Understanding Your Blepharoplasty Procedure

Phase 1: Pre-Operative Preparation (Days/Weeks Before Surgery)

1. Consultation & Consent: You’ve already discussed goals, risks, benefits, and the specific plan with your surgeon.
2. Medical Clearance:

• You’ll receive instructions to visit your Primary Care Physician (PCP).
• Your PCP will review your medical history, current medications, allergies, and perform a physical exam including vitals.
• The goal is to ensure you are medically stable for an office-based procedure under local anesthesia with oral sedation. Your PCP will sign a “clearance” form stating no significant medical contraindications exist.

3. Pre-Operative Instructions: You’ll receive detailed written instructions covering:

• Medications to STOP: Typically 1-2 weeks before:

• Aspirin, NSAIDs (Ibuprofen, Naproxen), blood thinners (consult PCP/surgeon about prescription blood thinners to ensure it is safe to hold before surgery).
• Certain supplements: Fish Oil, Vitamin E, fish oil, Ginkgo, Garlic, Ginseng, St. John’s Wort – anything that can increase bleeding).

• Medications to CONTINUE: Usually essential meds such as blood pressure, heart, breathing, and diabetic medications. The goal is to ensure that the blood pressure and blood sugar are normal a the time of surgery. Smoking Cessation: Strictly avoid smoking/vaping for at least 2 weeks before and after.
• Alcohol Avoidance: Stop alcohol 48-72 hours before and after surgery.
• Eating on the day of the procedure: Because most blepharoplasties are performed in the office under local anesthesia, patients are encouraged to have breakfast the morning of surgery.
• Arrival: Patients are scheduled to come in 30 minutes before the procedure to take oral sedatives like valium and to mark the eyelids before surgery. 
• Escort: MUST have a responsible adult driver to take you home and ideally stay with you for the first 24 hours (due to Valium effects).
• What to Wear/Bring: Comfortable, loose-fitting top (button-down preferred), no makeup/jewelry, bring glasses (can’t wear contacts), payment if required.
• Hygiene: Shower and wash your face/hair thoroughly the morning of surgery. Don’t apply lotions/makeup.

Phase 2: Day of Surgery – Arrival & Preparation

1. Check-In: Arrive at the office. 

• Blood pressure check
• Medication Administration:

• Oral Sedation: You’ll be given 1-2 Valium tablets to swallow with a small sip of water. This happens 30 minutes before the procedure starts to allow time for it to take effect (relaxation, reduced anxiety, mild amnesia).
• Possible Additional Oral Meds: Sometimes an oral painkiller (like hydrocodone) will be given alongside the Valium if the patient has taken a similar medication before and knows they tolerate it well.  Ask your surgeon specifically if you’ll receive anything else. No IV will be started.

2. Marking: Your surgeon will carefully mark the planned incision lines on your eyelids while you are sitting/upright.

Phase 3: During the Surgery (Approx. 1-2 Hours)

1. Positioning: You’ll lie comfortably on the operating table. 
2. Initial Local Anesthesia Injections and prepping the skin:

• The surgeon will inject the lidocaine with epinephrine under the skin in the marked areas of your eyelids.
• You will feel a little burning during these initial injections. The distraction provided by our surgical tech and the Valium helps you tolerate the injection.
• The area will start to feel numb very quickly following the  injection.
• The periocular area will be prepped and draped in sterile fashion.

• Surgery Begins:

• Once numb, the surgeon makes the incisions along the natural creases of your upper eyelids.
• You will likely feel some pressure, pulling, and movement, but should not feel sharp pain.

3. Surgical Technique:

• As the surgeon works deeper (through skin, muscle, towards the fat pads – the “compartments”), they will periodically check if you feel any sensation.
• Before working on a deeper layer (compartment), they will inject a small amount of the same local anesthetic mixture directly into that specific area.
• This ensures each layer is fully numb before it’s manipulated, maximizing comfort. These top-up injections are usually much less noticeable than the initial ones.

4. Surgical Steps: The surgeon will remove or reposition excess skin, muscle, and/or fat as planned. Bleeding points are carefully cauterized.
5. Closure: Fine sutures (stitches) or surgical glue are used to close the incisions. Antibiotic ointment is applied.
6. Communication: You are awake but sedated. If you feel ANY sharp pain at ANY point, tell the surgeon immediately so they can give more local anesthetic.

Phase 4: Immediate Post-Op (In Facility)

1. Recovery Area: You’ll be helped to sit up slowly and then moved to a recovery chair/area.
2. Initial Monitoring: Staff will check your comfort level and check vitals if needed. Vision might be slightly blurry initially (ointment, swelling).
3. Cold Compresses: Ice packs or cold compresses will be applied gently to your eyes to reduce swelling.
4. Post-Op Instructions Review: A nurse will verbally review your discharge instructions you received at the preoperative appointment. Key points include:

• Medications: Prescription for pain meds (often Acetaminophen/Tylenol or Tylenol with Codeine) + Antibiotic ointment. Instructions for OTC meds like Arnica (for bruising).
• Cold Compresses: How often and for how long (e.g., 15-20 mins every hour while awake for first 24-48 hrs).
• Head Elevation: Sleep with head elevated on 2-3 pillows for 1-2 weeks.
• Activity Restrictions: No bending, heavy lifting, straining, swimming, or strenuous exercise for 1-2 weeks. Avoid rubbing eyes.
• Wound Care: Apply the prescribed antibiotic eye ointment 4x/day along the upper eyelid stitches.
• Showering: Avoid direct heat and water pressure to the face for 2 weeks. Washing the hair from the back after 2 days is okay.
• Follow-Up: Date and time of your first post-op appointment (usually within a week).
• Red Flags: Symptoms requiring immediate call to the surgeon (e.g., sudden severe pain, vision loss, significant bleeding, signs of infection like fever/redness/pus).

5. Discharge: Your escort will take you home after a short recovery period. You cannot drive yourself.

Phase 5: Recovery at Home

• Follow all written instructions meticulously.
• Take tylenol as needed for pain.
• Apply cold compresses frequently.
• Keep head elevated.
• Walking, television, desk work okay as long as eyes don’t feel stained
• Attend all follow-up appointments.
• Be patient – swelling and bruising peak around days 2-3 and gradually subside over weeks.