Blepharoplasty/Brow Lift Recovery
We all age in 3 ways. Our skin begins to have surface changes (sun spots), we lose volume (mostly fat), and we lose elasticity in our skin. The rate at which these occur depends on your heritage and your degree of exposure to the environment (sun, smoke, etc).
There has been an evolution the way that eyebrows and eyelids are treated these days. Older procedures that focused on pulling the skin tight and always removing fat fell short of natural rejuvenation. Newer procedures focus on re-establishing youthful brow shape and creating a more holistic rejuvenation of the entire area around the eye. The goal is always to make you look like a younger version of yourself, not someone else.
I hope that this guide provides some useful information so that we set appropriate expectations and guide you through the recovery process. Think of us as a guide or partner. Most of the patients that come to see us have concerns about facial aging. This begins to occur when there is discord between the image you see in the mirror and your own self perception. We believe that we can maximize your quality of life by rectifying this discord. There can be times though that the upper eyelids simply start to impact your visual field.
I like to think of the face as a whole. Though we will discuss different areas of concern, it is usually critical to address neighboring areas of the face in order to ensure that we do not create a “surgical” appearance. There is a relationship that exists between the eyebrows and the upper eyelids. As age causes more laxity and brow weight to sit on the upper lid, the upper lid signals the forehead to pull harder. It is at this point that we begin to see horizontal lines form on the forehead. Many times, treating the brow and the upper eyelid together in a holistic approach gives us the most natural outcomes.
The lower eyelid develops “bags” or fullness that make us look tired or old. Historically the fat was simply removed. While this can still the best option, it ignores the true issue which is that the fat of the cheek that used to be fuller while younger no longer hides the tear trough and transition from lower eyelid to cheek. This means that sometimes the best approach is to rejuvenate the cheek at the same time as the lower eyelid.
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the Procedure
The Procedure
Lets start with the Eyebrow. The eyebrow is usually lifted by creating incisions that will be hidden in the hair and re-establish the youthful shape of the eyebrow. This does not create a “surprised” appearance, just one that is more alert or bright eyed.
Once the eyebrow is in the correct position, then the upper eyelid can be addressed. Many times, this means that less skin need be removed, which makes for a shorter incision and less scarring. There are also fat compartments within the upper eyelid that can also be contoured. The sutures that are used are very small and will be removed one week after your procedure.
The lower eyelid can be improved with an incision on the outside of the eyelid or on the inside of the eyelid. The goals of the surgery will dictate which may be used. While fat may be removed to get the best contour, there are many times that the fat can simply be repositioned into the “tear trough” in order to create a youthful transition from lower lid into the cheek. For more severe cases, the addition of facial fat grafting restores what is actually missing and creates a very natural mid-facial rejuvenation.
Additional Procedures
Facial fat grafting – We all lose fat in our face as we age. We can take fat from somewhere you don’t want it and replenish the fat that is missing. Restoring fat that has been lost with age can help to soften the appearance around the eyes, eliminate wrinkles and create a very natural result
The Day of Surgery
I will meet you at the surgery center where you will have the chance to meet your team including the anesthesiologist. The Anesthesiologist will review the documentation, that I have provided, with you to ensure accuracy and that we provide a smooth, safe anesthetic and recovery. Minimizing the risk of post op nausea and wooziness starts in the pre-op area. You will be given an IV so that we can hydrate you and the anesthesiologist can give medications during the procedure.
During your surgery, most of the time, you will have a breathing tube that helps keep you safe during your operation. This can make you feel like you have a scratchy throat after surgery for a couple of days. A nice throat coat tea or chloraseptic can help with the discomfort.
I like to use local anesthetic, even if you are asleep, during your surgery, so that you have very little discomfort after surgery. The numbing medication can last as long as 8-12 hours after surgery. It is typical to only require a single pain pill the night of surgery and then Tylenol and ibuprofen are all that are typically required, though you will have more pain medications available.
When your surgery is complete, the nurse will contact your family member to let them know your procedure is done and let you know the time for pickup. If the surgery runs longer than anticipated, this is not a bad thing, though it can cause some anxiety in your family. Your face is unique and we must take our time to ensure that every little detail is accounted for. The work done during your surgery must last for the next 10-20 years.
Recovery
The typical downtime from a blepharoplasty is about 1 week. Luckily this is not due to discomfort as we use long acting local anesthetic to improve recovery and frankly facial surgery is not typically painful. Our post operative dressings are very minimal. There will be some bruising and swelling, but you will be presentable to a stranger after a week.
If you wear eyeglasses, you may notice that your prescription seems wrong temporarily. The swelling around your eyes can have an impact on vision, but this will fade after the first week or two.
The early recovery is NOT the challenging aspect of facial rejuvenation. You are an energetic, successful individual that is not used to “taking it easy”. I find that people mentally tolerate the first week of recovery much better than the first month. You expect that the first week will be slow and relaxing, but your body needs time for all of the little details and nuances to become apparent after surgery. It is VERY common to feel frustrated around 1 month after surgery because you feel good, but you will still have little bits of swelling around your eyes that no stranger will notice, but you will notice. I promise, these frustrations subside and you will be happy with the transformation. No matter what, we are here to care for you. Whenever these feelings arise, give me a call. I am happy to help and offer reassurance.
Evening After Surgery
I recommend preparing a few soft, comforting dishes in preparation for surgery.. Dishes like soup, and yogurt can be soothing for your throat and easy to eat. In contrast to most recovery strategies, I DO NOT recommend icing your face. If we have used fat to rejuvenate your face, it is sensitive to cold and pressure. It is ok to use cool compresses though. Place gauze into an ice bath, wring out the gauze and then place the gauze over your eyes.
I recommend getting up and moving around at home. Surgery can increase your risk for blood clots in the legs and we want to keep that blood flowing. During the first evening, please ask for assistance from your loved one since you may not feel as stable as you normally do.
If you are a stomach or side sleeper, I recommend getting some wedge pillows or at least place a pillow behind your knees in order to help simplify sleeping on your back.
I recommend sleeping flat on your back.
If you need a small neck pillow, that is fine, but otherwise we want to avoid sleeping on the side of your face or worse sleeping in a chair where your head falls foreword. Swelling will follow gravity. If your face is below your head, your swelling will be worse. A deeply reclined recliner can be a nice option in order to avoid the tendency to roll over while you’re sleeping.
Incision Care
During the first week, you will have very small sutures along your incisions. All of these will be removed at your one week follow up. During the first week, I’d like you to apply bacitracin or Neosporin (antibiotic ointment) to your incisions 2x/ day. You may gently wash your face with luke warm water on the 2nd day after your surgery. You may have some numb spots, so I do not want you to burn yourself and not know it. I also recommend a little pampering. It can be very refreshing to have your hair washed by a loved one on the 3rd day after surgery. (Make sure the blow dryer is not too hot) If there is some crusting that occurs around the incisions that is ok.
Your incisions will never be as strong as what God gave you, but they will be maximum strength about 6 weeks after surgery.
Multi-Modal Therapy Medications
Tylenol – 1000mg every 6 hours scheduled for 5 days.
- Do not wait for pain. Tylenol makes up the foundation of your pain management and will decrease the amount of narcotics you will need.
Ibuprofen (600mg) take 1 every 6 hours scheduled for 3 days
- Do not wait for pain. Ibuprofen makes up the foundation of your pain management and will decrease the amount of narcotics you will need.
Gabapentin (100mg) take 1 every 8 hours for 14 days
- Do not wait for pain. Tylenol makes up the foundation of your pain management and will decrease the amount of narcotics you will need.
Tramadol (50mg) take 1 every 6 hours as needed for pain. If you use antidepressants, this will be exchanged for Oxycodone (5mg).
- It is okay to wait until you have pain. Tramadol is a long-acting narcotic that will begin to work in about 30 minutes and can last up to 6 hours. Oxycodone is a fast acting, strong medication that can exacerbate nausea and or make patients feel “loopy”.
Miralax – 1 cap full twice daily while using Tramadol until your first bowel movement.
- If there is an OTC (over the counter) stool softener you prefer, that is fine. We want to avoid constipation as bearing down can increase your blood pressure and in the first week can put you at risk for bleeding in addition to being uncomfortable.
Eye Drops
Refresh Natural Tears – These are sold OTC (over the counter) and does not require a prescription. You may use these as needed for any dry eye symptoms.
Tobradex – This is a combination of antibiotic and steroid that will help to minimize swelling and irritation in the first few days after surgery. Place one drop in each eye every 6 hours while awake. Do this for the first 5 days after surgery.
Medication Schedule
A proposed schedule has been supplied in order to simplify the scheduling of medication. We understand there are a lot of medications to follow, but rest assured, we believe Multi-Modal therapy provides the greatest comfort and decreases post-operative nausea, drowsiness, and constipation. If your pain has become severe or additional recommendations are needed, do not hesitate to contact our office.
| Medication | Multi-Modal Therapy Schedule |
|---|---|
| Tylenol (1000mg) | 4AM, 10AM, 4PM, 10 PM |
| Ibuprofen (600mg) | 4AM, 10AM, 4PM, 10 PM |
| Gabapentin (100mg) | 6AM, 2PM, 10PM |
| Tramadol (50mg) / Oxycodone (5mg) | 4AM, 8AM, 12PM, 4PM, 8PM, 12PM |
| Zofran (4mg) | 6AM, 2PM, 10PM |
Follow Up Schedule
1 Week
You will already be much less swollen than the first few days. You will have very minimal pain. If you have had a brow lift, many patients notice numbness at the top of their scalp. This is normal and will resolve over the course of months. Much of the bruising will already be yellowing.
We will check your liposuction areas as well (if we grafted fat). They will appear bruised and swollen. If you use contact lenses or corrective lenses, they may still feel like they are not quite the right prescription. This will go away. This visit will take about 30 minutes as all of the little sutures need to be removed in order to minimize scarring.
1 Month
You feel great! There are still small areas of swelling, particularly the under-eyes that tend to be very sensitive to surgery that may still look puffy. Your bruising is gone. Your incisions are healing well but they will still look a little more red than the surrounding skin. We want to make sure that we are right on track!
3 Months
You are enjoying the result of your surgery. The incisions are fading, but they will continue to improve all the way up to one year after surgery.
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well.
1 Year
“Why do I have to see the doctor?!” Facial rejuvenation is a life long process of constant assessment and reassessment. I want to ensure that you have healed well and that we have improved your quality of life. I also want to ensure that we continue to use the most cutting edge techniques that provide high quality, durable outcomes. I need your help to continue this process in order to ensure that our patients receive the best possible outcomes.
1 Week
You will already be much less swollen than the first few days. You will have very minimal pain. If you have had a brow lift, many patients notice numbness at the top of their scalp. This is normal and will resolve over the course of months. Much of the bruising will already be yellowing.
We will check your liposuction areas as well (if we grafted fat). They will appear bruised and swollen. If you use contact lenses or corrective lenses, they may still feel like they are not quite the right prescription. This will go away. This visit will take about 30 minutes as all of the little sutures need to be removed in order to minimize scarring.
1 Month
You feel great! There are still small areas of swelling, particularly the under-eyes that tend to be very sensitive to surgery that may still look puffy. Your bruising is gone. Your incisions are healing well but they will still look a little more red than the surrounding skin. We want to make sure that we are right on track!
3 Months
You are enjoying the result of your surgery. The incisions are fading, but they will continue to improve all the way up to one year after surgery.
6 Months
Feeling good, looking good! There are small nuances that we want to make sure are still progressing well.
1 Year
“Why do I have to see the doctor?!” Facial rejuvenation is a life long process of constant assessment and reassessment. I want to ensure that you have healed well and that we have improved your quality of life. I also want to ensure that we continue to use the most cutting edge techniques that provide high quality, durable outcomes. I need your help to continue this process in order to ensure that our patients receive the best possible outcomes.
Questions & Concerns
I am overjoyed and grateful to be part of your journey. I do not take this responsibility lightly. As questions and concerns arise, I expect you to contact me and my staff under any circumstances (925) 966-3920. This is a journey that is best done together. I look forward to caring for you and your family.
