Eyelid/Eyebrow Surgery

Known to medical people as blepharoplasty ("blephar" is the Greek word for eyelid), eyelid surgery is used to remove excess fat-often excess skin and muscle, too-from the upper and lower eyelids. This procedure is also used to correct drooping upper eyelids and puffy bags under the eyes. It can help people look younger and more alert, and (in some cases) help improve vision. But it can't eliminate dark circles under the eyes, lift sagging eyebrows, or remove crow's feet or other wrinkles. Sometimes, blepharoplasty is performed along with a facelift or brow lift.

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Q. Who are the best candidates, and what are the risks?

A. Most are healthy men and women, age 35 or older, who don't want to look tired even when they're not. If droopy, baggy eyelids are common in your family, and you're younger than 35, you need not wait years or decades to have the problem corrected. But regardless of your age, be aware of the risks if you have a thyroid problem (e.g., hypothyroidism; Grave's disease), diabetes, high blood pressure, dry eye (not enough tears), cardiovascular disease, a detached retina, or glaucoma.

Even if you don't have any of these problems, the procedure-like other cosmetic surgery procedures-might cause an infection or an adverse reaction to the anesthesia. Among the minor complications that sometimes occur following blepharoplasty are a few days of double vision or blurred vision, temporary swelling at the corner of the eyelids, or a slight asymmetry (not balanced) in healing or scarring. Also, after the surgery some patients may find it difficult to close their eyes when sleeping, and in rare cases this may be permanent. Also rare but possible is ectropion- the lower lids are pulled down-and additional surgery may be needed.

Risks can be reduced by consulting with, and having the procedure done by, a highly qualified plastic surgeon.

Q. What's the first step?

A. During your consultation at Dr. Kapoor's office, your condition will be evaluated, your medical history will be examined, your vision and ability to produce tears will be tested, and you'll be asked if you have any allergies, if you're taking any vitamins or medications, and if you smoke. Any of these can affect the outcome of the operation.

Dr. Kapoor will then discuss your goals and expectations and whether or not the procedure is appropriate for you. If it is, you can then schedule it, and you'll be given instructions on preparing for surgery. You'll need someone to drive you home after the surgery and also, perhaps, help you at home for a few days.

Q. Where will the surgery be performed?

A. In most cases, Dr. Kapoor performs this type of surgery at a Beverly Hills surgical center or in one of the hospitals he's affiliated with in Los Angeles, on an outpatient basis. Rarely does it require a hospital stay. Usually, a local anesthesia is administered to numb the area around the eyes, and an oral or intravenous sedative is also given. As the surgery is performed, you'll be awake but feeling no pain-just some tugging or mild discomfort. If general anesthesia is administered, you'll be asleep throughout the procedure.

Q. What happens during surgery?

A. Depending on how many eyelids will be operated on, the operation takes from one to two hours. Typically, the doctor will make incisions along the natural lines of your eyelids, in the creases of your upper eyelids and/or immediately below the eyelashes in the lower lids. Cutting a bit deeper into these incisions, he will then separate the skin from the underlying layers of fatty tissue and muscle, remove the excess fat, sand perhaps trim any sagging skin and muscle. Finally, he will close the incisions using ultra-fine sutures. Or, if you want only some pockets of fat removed from under your lower eyelids-and you're young with thick, elastic skin-the doctor may make an incision inside those eyelids, so that there's no visible scar.

Afterwards, the doctor may lubricate your eyes with an ophthalmic ointment and apply bandages where needed. As the anesthesia wears off, any discomfort can be controlled with the pain medications prescribed.

An eyebrow lift-to correct sagging brows that can make you look sad, angry, or tired and add years to your appearance-may be performed by itself or together with other surgery.

Q. Then what?

A. After eyelid surgery, it's important to keep your head elevated for a few days and to apply cold compresses to the surgical area to reduce swelling and bruising. Depending on the patient, bruising may last from two to four weeks, decreasing after the first week. It's also important to clean your eyes with eye drops or a special solution provided. During the first few weeks there may be excessive tearing, your eyes will be sensitive to indoor light, sunlight, wind and other irritants, and you may temporarily experience blurring or double vision.

The sutures will be removed several days to a week after the surgery, and then the swelling and discoloration should go down. You'll begin to look better and feel better, and be able to watch TV or read. But if you wear contact lenses, don't put them in for at least two weeks; even then, they may feel uncomfortable for a few more weeks until your eyelids recover from the surgery. Avoid moderate activities for at least three days (five days would be even better), and avoid strenuous activities for three weeks, especially those (bending, lifting, sports) that raise your blood pressure. Also avoid alcohol for several weeks.

Healing takes time, and scars from eyelid surgery may stay pink for three months or longer, until they fade to a nearly invisible fine white line.

Forehead Lift ("Brow Lift")

Q. Who can benefit from this procedure?

A. You can-if you'd like a more youthful and refreshed look for the area above your eyes, or want to correct drooping eyebrows, or are anxious to get rid of those furrows and horizontal lines that make you look angry, tired or sad. Typically, a forehead lift is performed on women and (to a lesser extent) men in the 40-to-60 age group, to make them look younger and have a more animated appearance.

But adults of any age can use it to minimize or remove frown lines or furrows caused by stress or certain types of muscle activity. It's also used to correct a low, heavy brow or furrowed lines above the nose. A forehead lift is often performed with a facelift, or with (or instead of) eyelid surgery.

Q. What is it?

A. During a forehead lift, the cosmetic surgeon removes or alters the forehead tissues and muscles that cause furrowing or drooping, raises the eyebrows, and minimizes frown lines. The incision may be hidden just behind the hairline. Or, if a precise viewing instrument called an endoscope is used, there are minimal, virtually invisible incisions.

Q. What are the risks?

A. Like any surgery, there are certain risks, such as potential damage to the nerves that control eyebrow-raising or forehead-wrinkling, formation of a broad scar (a rare complication), temporary or permanent loss of sensation along or near the incision line, infection, or bleeding. Statistics show that these complications occur in less than 1% of all endoscopic procedures.

Q. Where is the surgery performed?

A. Dr. Kapoor performs most forehead lifts at a Beverly Hills surgical center or in one of the hospitals he's affiliated with in Los Angeles, with the patient having a local anesthetic along with a sedative. If you're the patient, you'll be awake and relaxed and feel no pain-just some tugging and mild discomfort as your forehead is lifted.

Q. What happens during surgery?

A. If you're having a classic forehead lift, your hair won't be shaved, but any hair growing in front of the incision line may be trimmed. All the rest of your hair will be tied with rubber bands on either side of the incision line to keep it out of the way. In most cases, the surgeon makes a coronal incision that follows a headphone-like pattern. It starts at about ear level, runs across the top of the forehead, and continues down to the other ear. Since it's usually made well behind the hairline, the scar won't be visible. (Unless, of course, you lose your hair there.) If you're hairline is already high or receding, the incision is placed at the hairline. Whatever hair is available, comb it over the incision line.

After the incision is made a bit deeper, the surgeon carefully lifts the skin so he can remove some of the underlying tissue in order to alter or release your forehead muscles. At the same time, he may elevate your eyebrows and trim away excess skin at the incision point. Finally, the skin is replaced, the incision closed with stitches or clips, the rubber bands are removed from your hair, and your face and hair are washed to prevent irritation. Then the incision may be covered with gauze padding and your head wrapped in an elastic bandage to protect your new look.

If you're having an endoscopic forehead lift, the preparations are similar. But instead of one long coronal incision, you'll have three to five short scalp incisions, each about an inch long. An endoscope-a pencil-like camera connected to a TV monitor-is inserted through one of the incisions so your surgeon can view the muscles and tissues under the skin. Then, using another miniature instrument inserted through a different incision, he lifts the forehead skin and removes or alters the muscles and tissues. The result: a smoother, more youthful appearance. At about the same time, your eyebrows may be lifted to further enhance your new look.

Then the incisions are closed with stitches or clips, the surgical area washed, and an elastic bandage applied.

Q. What happens after surgery?

A. With a classic forehead lift, patients experience some numbness and temporary discomfort, with paid controlled by prescribed medication. If you're prone to headaches, your surgeon can have a longer-lasting local anesthesia administered during surgery. Once you're home, keep your head elevated for two or three days to reduce the swelling, which should disappear in about a week. If bandages were applied, they can be removed in a day or two, and most stitches or clips will be removed within two weeks. As the numbness atop your scalp goes away, indicating that the nerves are healing, you may experience itching, which can last as long as five or six months. You may also experience some hair loss around the incision, followed by the growth of thinner, temporary hair. In a few weeks or months, normal hair growth should resume in most cases.

If you had an endoscopic forehead lift, you'll probably feel some numbness, discomfort from the incision, mild swelling, and mild itching, but pain should be minimal. Within a week or so, the stitches or staples used will be removed. But if temporary fixation screws were inserted, they'll be taken out about two weeks after surgery. If you're like most endoscopic patients, recovery is fast and you'll feel ready to return to work in about a week. However, for the first few weeks avoid any activity that can increase your blood pressure. And avoid prolonged exposure to heat or the sun for several months. Visible signs of surgery should fade away within three weeks or so, and you may feel tired at first.