The eyes have often been called the windows to the soul, and display, for many, the primary index of a person's youthfulness and character. Women of ancient times recognized this and, lacking the availability of plastic surgery, emphasized their eyes above all other facial features with cosmetics. The Egyptians, Minotian, and Etruscan woman, through the use of cosmetics available to them, enlarged or slanted their eyes to grotesque proportions to command attention and suggest sensuality. This emphasis on the eyes has achieved acceptance and it is not uncommon today to note extraordinary variations in the use of cosmetics to exaggerate the eye area.
The use of plastic surgery has permitted rejuvenation of the aging eye through its ability to remove excessive skin which forms in both the upper and lower eyelids, as well as removing fat which is normally present around the eyeball and can protrude under the lids in unsightly "bags."The accumulation of water, particularly in the lower lids, can be reduced through the elimination of the space between the skin and muscles in this area where water stagnates. In younger women, improvement in the eye contour may be achieved by deepening the upper eyelid folds, altering the position of the brow, or slanting or widening the eye.
Terminology
Blepharoplasty: Cosmetic Surgery of the Eye
Excision Of Herniated Fat: Removal of genetic fat pads of the
lower eye lids present since adolescence or related to allergy
Correction of Ectropion or Entropion: Inversion or Eversion of the
lower lid margin from aging, surgery or facial paralysis
Surgery for the eye, which includes the brow area, upper lids, lower lids, and surrounding temple and forehead, can usually be performed safely as an office procedure under local anesthesia with or without sedation or under a light general anesthetic in our fully accrediated ambulatory surgical center or in the hospital associated with other procedures. The Center is certified by the Acceditation Association of Ambulatory Health Care (AAAHC) which is approved by the Medical Board and the Legislature of the State of California.
The surgery is variable, depending upon the type of problem which is presented to the doctor; each individual case demands a different approach.
Where excessive skin of the upper lids exists, the removal can be accomplished by making an incision in the deep recess of the upper eyelid and removing the excess skin and flabby muscle above it to just below the level of the bony portion of the eye socket, then stitching the wound. Should fat from inside the eye socket present toward the outside during this procedure, causing unsightly bulges, this can be removed simultaneously.
If the eye requires enlargement where there is a droopy eyelid, the muscle which elevates the upper lid can be tightened. This procedure is most commonly performed in women between the ages of 35 and 45, and occasionally in younger females who, because of heredity, have excessively heavy upper lids with fat protrusion and a poorly defined lid fold.
The excess skin of the lower lids is usually removed by first making an incision just beneath the lower rim of the eyelid and extending this into the temple area in one of the natural crease lines. The lower lid skin is then cut free from the underlying muscle and the excess is removed after the skin is pulled tightly toward the temple area. The wound is then closed with fine stitches and allowed to heal. Should fat from inside the eye socket protrude into the lower lid at the time of the surgery, this can be removed simultaneously. Or, if an excessively large muscle exists in the lower lid due to squinting, a portion of it can be safely excised in order to achieve a more flat appearance of the lower lid. By scarifying the muscle and creating a firm adhesion of the muscle to the skin during the healing process following surgery, the space where water accumulates can, in most cases, be eliminated and in doing so, improve the baggy lower lid appearance which is the result of water retention.
Occasionally, widening of the eye is desired. This can be accomplished by opening the eye at the extreme right or left side in a horizontal fashion, simultaneously with elevation of the temple or of the brow.
Since the brow is in intimate association with the eye, its appearance may either detract from or add to the overall effect produced by the eye. By incising the brow just above the brow hairs (brow Lift), varying eyebrow contours can be achieved. A high, arched brow, a curved brow, or a straight brow can be achieved in this manner. Where depression of the brow is required, as when the brow is too high, an incision may be made just below the brow hairs to achieve the correct aesthetic effect.
When the skin of the lower lid and the temple area (crow’s feet) is finely wrinkled, a light acid (TCA) skin peel may be required. Surgery cannot eliminate this problem and, at best, it can be improved only slightly.
BOTOX injections into the Crow’s feet are very effective but are only temporary (4-6 months) and may need to be repeated to maintain the effect.
ABOUT YOUR SURGERY
Office stay is usually 3 to 4 hours.
Anesthesia usually consists of light sedation or a light general anesthetic. A Board Certified (MD) Anesthesiologist will be in constant attendance to administer the anesthesia to ensure safety and comfort. Additionally, local anesthesia (Xylocaine with Adrenalin) is used.
NOTHING TO EAT OR DRINK 8 HOURS PRIOR TO YOUR SURGERY
Medications: Review your medications with Dr. Griffiths, he may want you to take some of your daily medications with a sip of water on the morning of surgery.
Clothing: Wear light comfortable cothing that is easy to take off and put on ( sweat pants, sneakers, polo shirt, etc.).
Ride Home: You must arrange a ride home and someone to be with you at all times the first night of surgery. Arrange to be dropped off and give the contact number of this person to call approximately 30 min. prior to your discharge.
Contact Lenses: Please remove contact lenses and bring your glasses.
Jewlery/Watches/Valubles: Please leave at home, the office is not responsible for protecting them or in case of loss.
BEFORE YOUR SURGERY
The surgical procedure involves some preparation on your part.
DO NOT become sunburned or over-exposed to sun rays two weeks prior to surgery.
Review your daily medications with Dr. Griffiths including any naturalopathic or herbal medicines.
DO NOT take any medications/drugs for two weeks prior to surgery without authorization from Dr. Griffiths. Especially important to avoid are birth control pills, weight reduction pills, sedatives, tranquilizers and antidepresant medicines (may react with the anesthetic (tricyclic antidepresants). Most important to avoid are blood thinners (Coumadin, Persanthine, Trental) and aspirin products (i.e., Bayer, Motrin, Advil, Anacin, Excedrin, etc.).
ALERT Dr. Griffiths to any family history or personal history of problems with anesthetics.
Wash your face and hair thoroughly with Phisohex the day before surgery and morning of. After washing your face, DO NOT re-apply make-up prior to surgery; make sure all mascara is removed. Do not apply lacquer or hair spray.
No fluids or food after midnight on the day of your surgery.
Bring dark glasses to the office on the day of your surgery.
AFTER YOUR SURGERY
Surgical aftercare requires cooperation on your part.
Following surgery, cold compresses are applied to the eyes for a period of 24-48 hours. Occasionally, the upper and lower eyelids maybe sutured together laterally, tarsorraphy stitch (allowing vision) to prevent ectropion (drooping of the lower eyelid) for three to four days. These sutures are placed when the lower eyelid skin is lax, prior surgery or excessive swelling is anticipated.
Stitches/Sutures: Two types of sutures are used: Absorbable and Nylon. The nylon sutures will be removed in 5-10 days (depandant on the swelling). The Absorbable sutures will begin to unravel in 5 days. You may apply hydrogen peroxide to the absorbable sutures with a Q-Tip lightly twice a day to assist in the resorption process.
Swelling and occasional bruising persists for one to two weeks thereafter.
Follow the diet prescribed for you. It is necessary to limit swelling so the tightening achieved by the surgery will be minimally compromised. Ordinarily, some swelling is expected from the surgery itself.
Stay calm. Tranquilizers will be given to you to help you with this, and a relaxed environment following surgery is mandatory, in order to limit swelling. DO NOT schedule surgery if you foresee any emotional problems which would upset you during your convalescence; emotional upsets will result in excessive swelling and a less-than-hoped-for result.
Dressings: Paper tape is applied to the lower lids to give strength while the swelling is subsiding. This will remain for 4-5 days. Keep the tape dry.
Apply cold compresses to the eyes constantly on the day of surgery, until bedtime. Use a clean, lint-free face cloth or sterile, cotton-free gauze packs. To make a cold compress; place ice in a clean bowl of tap water or distilled water. Dip the cloth or sterile gauze in the ice-chilled water and place the cold cloth/gauze on the eyes. DO NOT apply ice directly to your eyes at any time.
On the second day following surgery, apply cold compresses to the eyes for ten minutes every two hours.
On the third day, continue the cold compresses.
Remember, always keep the eyes closed when applying compresses to protect the cornea.
COMPLICATIONS OF SURGERY
In accordance with the legal doctrine of informed consent promulgated by the California courts, it is necessary to advise you of the possibility of complications after surgery.These complications are rare, and can include any consequence of a major operation. Every safety precaution will be taken to ensure the successful outcome of your surgery and any complication which might occur will be managed as the need demands.
Possible complications include but are not limited to:
- Bleeding
- Infection
- Blindness (extremely rare),
- Eye Muscle Damage with double vision
- Drooping eyelid (Ectropion)
- Poor scar appearance
- Poor overall result.
These complications are rare.
Consent and Arbitration Agreements
Dr. Griffiths will review this information with you and be sure that you are as completely imformed as possible. Dr. Griffiths utilizes medical-legal arbitration in his practice. This does not prevent you from claiming negligence and filing a medical malpractice suit. It does streamline the proceedings and you give up your right to a Jury Trial. The proceedings will be heard in front of an agreed upon arbitrator.
Dr. Griffiths will request that you sign a consent form and an arbitration aggreement
In general, the following is to be expected after surgery, and should not be cause for alarm:
1. Swelling: The treated area will be slightly swollen for one to four weeks. Excess swelling is not the rule, and usually indicates one or more of the following: Failure to follow the diet and/or conscious or subconscious emotional tension.
If excessive swelling develops, notify Dr. Griffiths immediately. You should, however, expect more swelling on awakening in the morning than later in the day.
2. Bruising: Bruising may occur following the surgery, and will involve any area where surgery was performed. Bruising is especially likely in individuals who normally bruise easily and will be noted one to three days following surgery, although sometimes it will occur later. In general, the younger the patient, the less bruising will occur, while older patients may rarely experience bruising low on the face.
3. Scars: Scars from the incision will be pink or red for a period of three to six months, depending on the healing nature of the individual. Scars will lie in the fold of the eyelid and, if an excessive hood is present in the outer corner of the eye, the scar is extended to the a crease line in the upper brow area. In the lower eyelid, scars will be placed below the eyelid rim and will extend beyond the corner of the eye in one of the crow's feet creases.
4. Tightness: Tightness will subside gradually following surgery, and is considered desirable to achieve a satisfactory end result. As a result of this tightness, the eyelids may not close completely, especially during sleep.
5. Loosening of the Skin: Some loosening of the skin of the eyelids is expected after the swelling subsides. The greatest loosening occurs in patients who swell the most, and in those who have the heaviest eyelids and most expressive eyes.
6.Blood Collection: Rarely there is a collection of blood under the skin which can be removed by a needle and syringe.
7. Crusting: Crusting of the incisions may occur, which delays wound healing.
8. Infection: Infection is extremely rare, but may occur if you do not follow these instructions carefully.
9.Pain: Pain following surgery is mild, if present, and is easily controlled by Tylenol. If your pain is severe, call Dr. Griffiths for further evaluation/instruction.
GENERAL INSTRUCTIONS FOLLOWING SURGERY
1.Sleep: Sleep on your back with two pillows (Head elevated to 30’). Sleep alone. Wear white cotton gloves to prevent scratching or irritating the treated area while you sleep.
2. Hands: Keep your hands away from your face.
3. Sneezing: Sneeze with your mouth open; blow your nose gently when necessary.
4. Diet: Follow the diet prescribed by Dr. Griffiths religiously following your surgery in order to achieve minimal swelling.
5.Showers/Baths: Showers or tub baths may be taken for 3 days following surgery. Sponge bathing is permissible. If tape in applied, keep it dry.
6. Hair: Generally, you can wash your hair after the first three days following surgery.
7. Rest: Rest for the first day or two; no undue exertion. Take the tranquilizers given to you, if necessary. No excessive talking, smiling, laughing, or forced facial expressions.
8. Discussing the surgery: Do not discuss your surgery with anyone but your family, since old wives' tales do more harm than good.
9. Post-op office visits: Remember to eat before seeing Dr. Griffiths for post-op visits, to avoid lightheadedness.
10. Results: Do not attempt to evaluate your results for at least one month following surgery. Remember, the final result may not be evident for as long as six to eight weeks. Avoid looking in a mirror during the early phases of recovery.
Payment:
The fee has been agreed upon with Dr. Griffiths. Please bring Full Payment at the time of the pre-op appointment or on the day of surgery. Acceptable forms of payment: Cash, Cashier’s Check, Personal Check (requires 7 days advance payment to clear), or Credit Card (additional 2% fee is applied).
The Payment includes:
- Surgeon’s Fee
- Assistant’s Fee
- Anesthesiologist Fee
- Operating Room Fee
- Nursing/Supplies/Medication Fee
- Post-operative Visits
Note: The surgeon’s fee for any re-operation which may be necessary will be included in this price. Anesthesia and Supply fees are not which would be an extra charge.
Please Write Down Your Questions and Bring Them to Your Pre-Op Appointment to Review with Dr. Griffiths.
