Eyelid surgeries are a very delicate surgical procedure. This must be done with great care and balance to give a good result to the patient. Patients that come to Dr. Jacobsen for correction generally of the upper eyelid where there is too much skin that tends to dangle down, and cause the appearance of advanced age or can also inhibit the vision of the patient by blocking some of the field of view with your eye.

Removal of this extra skin in the upper eyelid for the most part can be removed under local anesthesia in the office of Dr. Jacobson, in a comfortable suite. This skin removal of the upper eyelid is called a blepharoplasty and can be performed safely usually in less than an hour.

Sometimes insurance will cover the removal of the skin if the skin is physically blocking greater than 50% of your visual field in one direction. This can be measured by your optometrist or ophthalmologist with a “field of vision view”. Your insurance company will have a policy with regard to what they cover and what they do not cover. If your insurance company does not cover this procedure Dr. Jacobsen and his staff have a reasonable fee for this to be done in the office under local anesthesia.

At times, however, the operation must be done under general anesthesia in the Hospital if there is extensive skin to be removed or additional bulging of fat that requires removal. Normally the upper eyelid incision heals very well and is hidden very nicely, as the upper eyelid gets tucked back into the orbit when you open your eyes.

The lower eyelids are more complicated and usually require a general anesthesia to perform safely. These required incisions are designated directly under the eyelash of the lower lid and dissection of the fat, bulging underneath the eyeball and causing the eyelid to bulge out. Typically, the reason the lower eyelid looks too bulky is because the fat around the orbit is beginning to bulge out as you age. Sometimes, however, there is additional skin that requires removal as well. The lower eyelid is more complicated to perform but can be performed safely under anesthesia.

The incisions are finally closed with very fine suture material. Usually, Dr. Jacobsen uses 7-0 Vicryl absorbable suture material. The suture material is dissolvable and usually falls out on its own after about 2 weeks. The incisions are sealed with a fine layer of DermaBond a cyanoacrylate that is most like superglue except is flexible and is sterile. This seals the incision and prevents bleeding and allows you to shower after the surgery immediately. The incisions after the surgery required no creams or ointments or any specific care other than keeping them clean and dry with antibacterial soap and water. You may shower directly after the incision as well. It is best to treat the eyelids after surgery with ice taking care not to freeze the skin with direct icing but using indirect icing with frozen peas in thin Ziploc bags or masks that can be obtained at the pharmacy that are filled with gel that can be frozen and interchange throughout the first day or 2 after surgery. After the first 24 or 48 hours ice or cold packs will no longer help alleviate swelling. In the first day this can be very comforting and prevent additional bruising and minimize the swelling. The best way to minimize the swelling however, is to avoid lifting and straining after the operation. Even bending over to load the dishwasher can often allow your face to fill up with blood and feel congested, causing potential bruising or bleeding. It is best not to bend over or lift and to allow your family to help you with car doors and heavy doors wherever you are. You should sleep with the head of your bed elevated at least 30°, with an extra pillow which helps a great deal as well. Your blood pressure should be maintained in a normal range as well. Bruising always goes away with time and is always disappointing when patient skin bruising around her eyelids. This always goes away with time. it is best to avoid this is much as possible with your own postoperative care. If you are considering an eyelid lift in Phoenix feel free to contact Dr. Jacobsen’s Office with any questions or to schedule an appointment today!

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include oral orintravenous sedation or general anesthesia. Your doctor will recommend the best choice for you. The upper eyelids are often done in the office but the lower eyelids need to be done in the hospital.

Because the lower eyelid incisions when the lift is performed he is directly along the margin of the eyelashes rather than above or below the eyelashes it is very close then to the globe of your eyeball which must be protected with a corneal protector which is a plastic device that is inserted over your eye much like a shield to protect your eye during the surgery. This is uncomfortable while you are awake. He will be much more comfortable being asleep and allows me to do the surgery more safely for you so that you are exquisitely comfortable and exquisitely still so the fine details of your eye the lift can be done efficiently and perfectly. Once the surgery is completed you will see that you will be very comfortable as the eyeball itself is irrigated very carefully with sterile ophthalmologic solution before you wake up.

Step 2 - The incision

The incision lines for eyelid surgery are designed so the resultant scars will be well concealed within the natural structures of the eyelid region. The upper eyelid can be corrected through an incision within the natural crease on the eyelid. This allows for removal or repositioning of fat deposits, tightening of muscles, and removal of excess skin.

Conditions of the lower eyelid may be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelid is removed. Again, the excess fat can be repositioned or removed.

A transconjunctival incision, created on the inside of the lower eyelid, is an alternate technique to correct lower eyelid conditions and redistribute or remove excess fat. With this technique, no skin is removed.

Step 3 - Closing the incisions

Eyelid incisions typically are closed with:

• Removable sutures
• Skin adhesives
• Surgical tape