You will start off in a "holding area," a room where you will be prepared for surgery. You may be asked to change into a gown, put on a special bonnet to keep your hair off your face, and wear a pair of paper booties over your shoes.
While the staff should already have a copy of your medical history and physical examination from your surgeon, be sure to discuss any special or unusual medical requirements with the staff, including any allergies to medications, problems with abnormal bleeding, or serious cardiopulmonary limitations.
Once your blood pressure and pulse have been recorded, you will receive any oral sedation or, if intravenous sedation is to be used, an intravenous line will be inserted.
Once in the operating room, your surgeon will usually be accompanied by two staff members (a surgical assistant and a general medical assistant) and, if intravenous medications are to be used, an anesthesiologist or nurse anesthetist.
You will be positioned lying down on an operating table and cushioned to make you comfortable. Your face will be cleansed with a disinfectant, and sterile surgical drapes will cover all but your brows, eyes, and nose. The operating room lights will seem overly bright at first. Depending on your depth of sedation, you may hear your surgeon and staff talking to each other and to you. A blood pressure cuff wrapped around your arm will inflate periodically.
If you remain awake during your surgery, you will be instructed to keep your eyes closed except at certain times when your surgeon will want to inspect the effects of his or her work in progress. Do not worry about seeing much of what's going on; between your sedation and the bright lights, it's hard to make out any details.
If your surgery is performed under local anesthesia with sedation (the method used most commonly), you will feel some pressure throughout the operation but little or almost no pain. If you do feel noticeable discomfort, tell your surgeon, who will be able to inject additional local anesthetic.
Once surgery has finished, your surgeon will remove the drapes, clean off your face, and raise you up into a semi-reclining position. Your eyelids will be covered with moist, cool gauze pads, which feel very soothing.
Most patients stay this way for about 10-15 minutes. If there is no excessive bleeding, undue pain, and vital signs remain stable, you'll be moved back to a holding area for further observation over the next 30-60 minutes, after which you'll be transferred to a wheelchair and escorted with your driver to your car.
Bandages are not applied after blepharoplasty. Instead, a pair of dark wrap-around protective sunglasses serves as your "dressing". As you are escorted back to your car, a staff member will review all instructions with your driver. Because of your sedation, you will likely remember little of what happened or about what you are told, so all instructions are also given to you in writing.
Most surgeons will provide you with a courtesy "goody bag", containing such items as your sunglasses, an antibiotic ointment, a small supply of strong pain medication, a gel ice-pack, a bottle of artificial tears, an extra supply of sterile gauze, printed instructions, and your follow-up appointment card.
On the drive home, it is preferable to recline your seat back slightly and keep your eyes closed. If you were given an ice pack, you may apply it over a gauze pad over your eyelids (without the gauze, the ice pack may feel too cold). It is normal for the gauze to collect a small amount of blood mixed in with tears.
If you prefer to keep your eyes open, don't be surprised if your vision is blurry or even double (side effects of the sedation, local anesthetic, antibiotic ointment, and excessive tearing). Your eyelids will feel puffy and will not blink very well. Because the power of the orbicularis muscles may be weakened from the surgery, anesthesia, and developing swelling, your eyelids may appear to "hang", look "overdone", and not close fully.
Don't worry. Now is not the time to try to evaluate the success of your operation. Besides, if you think you look bad now, just wait until you see yourself tomorrow.