As we grow older, the skin begins to lose some of its elasticity, and the area around the eyes often begins to sag. These wrinkles, pouches beneath the eyes, and sagging upper eyelids can be greatly improved with eyelid surgery (blepharoplasty). Renowned throughout Southern California, Dr. Robert Singer has performed exceptional eyelid surgeries for many discriminating patients at his practice in La Jolla, San Diego.
Upper blepharoplasty (sometimes called an upper eyelid lift) can correct overhanging upper lids, while lower blepharoplasty (sometimes called a lower eyelid lift) most often eliminates bags under the eyes. Upper and lower eyelid surgery can be performed separately or concurrently if you have signs of aging both above and below the eyes.
Eyelid surgery patients find that their eyes appear larger and more attractive, which brings a brighter, more youthful appearance to the face.
Before & After Photos
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Your Blepharoplasty Consultation
During your eyelid surgery consultation, Dr. Singer will ask about the areas that concern you and your desired outcome. He will take a detailed medical history and will examine and evaluate you. He will then explain the options that are available and the pros and cons of each alternative.
This explanation will include what treatment option or options he recommends, where the surgery will be performed, what type of anesthesia will be used, a step-by-step explanation of what the recovery will be like, what is expected of you as a patient, and potential problems that can occur. Dr. Singer will also answer all of your questions during your consultation so that you can make an informed decision about your procedure(s).
Who Needs Eyelid Surgery?
Both younger and older healthy patients who have hooding of the upper eyelids or bags under the lower eyelids could benefit from blepharoplasty. Patients with “single eyelids” who wish “double eyelids” can also benefit from eyelid surgery.
Dr. Singer often performs eyelid surgery with a brow lift for optimal results. He may recommend a brow lift when there are deep forehead wrinkles, frown lines between the eyes, lines over the nose, or wrinkled, sagging upper eyelids that are caused by drooping eyebrows. Other surgical and non-surgical procedures that are frequently performed in combination with eyelid surgery include microfat grafts, Juvederm, facelift, and/or nose surgery.
The Eyelid Surgery Procedure
During eyelid surgery, excess skin and fat are removed, and stretched muscles are tightened. Using the latest techniques in facial plastic surgery, Dr. Singer smooths and sculpts upper lid creases and eliminates wrinkles and pouches beneath your eyes.
All eyelid surgery incisions are carefully positioned beneath the lashes or along your natural eyelid creases so that they are scarcely visible. The results are smooth, sculpted creases on the upper lids and elimination of most of the wrinkles and pouches beneath the eyes.
The length of eyelid lift surgery depends on several factors, including the extent of tissue laxity and the anatomy of your eyelids, but it generally takes 1-2 hours. Many patients who have previously had a blepharoplasty are referred to the Singer Surgical Centre for revision eyelid lift surgery. Revision blepharoplasty can take a little longer because of corrections that need to be made as a result of the initial eyelid surgery. If concurrent surgeries are done, such as a facelift, the length of the procedure will also be longer.
Anesthesia at our Accredited Operating Facility
At our AAAASF-accredited (American Association for Accreditation of Ambulatory Surgery Facilities) private operating facility in La Jolla, you will be taken care of by thoroughly trained personnel, including carefully selected, experienced, board-certified physician anesthesiologists.
Most of our patients are anesthetized using sedation, allowing them to be asleep while breathing on their own, but usually not requiring deeper general anesthesia. Sometimes, depending on the patient, general anesthesia is an option. In either case, you will be asleep, comfortable, and unaware of any pain during the procedure.
Some patients who feel more comfortable in a hospital after surgery and those who would benefit from closer monitoring are admitted to Scripps Memorial Hospital – La Jolla for 1 night after surgery. The Singer Surgical Centre is on the campus of the hospital and immediately adjacent to the main hospital building.
Recovery from Blepharoplasty
Most patients who have eyelid surgery say they are surprised that the post-operative discomfort is so mild. Patients more typically complain of tightness from swelling or a pulling sensation.
Understandably, after any surgical procedure, some discomfort can be expected, and pain tolerance varies from patient to patient. You will be provided with prescriptions for pain medication, as well as eye drops and an antibiotic to prevent infection. Many patients use the pain medication 2-5 days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report extreme pain after surgery.
Post-operative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising and swelling may take 2-3 weeks. Most patients can camouflage bruises fairly easily at 7-10 days with a concealer. Our aestheticians at the Singer Skin Care Center are available to help you with this during your recovery period.
You can also expect some drainage or crusting of your eyelids. Simply draw it away with a Q-Tip dipped in tap water.
Restrictions from work are generally 1-2 weeks after eyelid surgery. Because some bruising and swelling may still be present, an occasional patient will take 3 weeks off.
Smoking adversely affects your recovery by diminishing the blood supply to the skin. Patients must stop smoking for a minimum of 2 weeks prior to surgery to decrease the risk of these complications and continue smoking cessation after the procedure for a period of weeks.
Do not drink alcohol for 5 days after surgery, and do not drive for 4 days. You may wash your hair 3 days after surgery or the day the dressings are removed during a follow-up visit. You may resume wearing makeup 10-14 days following your procedure, and you can wear contact lenses within 2-3 weeks.
Aerobic activities should be avoided for 3 weeks following surgery. Any activity that potentially increases blood pressure will extend the amount of time it takes for post-operative swelling to resolve. This includes brisk walking, sex, and hot tubs.
The results of eyelid surgery may be considered permanent in that you will continue to look younger years later than you would have without undergoing the eyelid improvement. You will, for example, always look younger and better than a twin if you undergo the correction and the twin does not. Most patients can expect their results to last between 8-12 years. However, eyelid surgery cannot stop the aging process.
It may take several months until you are happy with the results and up to 1 year to see the final result.
Eyelid Surgery FAQs
The general comments from friends and associates after returning to normal activities “are:” Gee you look great. Did you change your hairstyle?” “New makeup? Or “Have you been on vacation?” Retaining your uniqueness is the sign of a successful procedure. Although the change may be significant to you, it’s not uncommon that friends and family don’t really notice the specific changes unless patients request dramatic changes. Eyelid or forehead surgery performed meticulously, in the hands of a skilled, experienced, board certified plastic surgeon should not result in an unnatural over-operated appearance. Most patients want to look natural and like themselves, yet refreshed. This is achieved by the artistic combination of repositioning and removing the lax excess tissue and adding micro fat grafts or fillers where the tissue is deficient.
Some of the characteristics of a good board certified aesthetic (cosmetic) plastic surgeon are: willingness to listen to patients, an ability to tell the difference between realistic and unrealistic expectations, being truthful about meeting each patient’s desires, and the ethics to tell a patient why something should not be done. Our biggest referral source is from satisfied patients – ones who have had realistic expectations and were satisfied with the results.
La Jolla (San Diego) board certified plastic surgeon Dr. Robert Singer will personally meet with you during the consultation. He will ask about the areas that concern you, what is your desired outcome, and take a detailed medical history. He will examine and evaluate you. He will then explain the options that are available and the pros and cons of each alternative. This explanation will include what treatment option/options he will recommend, where the surgery will be performed, what type of anesthesia, a step-by-step explanation of what the recovery will be like, what is expected of you as a patient, as well as the potential problems that may occur. Dr. Singer will answer all of your questions. You will then meet with the patient care coordinator, who will show you pre and post-op photos of the various options, explain the scheduling details, the costs involved, and answer any additional questions that you may have.
Yes, it’s generally preferred to combine procedures. It is financially beneficial because you only undergo 1 anesthesia and minimize the cost of the operating room and surgical supplies. In addition you minimize downtime by having to go through the recovery process following surgery only once. Commonly combined procedures with face lift surgery include the following:
• Brow lift
• Micro fat transfer
• Laser or dermabrasion
• BOTOX® Cosmetic or Dysport
• Face or neck lifts
• Chin implant
• Rhinoplasty (nasal surgery)
Most patients who have eyelid surgery say how surprised they are at how mild the discomfort is that they experience. Patients more typically complain of tightness from swelling or a pulling sensation. Understandably, after any surgical procedure, some discomfort can be expected and pain tolerance varies from patient to patient. All patients are provided with prescriptions for pain medication. Many patients use the prescription medication 2-5 days after surgery and then switch to Extra Strength Tylenol. It is uncommon for patients to report extreme pain after surgery.
The length of eyelid lift surgery depends on several factors including the extent of tissue laxity and the anatomy of each person’s eyelids, but generally takes 1-2 hours. Many patients who have previously had a blepharoplasty are referred to the Singer Surgical Centre for revision eyelid lift surgery. Revision blepharoplasty can take a little longer because of corrections that need to be made as a result of the initial eyelid surgery. If additional procedures like forehead surgery, micro fat injections, laser treatments or facial lifting are performed in conjunction with the eyelid surgery, it will naturally take longer.
Most eyelid or forehead surgeries are performed on an outpatient basis. Because you will be receiving sedation, you will need to make arrangements for a responsible adult to drive you home, to stay with you overnight and to drive you to our office for your first postoperative appointment the next day. Our patient coordinator can arrange for an experienced individual to help with your post-op care, if you do not have someone to take care of you after surgery. Patients having surgery must stay in the immediate La Jolla area overnight within 60 minutes of our facility.
Some patients who feel more comfortable in a hospital after surgery and those who would benefit from closer monitoring are admitted to Scripps Memorial Hospital – La Jolla for 1 to nights after surgery. The Singer Surgical Centre is on the campus of the hospital and immediately adjacent to the main hospital building.
Postoperative bruising and swelling begins to resolve at the end of the first week. Full resolution of bruising or swelling may take 2-3 weeks. Bruising is variable and many patients can camouflage bruises fairly easily at seven to ten days with a concealer. Our aestheticians at the Singer Skin Care Center are available to help patients with this during their recovery period.
It depends on the type of work you perform. Restrictions from work are generally 7 days to two weeks after eyelid surgery. Because some bruising and swelling may still be present, an occasional patient will take three weeks off to be safe.
The results of eyelid surgery may be considered permanent in that you will continue to look younger years later than you would have without undergoing the eyelid improvement. However, eyelid or forehead surgery cannot stop the aging process and you will continue to age. You will, however, always look younger and better than a twin, if you undergo the correction and the twin does not.
The results will vary from person-to-person. Most patients can expect their results to last between eight and twelve years. The length of time that patients enjoy a satisfactory improvement after an eyelid surgery depends on many factors including the quality of their skin, which is influenced by the degree of sun damage or loss of elasticity. Smokers typically have poorer quality skin. Older patients will see an earlier return of laxity, while younger patients will see a more long-lasting improvement.
Heredity is important. If your parents aged slowly, you probably will, too. Your diet, general health, time spent in the sun, smoking, weight gains and losses, emotional traumas, and type of skin will all play a role in determining how long the improvement will last.
No surgical procedure is without risk. Most complications associated with eyelid and forehead surgery, however, are minor. Here are some possible problems:
• Collection of blood under the skin (hematoma). This can be removed.
• Temporary crusting which forms on the incisions.
• Loss of sensation in the scalp (with forehead lifts). If this occurs, feeling will usually return in time. Numbness behind the scalp incision may last six months or more.
• Soreness and itching around the incisions. If these sensations occur, they will soon disappear.
• Depression. With aesthetic surgery, as with other surgical procedures, this sometimes occurs postoperatively. This is generally attributed to the normal response of the body to surgery and anesthesia.
• Dryness and irritation of the eyes. This is usually temporary, and is relieved by “artificial tears.”
• Asymmetry. No patient is identical from side to side. Small differences exist in all patients. In the occasional patient with a major difference, this can usually be improved with a secondary procedure.
Potential but unlikely complications:
• Poor healing of skin.
• Loss of small areas of skin (necrosis).
• Widening or thickening of a scar. If this happens, it can be revised at a later date in a simple office procedure. Incisions can never be guaranteed to “heal” in a certain way.
• Hair loss around the incision after forehead lift. If this occurs, the hair generally grows back in a few months.
• Pulling down of the lower eyelid. This is usually temporary, and gradually improves as the muscle regains its tone in the first few days, or weeks.
• Injury to the forehead branch of the facial nerve (with forehead procedures). This is usually temporary and corrects itself in the first few days or weeks.
Complications of a severe nature, which could be life threatening, or cause loss of vision on one side.
YOU MUST ENTER INTO YOUR SURGERY FULLY UNDERSTANDING NOT ONLY THE BENEFITS, BUT ALSO THE POSSIBLE PROBLEMS. ON OCCASION, A MINOR REVISION MAY BE NECESSARY TO ENHANCE THE FINAL RESULTS.
Eyelid, forehead, or brow surgery is usually performed at the Singer Surgical Centre on an outpatient basis under twilight sleep sedation anesthesia. A Board certified anesthesiologist will be present to make you comfortable and unaware throughout the procedure.
Before the surgery begins, you will be asked to change into a surgical gown and will be taken into a private operating room. An intravenous line will be inserted into a vein in your arm. This will make it possible for the anesthesiologist to administer fluids, and to deliver the necessary medications to make you comfortable. Monitoring devices will be connected to you, to assure your safety.
Dr. Singer will talk with you before you are sedated and use a surgical marking pen to draw several lines on your face. These will guide him during the operation. For the eyelid surgery, an elliptical incision is made in the upper lid in the natural crease of the lid. Excess skin, muscle, and fat are removed, and the skin is sutured. An incision is then made in the lower lid, just beneath the lashes. This incision extends slightly beyond the outside corner of the eye. Extra skin and fat are removed, sagging muscles are tightened, and the incision is sutured. If the incision is on the inside if the lid, fat, but no skin is removed, the skin can be tightened with the use of a laser.
For a forehead lift, the incision is generally made across the scalp, just behind the hairline. The skin of the forehead is loosened down to the brows, the necessary muscles are cut and the skin is pulled upward, redraping and trimming as needed. The incision, which is concealed by the hair, is closed with surgical clips, and a drain placed. For persons with a high forehead, this incision would not be satisfactory, since it would make the forehead even higher. In such cases the incision is made directly in front of the hairline, preserving the hairline’s original position.
When a forehead lift is performed on a man with a receding hairline, the incision can be placed in the mid forehead crease. There are instances when a supraorbital brow lift, instead of a forehead lift, will be recommended. In this procedure, the incision is made just above the eyebrows, and the skin is trimmed and pulled up.
Some patients may benefit from a recent breakthrough in technology that achieves correction of the forehead through a minimally invasive endoscopic approach to the muscles through several small incisions behind the hairline.
Eyelid, forehead, or brow lift surgery usually takes one and a half to two hours. If performed in conjunction with other procedures, surgery will naturally take longer.
You should expect:
• Moderate swelling, bruising, and bloodshot eyes which
last for about two weeks.
• Drainage or crusting of your eyelids. This is not infection.
Simply draw it away with a Q Tip dipped in tap water. If
your eyelashes are stuck together use the same technique
to tease them apart.
• A sensation of tightness, itching, and occasionally, tearing.
This subsides over several weeks. If you have had a
forehead lift, there may be a sensation of tightness in the
forehead that subsides in one to two weeks.
Call: (858) 455 0290 if you have:
• Severe pain that doesn’t respond to medication.
• Significant swelling, and/or unrelenting pain which occurs
more on one side than the other.
• Significant changes in vision, (mild blurring is normal).
• Any other problems or questions.
Activity: You should “take it easy” the day of your operation and the following days. Sleep on your back for two weeks, elevating your upper body on two or three pillows. By keeping your head elevated above your heart, swelling can be minimized. Because of your medications, you may need assistance getting to and from the bathroom for the first day.
Medications: Take the medications we’ve prescribed according to the instructions on the bottle. You may feel a little drowsy, so have someone help you. If you need a refill, call the office and give us the telephone number of your drugstore or pharmacy. Do not take aspirin for five days after your surgery.
Pain: Most patients feel that the discomfort from this surgery is minimal. The greatest period of discomfort usually lasts about twenty four to forty eight hours. Thereafter, you should have less discomfort and less need for medication. Occasionally, it lasts a little longer.
Smoking: Do not smoke for five days after surgery.
Alcohol: Do not drink alcohol for five days after surgery.
Driving: You may drive after four days.
Diet: Start with liquids the first day and then progress to your regular diet as you desire, restricting salt and artificial sweeteners.
Hair: You may wash your hair three days after surgery, or the day the dressing is removed. This should be done in the face up position. Do not bend your head forward. You may blow dry your hair with a warm hand dryer, or sit under a cool dryer, but do not use a hot dryer, electrical rollers, or curling irons for three weeks. (For forehead lift).
Compresses and ice packs: Apply continuous cold water compresses to your eyes for two days after surgery and then intermittently. This will decrease discomfort, swelling, and bruising. Our staff will explain how to make simple, effective ice packs that should be placed on the forehead for two days following surgery (if you have a forehead lift).
Reading and television: You may read and watch television at any time, but you may have blurred vision for a few days after surgery. This is normal.
Eyelid makeup: You will be instructed when you can resume application of makeup. This is usually about 10 14 days after surgery.
Contact lenses: You may wear your contacts two to three weeks after surgery. Occasionally, it will take longer until they fit properly.
Sun: Do not sit in the sun at all for three weeks after surgery. If the incisions are exposed, apply sunscreen for six months, and wear sunglasses.
Sports: Strenuous sports such as golf, tennis, swimming, bowling, jogging, aerobics, jazzercize, or bicycling may be resumed after three weeks. Refrain from any activity that significantly raises your body temperature and/or blood pressure for three weeks after surgery. This includes hot tubbing, sexual relations and brisk walking.
Work: Depending on the kind of work you do, you may return to your job as soon as you are comfortable.
Postoperative visits: The day after surgery: You will be seen at our Centre. If you are hospitalized, you will be seen there. You will be examined at this time. Subsequent visits: They will be determined by your progress. Sutures will be removed four to five days after surgery and the tapes replaced. This does not hurt. The forehead lift surgical clips will be removed about two weeks after surgery.
You will feel more comfortable using the private postoperative waiting room for your initial post operative visits.
Please feel free to call us at any time during your healing period.
THE OUTCOME OF YOUR SURGERY IS IN YOUR HANDS AS WELL AS THE DOCTOR’S. IT IS YOUR RESPONSIBILITY TO FOLLOW ALL INSTRUCTIONS GIVEN TO YOU.
Most patients will have some bruising. You can minimize bruising by following instructions and using Arnica 1-2 days before and after surgery.
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Why Choose Dr. Singer?
Dr. Singer has the respect of his peers and patients across San Diego and the surrounding Southern California area. He has helped thousands of San Diego residents with an eye for balance and beauty and the skills of an artist. Dr. Singer has been engaged in private practice in the La Jolla area of San Diego since 1976 and is now an internationally recognized plastic surgeon. You are in the best of hands with Board Certified Plastic Surgeon (American Board of Plastic Surgery) Dr. Singer.
Please learn more about Dr. Singer’s affiliations, memberships, awards, honors, and accomplishments. The full list and Dr. Singer’s curriculum vitae are available upon request.