Upper Eyelid Surgery (Upper Blepharoplasty)

Dr. Motykie will meet with you during your pre-operative appointment and he will take the time to answer any questions you may have about your surgery as well as to discuss your personal surgical plan in detail. Several different photographic views of your face will be taken during this visit for inclusion in your medical record. These photographs will also be used for reference during actual surgery as well as to show you the difference in your upper eyes before and after surgery.

Your pre-operative examination will include assessment of your forehead and upper and lower eyes. This assessment is critical in order to plan a surgery that can successfully produce naturally appearing upper eyelids that are as symmetrical and balanced with the remaining facial features as possible.

“Safety first” is Dr Motykie’s motto so you will be required to give a thorough medical history, undergo a complete physical examination and obtain certain laboratory tests in order to evaluate your general, overall health prior to any surgery. If you are on a weight-loss plan, it is best to be close to your target weight prior to having your surgery. Some patients ask if it is better to start and exercise and diet program before or after surgery; Dr. Motykie’s answer is always both. If you start your wellness program prior to your surgery your body will be in better health for surgery and if you have already begun a health and wellness program prior to surgery, it will be easier for you to resume that same lifestyle program after surgery.

You will also receive all of your post-operative instructions and prescriptions for medications to be taken during your post-operative course. It is advised that you fill these prescriptions prior to your surgical date and bring them with you on the day of your surgery. In this way you will have all of the medications you need prior to your surgery and any questions and/or concerns you may have can be addressed prior to your actual procedure. Included in these medications are pain medication and antibiotics. You will be instructed to avoid taking drugs containing aspirin, ibuprofen, blood thinning medication, anti-inflammatory drugs and any herbal supplements that are associated with an increased risk of bleeding during surgery. A complete list of medications, vitamins and herbs to avoid prior to your surgery will be given to you at you pre-operative appointment and it can also be downloaded by following this link(Medications to Avoid List).Depending on your health, you may be asked to take certain medications or adjust your current medications. Be prepared to discuss your use of any current medications, vitamins, herbal supplements, alcohol, tobacco and/or drugs.

If you smoke cigarettes, you absolutely must stop smoking well in advance of surgery. If you are a smoker, plan to quit at least two weeks prior to your surgery and not to resume smoking for at least two weeks after your surgery in order to avoid the increased risks of complications associated with smoking. It is absolutely imperative for smokers to follow these guidelines if they do not want to risk any healing complications after surgery. The nicotine in the cigarette smoke can causes the blood vessels necessary for proper healing to shrink which can lead to healing problems after surgery. It is also important to avoid sunlight exposure before and after your surgery because sunlight exposure can cause permanent darkening of post-operative bruising.

Guidelines on eating and drinking the night prior to surgery as well as everything you need to prepare and/or bring with you the day of surgery will also be explained and given to you in your pre-operative packet (Link to Pre-operative packet). Do not go on a stringent diet before or after surgery, as this can inhibit your ability to heal. If you develop a cold or infection of any kind prior to surgery, let Dr Motykie’s office know as soon as possible because your surgery may need to be postponed for safety reasons. Lastly, the consumption of alcohol prior to surgery can lead to an increased risk of bleeding during your surgery and you are therefore advised to limit your alcohol intake for the week prior to surgery. In addition, alcohol can interfere with your post-operative medications and should therefore be avoided as long as you are taking prescription medications (usually the first week after surgery).

During your recovery period, be sure to arrange for someone to drive you home after surgery and to take care of you for at least the first day or two after your surgery. (You may also need to have someone drive you back and forth for your first few follow-up visits). You will also be given several post-operative visit dates and specific times that you will need to follow-up with Dr Motykie during your recovery process.

Pre-Operative Marking

Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your upper eyes. The upper eyelids should be marked while you are awake so that accurate animated makings can be made. This marking technique will help to ensure a natural result and prevent under-resection of loose skin as well as over resection which can lead to the avoidable ”wide-eyed” appearance after surgery. The incision will be placed in your upper eyelid crease and it is not visible while your eyes are open. Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.

Anesthesia and Operating Facility

You can either have general anesthesia or awake anesthesia with sedation for your own personal comfort, safety and surgical ease. Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately 30 minutes to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance.   Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.

Surgical

After anesthesia is administered, an incision is made along the previously made markings that were drawn by Dr Motykie prior to your surgery. If a brow lift has been planned it is imperative that I be performed prior to the upper eyelid surgery because it will inherently improve the appearance of the upper eyes by lifting any attached drooping upper eyelid skin. Once this procedure is completed, the remaining upper eyelid skin needs to be reassessed in order to remove only the necessary amount during surgery. If a brow lift is not being performed attention can immediately be turned to the upper eyelid surgery. The standard technique involves placing an incision in the crease above each upper eyelid. Careful removal of the upper extra upper eyelid skin is then performed with care taken to preserve several important underlying structures of the upper eyelid. I prefer to remove very little upper orbital fat pads in order to preserve the youthful fullness of the upper eyelids. If too much fat is removed from this area, a sunken, tired appearance can result long-term after surgery. The incisions are then closed with a very thin suture that is typically removed 5-7 days after surgery. No dressings are needed on the upper eyes after the procedure is completed. Antibiotic ointment will be placed on the eyes and should be left in place overnight.

Recovery Room  

After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications. The most comfortable position to recover in after surgery is a reclining chair with your head elevated. Over the first night you will most likely find yourself having to use the bathroom frequently. This is normal and is due to the intravenous fluids you received during your surgical procedure. The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. The area surrounding the eyes may become swollen following the surgery. It should begin to subside after the first day. Some blurring vision is normal overnight due to swelling around the eyes.

The next morning following your surgery, you will return to Dr Motykie’s office for your first post-operative visit. Your eyes will be swollen and tender. Upon arrival to the office you will be escorted to a private examination room where your eyes will be examined. After your examination, you will be allowed to return back to your home. All of your questions will be answered and you will be given instructions for the following week.

• Diet: Mostly patients start with a liquid diet the night after surgery. Usually by the next day most patients are back to a normal diet.
• Medications: Some swelling, bruising and discomfort are normal immediately following surgery and it is typically controlled with your prescription pain medication. Do not take any other pain medication including Tylenol, aspirin or ibuprofen in combination with your pain medications unless you are given permission by Dr Motykie. A combination of Arnica Montana and Bromelain are encouraged after surgery in order to promote your healing process.
• Bathing: Showering and bathing are permitted the very next day after surgery.
• Activity: You may feel tired and sore for several days following the surgery. Light activity is allowed and encouraged including moving about your house and going for walks outside in order to aid the circulation in your lower extremities. However, no heavy lifting or strenuous activity should be attempted during your first week of recovery. You can usually return to a desk-type job within 72 hours, physical exercise generally can be resumed 2-3 weeks after surgery.

The results of your surgery will typically be obscured by swelling and bruising at one week after surgery. Your eyes may be bruised, swollen, and uncomfortable for a day or two, but the pain shouldn’t be severe. Any discomfort you do feel can be relieved with your prescribed medications but most patients say that lower eyelid surgery is almost “painless.” Some people can return to work after a few days and some after one week. Most patients can drive their vehicles within a few days after surgery, but plan on having someone drive you to your first few post-operative visits anyway. In regards to an exercise program, use common sense and use pain as your guide. The majority of patients are allowed to return to light, low impact cardiovascular exercise after the first week of recovery. Any stitches will be removed 5-7 days. Swelling and bruising will persist for a few days, but you can begin wearing makeup to help conceal these concerns.

• Dressings: You should apply an antibiotic ointment (Bacitracin and/or Neosporin) to the incision line once a day.
• Medications: Some continued swelling, bruising and discomfort are normal and they are typically controlled with your prescription pain medication and muscle relaxants. You should also be finishing your prescription antibiotics at this time. Arnica Montana and Bromelain may be continued for another week in order to promote your healing process.
• Bathing: You may bath and shower freely during the second week after surgery.
• Activity: Exercise of some sort is very important, even if it is just walking around your house. Having said this, rest is also important to the healing process and heavy lifting and strenuous activity are still restricted during the first month after surgery. You will be able to return to more strenuous exercise/heavy lifting at 2-3 weeks after surgery. Aerobic and impact cardio exercise should be avoided for one to two weeks post-operatively. Weight lifting should be avoided for 3-4 weeks post-operatively. You can typically return to work within a week and to full activity within a few weeks. Most patients are able to wear contact lenses sometime during the second week after surgery.

Depending on the amount of physical exertion required to perform your expected duties, you should already be back into your normal rhythm at work and the gym. When you return to the activity, start at half speed and increase to your normal routine as long as you do not feel any pain during and/or the day after your workout. Although exercising will not adversely affect your end result, it may temporarily cause more swelling immediately after the exercise that will subside over the next few hours. The majority of my lower eyelid surgery patients are back to their regular workout routine within a few weeks after their surgery. Sometimes patients may develop dry eyes after surgery that can be treated with eye drops until normal tear production returns. Over the next several months many of the benefits of your lower eyelid surgery will begin to materialize and you will begin to enjoy the transformation you have received from your upper eyelid surgery.

All patients vary in their ability and speed to recovery after surgery but most commonly you can expect the final result from surgery to be evident at six months after surgery. By this point in time, the upper eyelid incisions should be healing and inconspicuous. Many friends and colleagues may begin to ask you what your secret is to looking so young and rested. The upper eyelid skin is among the thinnest skin in the body and it therefore heals very quickly so you should already be enjoying the results of your rejuvenative surgery at this time. Lastly, many women who complain that they are unable to apply their upper eyelid make-up due to loose skin prior to surgery should now have a beautiful, youthful shape to their upper eyes that allows for the easy, smooth application of upper eyelid make-up. 

Deep wrinkles around the outer corner of the eyes (crow’s feet) that extend onto the temple are not greatly affected by upper eyelid surgery. These types of problems are best treated with BOTOX and/or laser resurfacing. Dark circles and/or “bags” underneath the eyes need to be addressed with lower eyelid surgery and/or facial fat grafting. It is very common for patients to perform upper and lower eyelid surgery at the same time (termed a “Quad” Blepharoplasty).

Prior to any possible every upper eyelid surgery, the position of the forehead (brow) must be evaluated since its descent with aging can lead to exacerbation of upper eyelid hooding that is often a complaint of patients also seeking upper eyelid surgery. If the forehead has begun to droop with age, it must be addressed by a browlift prior to upper eyelid surgery in order to create a balanced and natural look after surgery. If the brow is not properly addressed prior to upper eyelid surgery, too much upper eyelid skin can be removed which can actually pull the brow downward and worsen upper eyelid hooding. It is critical that you eyelid surgeon is aware of this fact and discusses it with you while planning any possible surgery on your upper eyelids if you expect to have a rested, natural appearance after surgery. A browlift also relaxes the muscles of your brow (forehead creases) and the muscles in between your eyes (the “11’s”) (which can also be accomplished with properly administered BOTOX as well). Lastly, upper eyelid surgery can be combined with any other facial rejuvenation surgery such as a facelift, facial fat grafting and laser skin resurfacing in order to help create a more natural, balanced appearance of the face when necessary.

For your own personal and confidential consultation, contact Dr. Motykie’s office today. Dr Motykie will answer all of your questions and together you can determine which procedure best fits your desires and needs. Remember, it is impossible for a surgeon to tell you the best approach for you without first listening to your desires and concerns and then performing a physical examination of your breasts and surrounding tissue. Out of town patients may send photographs in order to have a online consultation performed by Dr Motykie.

• Pre-Operative
• Day Of Surgery
• Post Operative 1 day | 1 week | 1 Month | Long  Term
• Combined Procedures

To find out more about eyelid surgery please contact us at 310-246-2355