• What if you've been diagnosed with high blood pressure (hypertension) and placed on medication by your general physician? Should you stop taking it before blepharoplasty surgery?
• What if you've been told you have "borderline" hypertension that simply needs to be watched?
• What if you have reason to suspect you indeed have high blood pressure but haven't been to your doctor in a while or are trying to control any elevation by natural means such as diet and exercise?
• What if you take blood pressure medications and your printed instructions say to be NPO (nothing by mouth) starting at midnight, which means you'll be skipping your usual morning dose?
If any of these questions pertain to you, be sure to run them by your surgeon well in advance of your operation.
Why? Elevated blood pressure and blepharoplasty are not a good mix.
The eyelids are highly vascular structures that can bleed freely during even the most "gentle" of operations. While bleeding on the surface is easily stopped, less commonly a sudden "pumper" can hide deep inside the orbital fat where it is difficult to locate.
Significant elevation of blood pressure during blepharoplasty is tightly associated with increased bleeding both during and after surgery, so much so that an experienced surgeon can usually suspect the elevation without needing to glance up at the blood pressure monitor.
Most patients undergoing blepharoplasty have a local anesthetic injected into their eyelids before any incisions are made. This is true in essentially every case performed under local anesthesia and true even for many cases employing "twilight sleep"or general anesthesia. Most such anesthetic solutions have epinephrine added to them help constrict tiny blood vessels in the surgical field. In patients with no history of hypertension, this tiny amount of epinephrine seldom elevates the pressure.
However, in patients with poorly controlled hypertension as well as those with unrecognized or "borderline" readings, blood pressure tends to be more labile and reactive to epinephrine. Readings can unexpectedly shoot high, causing bleeding that interferes with surgery and, less commonly, may turn dangerous.
Lowering such sudden elevations is not always easy, especially when an operation is underway in an office operating room without an intravenous line in place and an anesthesiologist in attendance. Once blood has flooded the surgical field or headed deeper into the orbit, the situation becomes an emergency.
How often does this happen? Fortunately, not very often but it's also not rare.
And what if a patient is already back at home only to have brisk bleeding appear later that afternoon or evening?
Most commonly, such bleeding is superficial (exiting from the incision and onto the skin). While alarming, it typically subsides quickly with rest and gently applied pressure.
If bleeding occurs into the eyelids but in front of the orbital septum, there is plenty of nearby soft tissue into which it can expand without harming the eye. What results is a "black eye" that may take a very long time to look normal again.
Of more concern is hemorrhage that either forces blood through the recently-operated orbital septum and into the orbit (orbital) or bleeding that starts within the orbital fat in back of the septum and surrounding the eye. If pressure within the inflexible bony orbit rises quickly to critical levels, the micro-circulation of the optic nerve can be compromised, resulting in vision loss. While rare, significant orbital hemorrhage is an emergency that requires immediate medical attention. d
How long after blepharoplasty is a patient at risk? Usually a few days at most, although a few spontaneous deep hemorrhages have occurred up to ten days after uncomplicated eyelid surgery ( there is one poorly documented case at 30 days). The only identifiable common feature in these rare instances of late severe bleeding is uncontrolled hypertension.