Do I need upper or lower eyelid surgery? [Shannon O'Brien, MD, Portland]

Eva Sheie (00:00):
So when you do this surgery, can you kind of walk us through the procedure? How does it work and how do you do that both for the upper and the lower eyelids?

Dr. O'Brien (00:09):
Yeah, so I'll start with the uppers. The upper eyelids, usually there's a little redundancy of skin and muscle, so I end up removing that and then I evaluate is there a little fat pocket and possibly remove some of that. So as I'm talking to somebody, we're looking in the mirror, we're going through what they see, we're going through what I see, making sure that they don't actually have a droopiness to their eyelid that would require an ophthalmologist to repair the muscles. That's sort of a different conversation called ptosis. But for the eyelid surgery that I do, once we figure out what is the patient's concern, then basically we come up with the plan. Sometimes this can be done with local anesthetic or numbing medicine only in the office for the uppers, and sometimes it's a bit more work or someone's just not up for having a procedure with numbing medicine in the office.

Dr. O'Brien (01:04):
And so in those situations, we would go to the operating room. It's a fairly straightforward, relatively short, about an hour, hour and a half for the uppers and under general anesthesia if circumstances were such that it needed to go to the, OR. Typically after surgery for the uppers, and eventually for the lowers, you go home the same day, you have tapes on your eyelids for a week. There's some stitches that come out and that's at a week's time and the tapes come off, and then most people can go back to work and feel pretty presentable at a conversational distance at a week's time. And then for the lower eyelids, it's much the same as far as the evaluation, seeing what's going on with the patient, making sure that what their concerns are, what the procedure can offer, and then also checking to check eyelid tightness, things like that, because sometimes there's some supportive stitches or things that need to be placed, and we go through all of that to make sure their eyelid position is pretty or handsome afterwards. And once I get through the planning process with them, then we similarly would go back to the operating room. I do not do lower eyelid surgery under local anesthetic in the office. It's just a little trickier smoothing out the fat bulges if you have to put a whole bunch of numbing medicine in. And so I have to sort of approach that with the patient asleep, and then I can finish numbing them up at the end to make sure they're comfortable when they wake up.

Eva Sheie (02:35):
Does the anesthetic change the way that the tissue behaves? I've never heard that before. That's interesting.

Dr. O'Brien (02:43):
Well, it's just when you inject it, it sort of fills up the skin. It sort of raises a wheel of fluid under the skin. And when you're trying to really look at the contour of the fat pockets and make sure that that transition between the eyelid and the cheek is nice and smooth, I find that if I put a whole bunch of numbing medicine in at the beginning, it makes it more difficult to tell that that contour is just right.

Eva Sheie (03:11):
How long does a numbing medicine last after surgery? Does it keep you comfortable for the rest of the day?

Dr. O'Brien (03:17):
I use some that it lasts for about six to eight hours, and then that initial sort of burny, stingy sensation that you would feel with the incision, it actually fades out pretty quickly. And then once that medicine wears off, it's usually not too bad. Most people take very little, if any, narcotic medication. Tylenol and ice packs are the majority of what's needed to manage the pain. And so keeping your head elevated, that kind of stuff, rest, but it's very manageable. Again, I think that's why it's such a popular thing. It just doesn't take so much out of the patient.

Eva Sheie (03:53):
If you do eyelid surgery when you're younger, let's say you're 40 or 45, can you do it again later?

Dr. O'Brien (04:01):
You can do eyelid surgery a second time. It's interesting how long it tends to last. We often see people feeling really good with their results, easily 15 years down the line. But oftentimes I'll have patients that are like, yeah, I'm 65, I'm looking at a facelift. I had my eyelids done in my forties and I still love them, and they do look good. So it definitely has a lasting effect. But there are times when the skin eventually develops enough laxity again or what have you, that another little refresher is beneficial. It can be done.

Eva Sheie (04:39):
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