Have you ever thought about getting a blepharoplasty to the upper lids, but you weren’t sure what the recovery was meant to be like? I’m Dr. Dominic Castalano at Elite Facial Plastic Surgery. And today I’m going to talk to you about the recovery when doing an upper lid blepharoplasty.
What to Expect on the Day of Surgery
Typically on your day of surgery, you’ll have your procedure and then once completed, you’ll have sutures that are running in the upper lids. These sutures are normally going to be a running knot where it’s kind of like a baseball stitch going through the skin.
Some surgeons may opt to do what are called subcuticular sutures where the suture goes below the skin. Others may also do interrupted or a combination. You can see there’s different ways to close the skin.
However, post-operatively what you’re going to do, especially when you get home, there should be some ointment, an antibiotic ointment, preferably over the incision line to help protect the skin and facilitate the healing process. I would also encourage you to make sure you don’t put too much on because some of those ointments can be irritating to the eye. So you just want a very small amount to keep a very light sheen or coating on there.
Days 1 and 2 Post-Op
After your first day on postoperative day two, you may notice a little bit more swelling. Sometimes that can be swelling without bruising or it can be a combination of the two. Bruising during your recovery period is normal.
However, if you notice excessive swelling, significant bulging, or certainly any pain, you should let your surgeon know immediately. But most patients are normally going to have a mild amount of swelling. You should be able to open your eyes and see. Certainly, if you have any problems with your vision, let your surgeon know.
Then after that first day, you’re going to want to clean the incision with a little bit of peroxide. Ideally, maybe use a Q-tip because that’s a little bit finer. And then after you remove a little bit of the crusting, put a little bit more ointment on there.
Days 2 Through 7 Care
Now, post-op days 2 through 7, you’re kind of repeating the same thing. I think you’ll find that you won’t have as much crusting every day that moves forward, and you’ll be able to see those sutures pretty clearly.
On your seventh postoperative day in my practice, I normally start to remove what I call the interrupted sutures at various tacking points. And then I’ll also typically cut the knot on that running suture. Normally that knot is going to be out on the side over here and also here more medially.
Depending upon how much swelling you have and how you’re healing, I may keep that suture in a couple more days or even another week. Normally what happens once those knots are cut, as the body continues to heal, those sutures will start to pull out a bit as well. Many times I’ll have patients trim that on their own.
When I see them in follow-up after their first postoperative day or first post-op week on day seven to seeing them back on either post-op day 10 or 14, I remove the remaining suture that’s present.
Long-Term Healing and Scar Maturation
From that point moving forward, you’re going to see that the incision has a little bit of a pink color to it, which is very normal. That pinking will take normally about 6 months to fully mature.
During that maturation process, I encourage patients to wear a small amount of sunscreen along the incision line, especially if you’re going to be outdoors for an extended period, and to certainly wear a hat. After 6 months, the incisions are mature.
During that maturing process, some patients can also put things like Mederma or Vitamin E; those are certainly reasonable. But at that point in time, the incision will continue to mature and ultimately, if the incision is placed in a good location, it should be barely visible if at all.
Lower Lid Transconjunctival Blepharoplasty Recovery
So what’s recovery like with a lower lid transconjunctival blepharoplasty? Now, compared to the upper lids where you’re making an incision through the skin on the top, with the transconjunctival approach, we make an incision behind the eyelid. In doing so, there are no sutures that are normally placed. That’s the benefit of doing the lower lid blepharoplasty surgery.
However, the day of the procedure, just like the upper lid blepharoplasty procedure, you’re going to have a little bit of swelling in the lower lid area. That’s very normal. That first night you could have a little bit more swelling to where it’s a little bit soft and puffy. But certainly, if it becomes very prominent, excessively bruised, or you have bleeding, any pain, or any problems with vision, you should let your surgeon know.
On postoperative day number one, after that lower lid procedure, there’s really not much you need to do because again, the incision is behind the lids and it should heal up very well. I usually tell patients more importantly is to take it easy while you’re recovering just to help facilitate your body resorbing the fluid and also facilitate the healing process.
Laser Resurfacing and Post-Op Intervals
Now, if you have had some laser resurfacing done to the lower lids, which is often done in my practice, you’ll be applying ointment on and off the skin that first night every 4 to 5 hours and you’ll continue that process till you follow up one week later. At your one-week follow-up, I normally will transition you from putting what’s called Aquaphor on the skin to more of a moisturizer in what I like to refer to as post-resurfacing care. At that point in time, you’ll continue that post-resurfacing care as you follow up.
Normally the follow-up intervals for both the upper and the lower lid blepharoplasty is going to be post-op week one, post-op week two, and then I normally see you back 2 weeks after that for your one-month checkup.
In some instances with the lower lid blepharoplasty and the patients who have had laser resurfacing, you can sometimes develop what’s called hyperpigmentation or dark tanning of the skin that has been resurfaced. In some instances, you will need to be placed on a prescriptive cream to help reverse that and slow that down and get the skin back to its normal tone. It’s not uncommon and it’s called post-inflammatory hyperpigmentation.
When Are You Fully Recovered?
So from a recovery standpoint, most patients are often inquiring as to when they’ll be, quote, “fully recovered” from their blepharoplasty. So that’s kind of a tricky question because it’s not like a light switch where it’s just on one minute and off the next. The healing process with anything that we do in facial plastic surgery is just that—it’s a gradual process.
However, with the upper lid blepharoplasty, usually, I’m recommending patients kind of evaluate things in periods of weeks. As you’ll see, the first week you’re caring for the site, and the sutures come out after about a week up to two weeks. And then once the sutures are out, that incision line takes time to fully mature. Any incision on the face area takes about 6 months to fully mature.
What I tell most patients is give that upper lid blepharoplasty a good 6 weeks to kind of allow things to settle. During that time period, even though the incision is maturing, you’re going to still have a little bit of swelling, especially in the upper lid area as the area is trying to recreate what are called the lymphatics to help continue to drain fluid. As a rule of thumb, I would tell you to judge your upper lid blepharoplasty at 6-week intervals. Usually, by 3 months the swelling is resolved. However, the incision will still be maturing for another 3 months to give that six-month time period for incisional maturation.
Lower Lid Blepharoplasty Results Timeline
How long will it be before you see full results from your lower lid blepharoplasty? As with the upper lid blepharoplasty, it’s kind of a gray area from the standpoint that it’s not like there’s one hard set rule. What I usually tell my patients is follow the healing process over a period of weeks.
I normally tell most patients give it about a good four to 6 weeks before you’re really seeing a lot of improvement from a swelling standpoint. And then every six weeks thereafter, usually by three months, you’re starting to see what the lower lids are going to look like. From three months to six months, there may be a little bit of residual swelling that resolves, but unlike the upper lid blepharoplasty where there’s an incision up in the skin crease, normally with the lower lids, because it’s mucosa, it tends to heal a little bit quicker.
Warning Signs to Watch For
What are some things you should look for that mean you need to contact your doctor? First of all, what I would say is if you have swelling with pain or any vision issues at all, you should definitely contact your surgeon immediately. If you have any excessive bleeding, for instance, to where it’s associated with also swelling and any discomfort at all and problems with vision, I would definitely contact your physician.
If you’re having any pain at all, then I would certainly contact your physician so that way they can guide you through the healing process. When it comes to the upper and lower lids, if there is any swelling, it’s a confined area. You really should contact your surgeon if you have any questions or concerns. Don’t hesitate because it’s important for your surgeon to know what’s going on versus you trying to not bother them.
