At Alexander Cosmetic Surgery, the Eyelid Lift is one of the procedures we perform on an almost daily basis. It is one of the most predictable procedures patients can undergo, causes little to no pain, requires little down time, and rarely leads to problems.

I have found that most patients are pretty satisfied with how they look, they’re just not happy with the changes of age. Patients don’t want to look different, or changed, just fresher and younger. Most just want to turn back the clock several years. Many patients comment that they look older than they feel, but are wary of cosmetic eyelid surgery, especially if they've seen poor outcomes in others. We often hear, “I don’t want to look funny, or surprised.”

We have all seen celebrities, friends, or people on the street with an overdone, surprised surgical look. You will be relieved to know that this “look” can easily be avoided, and does not happen accidentally. This unnatural look is usually caused by a couple of avoidable issues.

First, when patients receive a consultation for heavy upper eyelid skin, plastic surgeons too often recommend, and perform, brow lifts in conjunction with upper eyelid surgery because a brow lift is also successful in removing unwanted eyelid skin. However, this can frequently result in a brow that is too elevated and unnatural. This procedure can artificially create a rounded, hollow look to the orbital area actually making a patient look older.

Second, some surgeons perform a procedure which disconnects the attachments of the lateral eyelid and repositions it higher creating a turned up, or “cat’s eye,” appearance. Unless the patient already has a very droopy lower eyelid, this procedure will usually lead to an unnatural, pulled appearance.

In our practice we have found that a completely natural result can be obtained by avoiding brow lifts except when obviously necessary and by simply tailoring away the extra fold of eyelid skin without changing anything else around the eye. Well done Eyelid Lifts should be undetectable and completely natural.

Procedures often performed in conjunction with a Eyelid surgery to rejuvenate the face are QuickLift™, Brow Lift, (occasionally!) to correct a sagging or deeply furrowed brow, and Chemical or Laser peels to smooth sun-damaged skin.

There are several important factors to choosing a surgeon, including recommendations from friends, personality, physician training and board certification, and experience.

Referral from Friends: Many prospective patients find confidence if they have a close friend or other trusted individual who has already undergone a successful procedure. This is often a good first step in making a decision. However, not all patients know someone who has had surgery. Most of our patients are referred by satisfied friends who have been our patients.

Personality: It is important to develop a good relationship with a surgeon, where communication is easy and trust can be developed. A patient needs to feel intuitively that they are in good hands with someone they can trust. Bedside manner is important.

Training and Certification: In years past, only plastic surgeons performed facelifts. However, in recent years doctors from many different specialties are more commonly performing cosmetic surgery procedures, including Ear, Nose, and Throat doctors (also known as otolaryngologists and facial plastic surgeons), Dermatologists, Ophthalmologists, and Gynecologists. Only a surgeon who has completed residency training in an accredited training program can become certified by the American Board of Plastic Surgery. There are many Boards, and it is easy for patients to become confused, or assume that when a doctor says they are “Board Certified” it all means the same thing. BE CAREFUL! Learn more about the significance of Board Certification here.

Experience: Finally, consider the physician's experience, the most important factor in making a decision. As with all professions, expertise is directly proportional to experience, meaning the total number of procedures performed. Medical literature illustrates that biggest predictor of success in surgery is volume, in other words, the number of times that a doctor has performed a procedure.

If the doctor is recommending a specific procedure, how many has he performed? How often does the surgeon perform this procedure?

While board certifications and training are important, a surgeon's experience with the procedure itself is more important. Don't hesitate to ask pointed questions about recommended procedures.

Who Is a Good Candidate for an Eye Lift? Eyelid surgery is usually performed on adult men and women who have healthy facial tissue and muscles and have realistic goals for improvement of the upper and/or lower eyelids and surrounding area. Occasionally younger patients, even in their late teens or early twenties have significant excess of upper eyelid skin or lower eyelid fat that is an inherited condition and not associated with the aging process.

GOOD CANIDATES ARE?

• Healthy individuals who do not have a life-threatening illness or medical conditions that can impair healing
• Individuals with a positive outlook and specific goals in mind for eyelid surgery
• Individuals without serious eye conditions

You must tell your doctor if you have any of these medical conditions:

• Glaucoma
• Dry eyes
• Detached retina
• Thyroid disorders such as Graves’ disease and under or overactive thyroid
• Cardiovascular disease, high blood pressure or other circulatory disorders
• Diabetes

But because every case is unique, the only way to accurately determine which procedure is best for you is to consult with Dr. Alexander. Also, there are many options to rejuvenate the structures around the eye, making the eye look larger and more rested.

To ensure the most natural looking results, it's imperative for a surgeon to recommend the procedure which most appropriately matches the patient’s needs and to offer realistic expectations for post-surgery outcomes. When you meet with a surgeon, you should expect a full discussion of the surgically appropriate options for your face, which is uniquely yours.

A good surgeon goes through a series of examinations and observations that are individual and dependent upon your specific situation and goals, but also factor in the surgeon's expertise, training and experience. Be wary of the “one-size-fits-all” approach.

This is particularly important because as medicine has advanced, patients have more options available.

What to expect during your consultation
The success of your Eyelid Lift depends very much on your complete candidness during your consultation. We will ask you questions about your health, desires and lifestyle. Be prepared to discuss:

• Why you want the surgery, your expectations and desired outcome
• The options available to you for facial rejuvenation
• Medical conditions, drug allergies and medical treatments
• Use of current medications, vitamins, herbal supplements, alcohol, tobacco and drugs
• Previous surgeries

We may also:

• Examine and measure your face.
• Take digital photographs for computer imaging
• Discuss your options and recommend a course of treatment
• Discuss likely outcomes of a QuickLift™ and any risks or potential complications
• Discuss the anesthesia options available

Other procedures can further enhance the outcome of a Eyelid Lift. They include:

• Resurfacing techniques to improve the tone and texture of eyelid skin
• Fat transplantation to the tear trough

Prior to surgery, we will have you:

• Take certain medications or adjust your current medications
• Avoid taking aspirin, anti-inflammatory drugs and herbal supplements as they can increase bleeding
• Stop smoking well in advance of surgery

During a Pre Operative appointment, usually 1-2 weeks before surgery, we will:

• Get lab testing or a medical evaluation
• Tell you what to do on the night before and morning of surgery
• Discuss the use of anesthesia during your procedure
• Explain post-operative care and follow-up, and what help you will need after the procedure

Although Eyelid surgery is relatively straightforward, it's important to remember that the procedure still requires surgery. Even a deep laser peel or chemical peel, which help reduce lines and tighten skin, cannot compete with a surgical procedure.

Medications are administered for your comfort during the surgical procedure. The choices include local anesthesia, intravenous sedation and general anesthesia. We will recommend the best choice for you based on your personality, your desires, and the complexity of your procedure.

The procedure typically takes about 30 minutes for the upper eyelids and 30-60 minutes for the lower eyelids depending on the individual face and certain surgical variables.

There are four basic steps to a Eyelid surgery.

Step 1 – Marking
It is important to mark the eyelids carefully with the patient in an upright position so that the exact amount of skin can be removed.

Step 2 – The incision
The incision lines for eyelid surgery are designed for scars to be well concealed within the natural structures of the eyelid region. Droopy conditions of the upper eyelid can be corrected through an incision within the natural crease of the upper eyelid. Laterally, the incision must be extended slightly beyond the eye to remove excess skin which is always present in this area. The incision is slanted upward so that the tiny scar will fall into a natural smile line.

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 eyelids is removed.

A transconjunctival incision, one hidden inside the lower eyelid, is an alternate technique to correct lower eyelid conditions and redistribute or remove excess fat. This is often done in younger patients who require no excess skin removal or with a patient who is undergoing a chemical or laser peel of the lower eyelids.

Step 3 – Removing Excess Fat and Skin
Excess skin and fat is removed to provide a youthful, smooth contour to the lids. Occasionally, fat in the lower eyelid is repositioned along the lower orbital rim to fill deep hollows in the tear trough.

Step 4 – Closing
TThis is the final tailoring step, where the incisions are meticulously closed with removable sutures. We use removable sutures to improve the healing process and minimize scarring.

Optional Added Step: Sometimes a laser or chemical peel is done of the lower eyelids or crow’s feet to smooth out unwanted lines caused by sun damage or aging.

Pain from the Eyelid surgery is usually minimal. Pain pills are provided, but are usually not required after a couple of days. Significant pain is extremely rare and may be the sign of a serious complication, so your physician should be notified.

Important facts about the safety and risks of Eyelid surgery
The decision to have eyelid surgery is extremely personal and you’ll have to decide if the benefits will achieve your goals and if the risks and potential complications are acceptable. In general, the overall risks are very small this type of surgery.

We will explain in detail the risks associated with surgery. You will be asked to sign consent forms to ensure that you fully understand the procedure you will undergo and any risks and potential complications.

The risks include:

• Unfavorable scarring.
• Temporarily blurred or imapaired vision
• Dry eyes
• Difficulty closing your eyes
• Lid lag, a pulling down of the lower eyelid may occur and is often temporary
• Ectropion, rolling of the eyelid outwards
• Bleeding (hematoma)
• Poor wound healing
• Infection
• Fluid accumulation
• Numbness and other changes in skin sensation
• Anesthesia risks
• Eyelid disorders that involve abnormal position of the upper eyelids (eyelid ptosis), loose eyelid skin, or abnormal laxness of the lower eyelid (ectropion) can coexist with sagging forehead and eyebrow structures; brow lift surgery will not correct these disorders; additional surgery may be required
• Skin discoloration and swelling
• Possibility of revisional surgery
• Loss of eyesight

Be sure to ask questions: It’s very important to ask your surgeon questions about your procedure. It’s natural to feel some anxiety, whether it’s excitement for your anticipated new look or a bit of preoperative stress. Don’t be shy about discussing these feelings with us.

Although our society is increasingly geared toward instant gratification, rushing the healing process is never a good idea. It’s easy for patients to get a little too active too quickly. The body has its own pace, and your body's recovery speed is unique to you. As with any procedure, we have specific guidelines for preparation and recovery.

Recovery times vary from patient to patient. Eyelid Lift recovery, tends to take about 4-10 days, with the average patient looking very good at about one week. Bear in mind, however, that these are averages. Some individuals may heal much more quickly, while others may take longer to fully recover. A patient who tends to have more bruising and swelling than normal will take longer to heal.

Most patients should allow one week before returning to work and other normal day-to-day activities and about two weeks before working out.

Be careful
Following your doctor's instructions regarding medications and other post-operative measures is key to a quick recovery. Herbal medications are available to reduce swelling, bruising, and to speed your recovery.
It is important that the surgical incisions are not subjected to excessive force, abrasion, or motion during the time of healing. Avoid wearing any clothing that must go over your head. We will give you specific instructions on how to care for yourself.

When you go home
Be sure to arrange for someone to drive you to and from surgery and to stay with you for at least the first night following surgery.

When your procedure is completed, a bandage will gently be placed around your eyes to minimize swelling and bruising. Although a bandage is not absolutely necessary, it greatly decreases swelling and speeds your recovery time. It is also a reminder to take it easy for the first day. If you become claustrophobic or uncomfortable, the bandage can be removed at any time. Cold compresses are then applied for the first 48 hours.

It is normal for the eyes to feel tight. If one side is significantly more painful or swollen than the other side you should call the office.

You will be given specific instructions that includes:

• how to care for the surgical site
• medications to apply or take orally to aid healing and reduce the potential for infection
• specific concerns to look for at the surgical site or in overall health
• when to return to the office

We will see you the day after surgery, then on the 4th or 5th day to remove your sutures. At one week you can resume normal activities. At two weeks you can begin light exercise, and at three weeks there are no restrictions.

The results of eyelid surgery will appear gradually as swelling and bruising subside to reveal a smooth, better-defined eyelid and surrounding region, and an alert and rejuvenated appearance.

It's natural to feel impatient about seeing the “new” you, but you'll need to be patient as your face heals from the surgery. Your final results will appear within several weeks, but it may take up to a year for incision lines to fully refine. Once healed, the incision lines from an Eyelid Lift are nearly invisible in almost all patients. While eyelid surgery can be expected to correct certain conditions permanently, you will continue to age naturally. Life-long sun protection will help to maintain your results.

Because I have worked with so many patients, I can look at someone relatively early in their recovery and say, "You look great," even though that patient can only see how they look that day — not how they will look a few weeks later. Your final result should not only restore a more youthful and rested appearance, but also help you feel more confident about yourself.

After a few months pass it is not uncommon for patients to become so used to their new appearances that they barely notice the change. This is similar to when you get a new haircut and can't help but notice your reflection every time you pass a mirror. After a few months, your self-image resets, and you may not recall how drastic the change is until you happen upon an old photograph.

The same phenomenon occurs with facial rejuvenation, and is one of the main reasons we take “before” pictures. Patients quickly forget how they used to look! For the first few months after a procedure, the change is dramatic, and the mind is constantly noticing and comparing the younger look to the older face. After a few months, the mind has reset the new look as the new self-image. Once this becomes the new norm, it is easy to look in the mirror and still see some signs of aging. However, when the patient looks at old pictures, they are often surprised they have forgotten what they used to look like, and how much they have improved.

If our patients tell us they’re receiving a lot of compliments, but nobody knows they’ve had surgery, we feel like we’ve achieved our goal. And one of the ways we do this is by keeping things very simple and conservative. Some surgeons overplay their artistic ability and make recommendations that really change a person’s eyes and make them look quite a bit different than they used to. Our goal is to not change a person’s appearance, just to give them a better version of what they already have.

In general our patients are very pleased with their Eyelid Lift results. The practice of medicine and surgery is not an exact science. Although good results are expected, there is no guarantee. Small revisions are occasionally necessary.

Continuing a Skin Care program can help maintain your result and help keep your skin young and healthy. We offer a complimentary facial after your procedure to introduce you to our Aesthetician, Leanne, and our Physician Assistant, Joanna, in our excellent Skin Care Clinic.

Life-long sun protection will help to maintain your rejuvenated appearance by minimizing photo-aging or sun damage. In addition, a healthy lifestyle will also help extend the results of your rejuvenated, more youthful appearance.

How much does the Eyelid Lift cost?
A quote will be provided to you after your consult with Dr. Alexander. Cost is always a consideration in elective surgery. We offer patient financing plans, so be sure to ask.

Costs include:

• Surgeon’s fee
• Operating Room and Supplies
• Prescriptions for medication
• Medical tests
• Anesthesia fees (if not done under local anesthesia)

• Blepharoplasty: Eyelid surgery to improve the appearance of upper eyelids, lower eyelids or both.


• Ectropion: When the lower eyelid is rolled outward after eyelid surgery; often a temporary condition.


• Skin resurfacing: Treatment to improve the texture, clarity and overall appearance of your skin, usually with a chemical or laser peel.


• Tear trough: A groove below the lower eyelids extending from the nose across the upper cheek.


• Transconjunctival incision: Incision hidden inside the lower eyelid.


• Local Anesthesia: the surgical area is numbed up, but the patient is awake. Sometimes a patient will be given an oral medication, like Valium, to help with relaxation.


• Sedation (Twilight) Anesthesia: the patient is given an iv, and is made sleepy with medications given through the iv. The level of sedation can be adjusted, from barely sleep to very sleepy. Sometimes sedation is given by the surgeon, and other times it is administered by an Anesthesiologist.


• General anesthesia: the patient is asleep, requiring that the airway be protected, either by a standard breathing tube, or by a laryngeal mask (LMA), an inflatable mask that goes in the back of the throat but doesn’t go down the trachea. Through the airway, an anesthesiologist gives gases to put the patient asleep. Drugs may also be given through the iv.