From reimbursement criteria to tips for a quick recovery: Here you can find out what an ophthalmologist says you need to know about eyelid surgery.
Are you having doubts about eyelid correction and have already tried to read up on the procedure? Then you’ve probably noticed that even a brief internet search can get you caught up in the online sales pitches of thousands of providers. Worry not, as ophthalmologist and eye surgeon Dion Paridaens Phd MD lists the most important facts about corrective eye surgery. From costs and reimbursement to alternatives and recovery tips, here’s what you need to know to find out whether eyelid surgery is for you or maybe not.
Reasons for eyelid correction
“The most commonly performed cosmetic eyelid surgery is upper eyelid blepharoplasty,” says Dr Dion Paridaens, ophthalmologist and eye surgeon at ELZA Clinic in Zurich and Het Oogziekenhuis Rotterdam. With age, the skin slackens. In some people, this causes the eyelids to stretch and hang over the eyes. This is called dermatochalacia. “Most people complain of looking tired,” explains Paridaens. “Sometimes they also complain of headaches because they automatically frown more to raise their eyelids. This creates a kind of six-pack in the forehead, which also leads to wrinkles forming more quickly.”
Upper eyelid correction
In an upper eyelid correction, a specialised ophthalmologist or plastic surgeon cuts into the crease of the eye. The excess skin, including the underlying muscle and fat tissue, is then removed and the wound is sutured. The scar runs in the natural eye socket, concealing the wound in a natural way.
Before and after eyelid correction
Still not sure what to expect from the final result? Then ask your doctor to show you some before and after pictures. A golden tip: also check your potential provider’s social media to get a better impression of the procedure.
Lower eyelid correction
But it’s not just the upper eyelids that can be worked on. “Some people have these bags of water in their eyes,” Paridaens explains. “You often see ‘garlands’ like this in smokers because their skin is in worse condition.” Smokers are not the only ones who suffer from droopy lower eyelids.
For some, the fat in the eye socket can also extend to the lower eyelid. If this affects you, we’re afraid we have some bad news for you. Correcting a lower eyelid is a lot more difficult than correcting an upper eyelid. “You actually have to do three operations in one to get a good effect,” says Paridaens. “It’s much more precise and the bad surgeon is more noticeable.”
Surgical procedures on the upper and lower eyelid in one session
Many people with excess skin on the upper and lower eyelids want surgery on all 4 eyelids in one session. This is efficient as you do not have to undergo two procedures with a post-operative recovery period. This is often done under anaesthesia as it is a slightly longer procedure. The good thing is that you don’t notice it. Post-operatively, there may be a little more swelling than if the upper and lower eyelids were operated on separately.
Costs for eyelid correction
The difference between lower and upper eyelid correction is also reflected in the costs. For an operation on both lower eyelids, you will pay almost twice as much in a good clinic.
Inexpensive eyelid correction
Now it may seem tempting to take a closer look at a budget provider, but be aware that you are compromising on quality. “One doctor treats you in his back room with unsterile gloves and rolled-up sleeves,” says Paridaens. “The other doctor treats you in the operating theatre under hygienic conditions to reduce the risk of infection to almost zero.” In the latter case, you do pay the rent for the operating theatre, the cost of extra care and good aftercare.
The main difference is the specific experience (and talent) of the surgeon performing the procedure. “An experienced surgeon with more than 35,000 procedures usually has a greater chance of success than someone who has little experience or is not optimally trained.”
Is eyelid correction reimbursed?
“There is only one criterion for reimbursement, and that is a visual impairment,” explains Paridaens. This only happens when the eyelid has protruded far enough to cover part of the pupil. If you want to check for yourself whether this is the case, make sure your eyebrow does not move with it. If your eye is covered, you will almost automatically pull it up, so you may miss the reimbursement. Do you think there may be a visual impairment? Your ophthalmologist/eye surgeon can perform a visual field exam and contact your health insurance provider.
Recovery after eyelid surgery
What can you expect from recovery after eyelid surgery? After one week the stitches go away, after two weeks you can do sports again and after six weeks your scars are taut to the maximum.” After three months, most people’s eyelids look very neat. If there are still small bumps or irregularities, they will disappear within a year.
If you don’t bend over too often or exert yourself too much in the weeks after the operation, the likelihood of blue eyelids is very small. What you can count on anyway: puffy eyes. Everyone who has eyelid surgery will have fluid left behind after the operation. Fortunately, this disappears on its own within about a fortnight.
Tips after eyelid correction
In addition to the standard rules of life, Dr Paridaens has three additional tips to speed up recovery after eyelid surgery.
1. “For the first two days, place a bag of frozen peas on your closed eyelids with a folded tissue in between,” says Paridaens. “Do this every hour for at least fifteen minutes. The frozen peas penetrate the deep groove of the eyelid very well and cool the eyelids better than standard ice goggles.
2. To prevent complications such as infections, Paridaens advises not to rub your eyes for a fortnight. This applies not only during the day but also at night. “To prevent reflexively scratching your eyes while you sleep, you can put transparent caps over your eyes at night for the first week.”
3. “To further reduce itching, I also recommend applying a thin layer of Vaseline (or antibiotic ointment) to the wound twice a day from the second day after surgery,” says Paridaens. After the stitches are removed, you can apply scar gel for six to eight weeks to reduce scarring.
Eyelid correction complications
Eyelid corrections are still surgical procedures, so there is always a risk of complications. Therefore, always look for signs of infection, such as increasing redness, swelling or pain at the wound site. Fever can also be a sign of infection. In such cases, it is advisable to consult a doctor. There is also a very small risk of bleeding in the eye socket. Alarming symptoms are sudden protrusion of the eye, pressure pain behind the eye and tight eyelids.
Eyelid surgery reduces forehead wrinkles
If too much skin is removed during an upper eyelid correction, the incentive to chronically raise the eyebrows is removed and thus the strong wrinkling that we see with excess upper eyelid skin is also counteracted. One consequence of an upper eyelid correction can be that the initially strongly raised eyebrows (questioning look) drop somewhat to a normal level.
Unfortunately, even moderately experienced surgeons experience unnecessary complications, such as a considerable asymmetry in the position of the scar. This can be avoided if the surgeon places the incision marks exactly symmetrically. It can also happen that doctors place their marks too high or too low. This can lead to a visible scar or – in the worst case – incomplete eye closure.
In addition, there are doctors who cause irregular scars due to their surgical technique. Cutting too deeply can also lead to adhesions.
Fortunately, the likelihood of such undesirable results is minimal in the hands of experienced surgeons with an understanding of eyelid surgery, knowledge of the eye (!) and sound training, for example through a fellowship at a renowned institution.
Experience shows that patient satisfaction is high when the procedure is performed properly and the surgeon is able to translate the patient’s wishes into the result.
Dr Dion Paridaens works as an ophthalmologist and oculoplastic surgeon at the ELZA Clinic in Zurich and at the Rotterdam Eye Clinic. He is a trainer for 27 ophthalmology residents, International Fellowship Director and Chairman of the Medical Staff of the Rotterdam Eye Clinic. He is also the new President of the European Society of Ophthalmic Plastic & Reconstructive Surgery (ESOPRS).
