If the upper eyelid blocks the line of sight (the pupil) or restricts the upper field of vision, this is a functional problem, the lid surgery will be covered by provincial health insurance. AHS and OHIP do NOT pay for eyelid surgery that is performed purely for cosmetic reasons. To help make this determination, take a picture of the patient looking straight ahead, and not using the forehead muscles ( do not wrinkle the brow). Bring this picture to the office consultation.
Each patient has a unique perspective on what is aesthetically pleasing. No surgeon can guarantee that the patient will be completely satisfied with the surgical result and you may perceive asymmetry in your eyelid following surgery, that others may not notice. “Cosmetic” procedures usually do not make the patient feel more comfortable, since the eyelid may feel tighter or drier.
Dr. Ing can try to make the eyelids more congruent, but cannot make perfect what is imperfect to begin with. Many people including fashion models and celebrities have small amounts of eyelid asymmetry. (Canadian Journal of Ophthalmology, 2006, Ing et al.)
Many patients with droopy eyelids may have pre-existing unstable tear films or “dry eyes”. Patients with dry eyes often complain of itchy, scratchy burning eyes. When the eyelids are lifted to the appropriate height, more evaporation will occur. After ptosis or blepharoplasty surgery, chronic lubricating drops may be required.
On the day of surgery, bring in a printed picture showing your droopy lid in its present state.
In adults, the surgery is done awake, to better facilitate lid height adjustment. The local anesthetic freezing injection may hurt for 40 seconds.
The eyelid skin is the thinnest skin in the body and has a good blood supply. After surgery the lid is often puffy bruised and swollen for several weeks. The bruising is usually most prominent by the third day, and then slowly improves. Using cold water compresses for the first two days after surgery may help decrease the swelling.
You can take showers the same day but do not go swimming and do not rub the stitches. Wash your hands frequently.
Your vision may be blurry if the antibiotic ointment used on the skin melts in to the eyes.
In the first few days after surgery, the eyelids may not close completely. Usually this improves, but patients should use frequent artificial tears and ointment during the first few days or weeks after surgery.
The eyelid tissue is delicate. It is difficult to exactly adjust the lid height because the local anesthetic, open wound, tissue swelling and bleeding cause variations in lid height. We usually do not repeat eyelid surgery if there is only a small amount of post-operative asymmetry. A 1-2 mm difference in the lid height, or mild asymmetry in the shape of the lid (contour) is an acceptable result. If there is marked discrepancy in the lid height or contour, an augmentation or revision procedure can be considered.
In patients undergoing blepharoplasty, all the wrinkles and eyelid skin will NOT be removed. Some skin must be left behind or else the eyes will not close properly.
You may have a permanent scar after lid surgery. In the majority of patients, the scar becomes less noticeable with time. In the upper lid, the incision is usually partially concealed by the natural lid crease when your eye is open. Occasionally one of the “permanent” black sutures may show through the skin and necessitate revision surgery.
Rare, life-threatening infections have been reported after eyelid surgery. While the wound is healing, wash your hands frequently, use your antibiotic ointment, do not go swimming, and do not let the family pet lick your face.
Many procedures may have to be repeated within three to five years as the face continues to age, descend and tissues become more lax.