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The number of blepharoplasties performed annually in the United States has more than doubled in the past four years for many reasons:
Well-performed cosmetic eyelid surgery yields a natural-appearing enhancement of the most important feature of the face (your eyes!) without breaking the bank or putting you out-of-commission for many months at a time. In the hands of a skilled surgeon, the operation is quite safe relative to other plastic surgery procedures. Recovery is relatively painless, and the improvement is long-lasting.
Still, not every person will be delighted with the outcome. Some, of course, may experience true surgical complications, a subject discussed elsewhere. Those people aside, however, there are others who by all objective measures have undergone technically and aesthetically proficient surgery but remain unhappy. Such people tend to fall into several categories:
• patients who chose surgery to look naturually fresher but then could only visualize the expected result as "different"
• patients who really hoped to look different instead of fresher but did not attain that unattainable fantasy state
• patients who expected their eyelids to look like those of another person (especially when that other person is a model or a celebrity)
• patients who thought surgical precision was absolute
• patients who thought healing was a quick and effortless process
• patients who thought cosmetic surgeons were magicians rather than technicians
• people who confused cosmetic surgery "reality" television shows with reality
• patients who requested a conservative result but then were unhappy about their expected "undercorrection"
• older patients with more more advanced change or relatively unhealthy or damaged tissues
• patients with other noticeable nearby facial problems (such as a droopy face requiring face lift)
• patients with psychological disorders (see next chapter)
In some instances, revisional surgery after a reasonable amount of healing may be of limited benefit. Unfortunately, some patients will never be happy no matter how many operations or revisions they undergo or how objectively satisfactory are their outcomes. Put bluntly, there are some patients who can never be satisfied by cosmetic surgery.
Interestingly, there is another small group who can be too satisfied with cosmetic surgery. That is, there are some people who love each and every procedure and can't seem to get enough of them. While these patients may be easy to please and firmly convinced that they are helping themselves to look better, the net effect can be quite the opposite.
It is important to remember that a satisfactory result does not mean perfection or even near-perfection. No surgeon is perfect, no wound ever heals perfectly, every patient possesses some pre-existing anatomic features that impose limits, and all operations work better on one patient than the next. Unrealistic expectations are the most difficult of "complications" because there is no effective remedy. This doesn't mean that a postoperative shortcoming cannot be addressed. However, a real problem should exist, not merely the yearning to "improve" on an already satisfactory result.
With first time blepharoplasty, a realistic expectation is about a 75-90% improvement in the upper eyelids and a 60-80% improvement in the lowers. Some slight asymmetry should be expected. With Asian double eyelid surgery, requested crease heights and shapes can usually be approximated within certain ranges but not guaranteed.
No matter what you may believe after viewing "infomercials" on television or in print, only seldom is a patient fully happy with every aspect of the result because all operations possess inherent drawbacks and limitations. A satisfied patient is one who understands and accepts this reality, who sees the proverbial glass not as partially empty but rather nearly full.
With revisional blepharoplasty or advanced operations such as orbital fat grafting for eyelid hollowness undertaken to improve on an unsatisfactory result, expectations must be lowered. A realistic goal is a noticeable but partial improvement that looks more natural and not a normal eyelid.
Next:
Psychological Considerations
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