While rates of healing after blepharoplasty vary widely and can sometimes be a source of worry, the final result is what matters most. One of the biggest problems about recovery from cosmetic eyelid surgery is that your face and eyes are always on display and rather hard to hide.
Not only does this high visibility allow you, your friends, and your family to monitor (and worry about) every little change, but it also makes the process seem to take longer. (Note: One's appearance during the immediate postoperative period has been summarized in the preceding chapter.)
Expect to wake up on the morning after blepharoplasty, study yourself in the mirror, and then seriously question why you ever considered doing such a thing to yourself.
Swelling can be extreme, and sometimes it may feel as if your eyes will barely open. Fortunately, improvement is usually rapid. Once you are upright, gravity will help drain some of the swelling down into your cheeks. Blinking helps to "pump" away some of this initial inflammatory swelling that builds up while you are lying flat.
Over the first few days, you may feel that your cheeks resemble those of a chipmunk storing acorns, and the bruising may discolor your swollen cheeks all the way down to your chin (although, both of these extremes are uncommon). The difference between eyelid surgery bruising and most other bruises you have ever experienced is that the eyelids don't require much blood to grow intensely colored. Even a few drops of blood mixed in with tissue fluid can tint the thin skin of the eyelid region (much like food coloring, where one or two drops turn the whole bowl of white frosting pink).
The intense red color of the first few days will give way to a muddy purple and finally a yellow hue that appears just prior to full disappearance. Often, the last area to clear is at the top of the cheek (where a creme concealer makeup can be quite effective).
The clear conjunctiva lining the sclera (white) of the eye may become lifted up like a blister, a not uncommon development known as chemosis. If a drop of blood happens to color that fluid, the white of the eye may even appear red. Think of this as another superficial "bruise" that will resolve like your skin bruising. Since chemosis can push the lower eyelid slightly away from the eyeball, use of an over-the-counter moisturizing eyedrop and avoidance of dust and wind may help the eye to feel more comfortable.
The routine use of oral corticosteroids (for example, prednisone) after uncomplicated blepharoplasty is of little proven value, while the risks of taking such medications are very well documented.
If you become discouraged by your early appearance, just remember that swelling and bruising always disappear.
As you finally start to notice some signs of improvement, don't be disappointed if the next morning you look a little worse. This pattern of "better in the evening-worse in the morning" may persist for several weeks and is related to lying flat while sleeping. Don't worry about it, and don't make yourself miserable trying to sleep upright in a chair.
If itching becomes too bothersome, switch back to the cold compresses (the way you did on the day of your surgery).
Numbness of the upper lashes is a sometimes alarming nuisance and is discussed on the next page.
All patients heal at different rates. While common sense may suggest otherwise, patients with sun-damaged skin generally heal faster and with less scarring than those with "pampered" skin. Older patients often heal less aggressively than younger patients. Asian patients tend to heal slightly slower than non-Asian patients. External factors (smoking, premature or excessive physical activity, too much salt, etc) can all delay healing.
It is not that unusual to experience a case of "the blues" following blepharoplasty surgery. It often hits during the first month when the excitement surrounding the operation has waned and you finally face the fact that full healing is going to take more than a few weeks. Try to focus on something other than your eyelids. Why? Because the more you think about them, the slower they will heal (or so it seems).
Remember, too -- if your expectations with respect to the process and timetable of healing are unrealistic, you are only going to make yourself miserable. Be sure that you understand the following:
While most bruising after blepharoplasty is gone in about two weeks, about 10-20% of the swelling will persist for a long time. Such swelling may generate small imperfections such as slight asymmetry, an undesirable crinkling of the skin, or a pouching of the lid away from the eye. Your eyelids will continue to "thin out" for at least four to six months after surgery, and there is no miracle potion or magic pill that will hasten the process.
Once the bruising and most of the initial swelling are gone, it is only natural to concentrate on the visible skin scars. All early scars pass through phases:
• At first, they will appear red (sometimes very red) and slightly thickened.
• In some patients, this thickening may increase at around four weeks after surgery and the scar may appear slightly shiny.
• Small cysts (milia, "whiteheads") may emerge from within the incision but almost always melt away without any special treatment.
• After upper eyelid blepharoplasty, it is not unusual to note some extra bumpiness at either end of the incision. This usually resolves over several months.
• While small lumps or bumps that do not disappear can be removed, it is preferable to give them a chance to go away on their own.
• As with any recovering wound, you will notice day-to-day improvement at first, then week-to-week improvement for a month, then month-to-month improvement for six to twelve months. In fact, the body continues to remodel and improve upon all scars forever.
• "Scars on top of scars" (such as with touch-ups or revisions) take longer to reach best appearance.
• Massaging a blepharoplasty scar to try to make it heal faster is, in our opinion, not always helpful. Furthermore, applying any pressure directly against the eyeball is not a good idea.
• If the lids feel dry, you may wish to use an over-the-counter eye cream or gel (any brand) after a few weeks. We do not recommend the use of pure Vitamin E oil.
Just as the visible skin scars take time to soften, so do the invisible internal scars hidden in deeper layers (muscle, septum, fat, tendons). A blepharoplasty wound is comprised of far more than skin; in most cases, three or four internal eyelid layers are also undergoing healing and scar maturation but at a much slower rate.
Until this internal healing is well underway, your eyelids will seem overly stiff, slightly "rubbery" to the touch, and possibly too tight or not fully opened. The faster-healing skin may drape unevenly over the crease and at the ends of the incision.
Attempting to evaluate the success of your blepharoplasty prior to more substantial healing is difficult even for the surgeon.
FACING THE PUBLIC
As a rule of thumb, most patients feel comfortable about facing the public in about two weeks, although this period may be longer with more involved procedures, in those prone to slower healing, or in patients who are more sensitive about appearance.
How long will you look "hideous"? It depends what you mean by that, but probably about three or four days. How long before you look your absolute best? Four to six months (but sometimes up to a year). In between should be viewed as an "interesting experience" over which you should try hard not to stress.