What exactly is Cosmetic Eyelid Surgery: An Eyelid Specialist in Denver Dispels the myths concerning Blepharoplasty
Most patients think that blepharoplasty surgery is a simple easy procedure that anyone can do, has no downtime and everyone has a great result if performed by a “good enough surgeon” Nothing could be further from the truth. As an oculoplastic surgery in Denver I perform blepharoplasty surgery regularly in my office. Is in fact most common cosmetic procedure I perform. Here are the details of what exactly is a blepharoplasty in 2019 and everything that's involved. There's several myths that I will dispel concerning cosmetic eyelid surgery and blepharoplasty. I hope patients in Denver and elsewhere interested in cosmetic eyelid surgery can get the basics of what to expect and look for.
Myth #1: All eyelid surgeries are blepharoplasties
One of the most common myths that patients in Denver believe is that any eyelid surgery is a blepharoplasty. There is nothing further from the truth. A blepharoplasty is essentially removal of skin and/or fat along with possible transposition of fat to improve the aesthetics of the eyelid. There are literally 100s of eyelid procedures that are performed and some are even combined with blepharoplasty. These procedures are done for cosmetic purposes but also reconstructive purposes. One of the most common is a ptosis repair. In this procedure we elevate the height of the eyelid to open it. The second is a lower eyelid canthoplasty where we tighten the lower eyelids if they are loose. These procedures are sometimes combined with blepharoplasty to improve the aesthetic outcomes of a surgery. It is clear to understand that cosmetic eyelid surgery is a complex procedure and not just a “pinch of skin” removal. Yes, that can be done for some patients but definitely not everyone. As an oculoplastic surgeon I often find patients have confusion about that.
Some of these other procedures such as eyelid raising or lower eyelid tightening are covered by insurance if the problem is bad enough. That doesn’t mean that a blepharoplasty is also going to be included in the surgery for free. A blepharoplasty would be a separate procedure that is not covered by insurance that can be done at the same time as well.
It is important to understand what exactly is going to be done during your cosmetic eyelid surgery. That could include a blepharoplasty but also other procedures if needed.
Myth #2: I should expect my eyelids to be perfect after cosmetic eyelid surgery
A famous eyelid plastic surgery specialist (oculoplastic surgeon) once said “Remember the eyelids are sisters and not twins. They do not exactly look the same before surgery and it is impossible for them to look exactly the same after surgery. That is a fool’s journey”. That is definitely true. During surgery on the eyelids we attempt to cosmetically improve the eyelids and make them more symmetric but they are not going to be 100% identical. Just like our hands, feet, ears, breasts and cheeks, the eyelids on even the most symmetrical appearing person are slightly different. It is critical to know that. The most unhappy patients my partner and I see for second opinions are surprisingly not patients who have had a complication from blepharoplasty but those that are seeking perfection and didn’t feel they got it from their previous surgeon. Any expert in the field of cosmetic eyelid surgery knows that we can try to make things better but we cannot make it perfect.
Myth #3: Recovery is easy. I should expect two days and then back to normal
Recovery after cosmetic eyelid is roughly two weeks but final healing takes months. That being said, some patients feel “I am a good healer” or “I did great after my knee operation” and feel they will be good in a couple days. That has nothing to do with your eyelid surgery recovery. The eyes are sensitive and since surgery results in swelling and bruising of the face, patients are more sensitive to the healing and bruising as they recover. Mild swelling on your knee is easy to ignore. Depending on the patient mild swelling on your eyelid may not be. I tell patients give two weeks on average before returning to social situations. That being said if one has a complication or delayed healing i can imagine someone taking 6-8 weeks to heal. Any surgeon who guarantees outcomes or says that 100% of their patients are back to normal in two days are trying to lure you into surgery and should be avoided in my opinion.
Myth #4: There are no risks to the surgery.
Cosmetic eyelid surgery is just that….surgery. Surgery carries inherent risks. Though blepharoplasty and cosmetic eyelid surgery carries in general low risks, they do exist. For example in life even the most mundane activity carries risks. The lifetime risk of dying in a motor vehicle accident is roughly 1 out of 113. That is almost 1%! We don’t consider that risk generally when we drive to the doctors office but that risk does exists. I explain to patient that there are “worst risks” and “common risks”. Worst risks are analogous to dying in a car accident on the drive to the doctors office. It is not common but is probably the worst thing that can happen. For blepharoplasty these include vision loss and double vision. The more common risks are things that are more likely to happen. In the driving to the doctor’s office that would include being late or getting lost. For cosmetic eyelid surgery it includes asymmetry of appearance, trouble closing the eyes, dry eyes, or not liking the results. It is important to learn about risks of the surgery before undergoing any eyelid surgery, cosmetic surgery or surgery in general.
Myth #5: Anyone can perform the surgery: I don’t need a specialist for this
Blepharoplasty or Cosmetic eyelid surgery is an extremely complicated detailed and specialized eye surgery. Eyelid specialist take two years to master the fundamentals of the surgery. Often this includes hundreds if not thousands of eyelid surgeries. Surgeons who occasionally perform the surgery may not even understanding anatomy enough to reduce the risks of a complication. There are a myriad of eye conditions that can make blepharoplasty even more complicated to perform. These include thyroid eye disease, floppy eyelid syndrome, previous botox and fillers, variations in anatomy or having undergone previous eyelid surgery for example. If a surgeon can’t identify these things they won’t see it during surgery. If you have never driven on snow or ice before you are much less likely to identify a dangerous road. It is important to learn all the risks of eyelid surgery or any surgery you are undergoing and talk to your eyelid specialist.
Myth #6: The pictures on the internet are representative of outcomes for cosmetic eyelid surgery
If you look at facebook at friends and what they are doing, you may have the impression that they are all constantly living dynamic, exciting, amazing lives. They aren’t. Facebook has tendency to draw out the most fun and exciting experiences of people to be posted. Before and after photos on the internet are similar in that regard. Doctors post pictures of patients before and after photos on the internet to show potential patients. Some doctors don’t even post their own pictures and try to pawn off others work as their own. (I know because I have been victimized by that). Remember a lot of doctors try to post their highlight reel on the internet. Only their best work or best outcomes are posted. I try to put a large spread of patients because at the end of the day there is variability to outcomes and not everyone’s surgery will turn out the exact same way. Everyone is capable of having a fair, good or great outcome. If I am a surgeon and post only great outcomes and leave out good or fair outcomes, there will be patients who undergo surgery with me with unrealistic expectations. If I am not that busy as a surgeon I may not care. Business is business. For me personally, I would rather have happy patients who know what to expect and have realistic expectations.
Myth#7: The outcomes of cosmetic eyelid surgery are very close to the same for everyone
Everyone is different. How they heal is different. Their tissue is different. Their immune system is different. Different times in their lives mean that their tissue and healing is different. A 20 year old undergoing surgery is different than the same patient having eyelid surgery at 75. Just because a neighbor’s eyelids turn out a certain way, does not mean that yours will. Yours could be similar, better or worse. The secret is that to a certain extent most eyelid specialists don’t know how you will do exactly until they actually do your surgery. If you train for a marathon you may have a general idea of how you will do but you won’t know for sure until your do it. Your time will vary based on weather, the actual day of the race, how you feel, recovery from previous training and multitude of other factors. It is just like that for surgery. We have a general idea but won’t know exactly until your surgery is completed. The best surgeons are ones who can optimize your outcomes for you.
Myth #8: There is a one size fits all type of cosmetic eyelid surgery
Some surgeons tout a new technique or that they always use fat transfer on “everyone”. Guess what? Everyone isn’t the same so every technique is not the same for the best outcome on everyone. A junior surgeon uses the same approach one everyone. An expert surgeon realizes that things are different and alters plans to accomodate differences to try to optimize the outcomes for the patient.
Myth #9: Lower eyelid filler is going to replace cosmetic eyelid surgery
This will never happen. You heard it here first. I perform a lot of eyelid filler but it has its limitations. Filler improves puffiness of the lower eyelid by injecting material around puffiness. There are patients who have too much puffiness for filler to work without looking abnormal and wierd. Atleast until filler improves in technology it will never replace surgery, At this stage there is no permanent solution for eyelid aging comparable to surgery. Some patients who have a hollow tear trough to mild puffiness in their 30s or 40s may benefit from filler instead of surgery but at some point they will need surgery.
Myth #10: I should use cost to determine who I get to do my eyelid surgery
In short, you get what you pay for...did I mention its surgery on your eyes and face? To be an honest, an expert plastic surgery subspecialist is not cheap. This isn’t something like botox or filler where the risks are lower and there is reversibility.