Below are some of the most common questions about Blepharoplasty and Eyelid Surgery.
Medical insurance does not cover surgery where the main goal is to improve your appearance. Insurance will sometimes pay for upper blepharoplasty surgery, but only in patients who have so much excess eyelid skin that it is blocking a significant portion of their vision. In these instances, the surgery is termed functional blepharoplasty and the goal of the surgery is to improve vision. While the appearance of the eyelids often does improve after a functional procedure, this is not the main goal of the surgery. Several steps of a cosmetic procedure which improve the appearance of the eyelids, such as removal of excess eyelid fat or formation of an eyelid crease, are not typically performed. Insurance never pays for lower eyelid blepharoplasty.
When we look at a person’s face, the largest part of our attention is subconsciously focused on the eyes. As a person ages, excess skin and fat accumulate around the eyes and result in a “tired” appearance, often many years before significant signs of aging are visible on the rest of the face. Rejuvenation of the eyelids not only makes a person look younger, but more awake and energetic. See the before and after eyelid surgery in Boston photos on this website for examples.
It depends. If there is a medical reason why you think you need surgery, you should schedule a medical consultation and may need a referral from your primary care physician. If your main interest is in improving your appearance, you are encouraged to come in for a cosmetic consult.
There are essentially three different types of plastic surgeons, each of which undergo surgical training with emphasis on different parts of the body. After finishing college, all plastic surgeons complete four years of medical school, followed by an additional year of internship. An ophthalmic plastic surgeon (also known as an oculoplastic surgeon or oculofacial surgeon) completes a three year residency in ophthalmology (eye surgery) and then pursues an additional one to two years of specialized training in plastic surgery. Most ophthalmic plastic surgeons spend the majority of their time performing eyelid surgery.
A general plastic surgeon receives training in general surgery, with an emphasis on gastrointestinal and abdominal surgery, before pursuing specialized training in plastic surgery. Because of the emphasis of their training, most general plastic surgeons choose to concentrate on surgery of the trunk, including liposuction and breast surgery. A facial plastic surgeon completes a residency in ear, nose and throat surgery prior to training in plastic surgery. Most facial plastic surgeons focus their practice on facelifts and rhinoplasty (nose surgery).
More information about oculoplastic surgery is available through the American Society of Ophthalmic Plastic and Reconstructive Surgery.
Most plastic surgeons and some other physicians (including non-surgeons!) perform cosmetic eyelid surgery. However, ophthalmic plastic surgeons receive the most comprehensive training in eyelid surgery and are uniquely qualified to perform cosmetic eyelid procedures.
Eyelids play an essential role in eye health by spreading the tear film across the surface of the eye. Without properly functioning eyelids, the cornea of the eye becomes dry, leading to severe eye pain, vision loss and infection. While surgery related complications are not common, they do sometimes occur. Ophthalmic plastic surgeons are also fully trained eye doctors and most qualified to manage postoperative problems.
In addition to cosmetic surgery, ophthalmic plastic surgeons perform large numbers of reconstructive eyelid surgeries in patients with eyelid skin cancers or eyelid malpositions. Dr. Kapadia performs hundreds of eyelid surgeries each year, making him uniquely qualified to perform cosmetic eyelid surgery.
There are a variety of reasons why patients may be unhappy with the results of cosmetic surgery. Dr. Kapadia performs a large number of eyelid surgeries each year and is uniquely qualified to treat patients who are unhappy with prior surgery.
Dark circles under the eyes can represent a number of different problems, each of which is treated differently. The space behind the eye, known as the orbit, contains a significant amount of fatty tissue. Orbital fat probably evolved to help cushion the eye from impact. However, as we get older, the support structures which keep the fat behind the eye weaken, and the fat moves forward into the eyelids. This results in a fullness to the lower eyelids which most people find aesthetically unpleasing. This fullness, commonly referred to as “puffy eyes” or “baggy eyes”, makes people look older and tired. The best treatment for this type of problem is usually removal of excess fat with a lower lid blepharoplasty procedure. Excess skin can be trimmed and tightened at the same time.
Some people have a minimal amount of extra fat, but have a significant depression or hollowness in their lower eyelids. If you have this problem, you can usually feel the underlying bone when you touch the area with your finger. Patients who have had an overly aggressive lower lid blepharoplasty in the past may have a similar problem. The modern way to treat this hollowness is with injectable fillers such as Restylane . These treatments are less invasive than traditional surgery often last several years. Some surgeons advocate grafting or repositioning of fat to reduce hollows under the eyes, but I find that this treatment is much less reliable than injection of fillers. In some patients, a lid tightening procedure known as canthoplasty can make a big improvement in the appearance lower eyelid contours.
More information about the treatment of dark circles is contained in the articles section of this website.
Yes. Dr. Kapadia has a large functional (non-cosmetic) surgery practice. He performs a wide range of procedures on the eyelids including ectropion repair and entropion repair as well as functional (medically necessary) ptosis repair and upper blepharoplasty surgery. If you are interested in one of these surgeries, you should book a medical consultation.
Periocular skin cancers are treated using a team approach with an expert dermatologists at Tufts Medical Center. Tumors are excised by dermatologists trained in Mohs micrographic surgery. Tissue is removed and checked under the microscope until the surgical margins are tumor free. After the excision of the tumor is complete, patients report to the operating room to have reconstruction of their eyelids by Dr. Kapadia. The excision of the tumor and reconstructive surgery are performed on the same day, limiting the number of trips for the patient and their family. Skin cancers such as basal cell carcinoma and squamous cell carcinoma are usually treated in this manner, other types of skin cancers may be treated in this manner as well. Patients with aggressive cancers such as malignant melanoma, Merkel cell tumors or sebaceous cell carcinoma may benefit from sentinel node mapping, a procedure to see if the cancer has spread to lymph nodes. This procedure is performed by a head and neck surgeon at Tufts Medical Center.
The anesthesia requirements for eyelid surgery vary considerably by type of surgery. Some surgeries and minor procedures are performed in the office under local anesthesia with patients awake, while more extensive surgeries are performed in the hospital with either intravenous sedation (aka conscious sedation) or general anesthesia. Most patients are able to leave the hospital within 1-2 hours after their surgery.
The most important factor prior to surgery is to discontinue the use of all blood-thinning medications with permission of your primary care physician. Typically, aspirin, plavix and non-steroidal medications such as ibuprofen, Motrin, Alleve, naprosyn and Celebrex are stopped for two weeks prior to surgery. Vitamin E and all herbal medications should also be stopped two weeks prior to surgery. Patients on coumadin typically stop this medication five days prior to surgery. Again, you need permission from your primary care physician before making any changes to your daily medication regimen. All medicines can usually be resumed 1-2 days after surgery.
The recovery after surgery varies considerably from patient to patient and is difficult to predict before surgery. There is often a considerable amount of swelling which peaks at 1-2 days after the procedure and gets better each day afterward. Some patients may get “black and blue” bruises in their eyelids and cheeks from the breakage of small blood vessels. Dr. Kapadia recommends taking two weeks off of work for most patients if possible, but many patients choose to return to work 7-10 days after surgery. Patients who can work from home are often on their computers the next day. It just takes time to look presentable.
There can often be a small amount of residual swelling which persists for several months after surgery, so it takes time to see the full results. Coverup type makeup can be worn the day after surgery. Dark makeup such as eyeliner or mascara should not be worn for at least 2 weeks after surgery.
Arnica montana is an herbal supplement which may help reduce the amount of bruising and swelling after surgery. This supplement is recommended to patients who want to do everything possible to minimize their recovery time. However, many patients do not feel comfortable taking herbal medications which do not have proven therapeutic value and should not feel that it is necessary to take this supplement.