsurgical. If we recommend one over the other, there’s a good reason. Whether you’re a good candidate involves knowing what your goals are and knowing what is involved with eyelid surgery: whether you have time to recover and heal. I find sometimes, I have patients who will choose noninvasive options because they just don’t have the time to recover from surgery right now.”

Describe the Recovery from Eyelid Surgery?

Typically, there is mild to moderate swelling for the first 48 hours following surgery. We ask patients to keep their head elevated with their body in a semi-reclined position when sleeping. Patients will apply cool compresses over the eyelids and use artificial tears to keep the eyes moist. Pain is generally mild and typically managed with oral pain medications. Though experiences can vary, often patients move to regular Tylenol after 48 hours. We require all patients to avoid Aspirin, Motrin, Ibuprofen and Advil, and herbal supplements for two weeks before surgery and several weeks after surgery. We ask patients to avoid bending straining, exercise, and heavy lifting for about ten days after surgery. Sutures are removed on post-operative day five and day seven. Light concealer can be applied after one week.

Which Procedures Do You Typically Combine with Eyelid Surgery?

“Browlifts are commonly combined with eyelid surgery and sometimes facelifts. Often when the brow is not too low, we will combine ultrasound noninvasive treatments to conservatively lift the brow before we perform eyelid surgery. It really depends on the patient and their goals, needs and medical condition.”

The Bottom Line

“If you have extra eyelid skin causing wrinkles on the upper eyelid or covering most of your upper eyelid and it really bothers you, that’s a good reason to seek a consultation with a facial plastic surgeon and consider eyelid surgery.”