|Pain Level After Surgery||Mild|
|Anesthesia||General or local anesthetic with oral sedation|
|Duration of Surgery||1 hour (upper eyelids) 1 hour (lower eyelids)|
2 hours (Upper and lower eyelids)
|Scars||Minimal scar (upper eyelid crease) Minimal scar (under lower eyelashes)|
|Final Results||6 months|
|Return to regular activity||1 week (upper eyelids or lower eyelids) 2 weeks (upper and lower eyelids)|
|Resume Exercise||4 weeks|
The eyes are the windows to the soul. They are our most cherished feature of individualism, beauty, and self expression. They are also the first target in the face that is affected by the aging process. Eyelid lifts can offer a huge improvement in the general facial appearance when the eyes start showing their age. Moreover, removal of the excess skin of the upper eyelid improves the visual fields tremendously as well as “adds light” to the room.
Women apply eye shadow and mascara, so they may notice laxity of skin and excess fat around their eyes sooner than men. Women tend to have eyelid lifts as early as their twenties. In men, it is usually an operation that is sought as early as in their forties. By having upper and/or lower eyelid lifts, the look of “being tired” or having not had “enough sleep” is replaced with a refreshed look and that “just came back from vacation” appearance.
This technique is simple, safe, effective and yields excellent results consistently with a very low complication rate. When people have eyelid lifts, they want their character to be preserved. They want to look natural, and not like somebody else. This technique achieves that goal.
An initial consultation is set-up where we discuss the eyelid lift procedure and whether you are a good candidate for the surgery. Your medical history is reviewed, and you will be asked to see your medical doctor for a physical check-up and a few labs to make sure you can undergo the surgery safely. If you have any existing eye condition, such as dry eyes, lasik surgery, glaucoma, or cataracts, you will be asked to see your ophthalmologist as well for surgical clearance. You are asked to stop medications that cause bleeding, such as aspirin, or aspirin-like products (Motrin or Ibuprofen), a week before this procedure. You are asked to stop smoking two weeks before and two weeks after surgery, for the surgery to be performed safely, and for you to have optimal results. You are given the opportunity to talk to patients who have had the same surgery you are considering. We will see you shortly after the surgery (in a day or two usually). You are always welcome to come back for follow-up, even years after your surgery, free of charge.
THE UPPER EYELID LIFT PROCEDURE
People fall into three categories: Excess skin of the upper eyelid, excess fat of the upper eyelid, or both. The procedure is relatively simple and straightforward. A patient, who is deemed a good candidate for this procedure, is given antibiotics, and anesthetized in the operating room. Local Anesthesia is used to anesthetize the eyelids and give post-operative relief. Next, the excess skin is removed, and the excess fat is removed from the upper eyelid, as needed. The incision is closed, leaving a fine scar in the upper eyelid crease that is usually imperceptible with time. Care is taken not to remove too much fat and give a “hollow” look.
“Dr. Bitar performed upper and lower eyelid lifts on me and I’m seeing amazing results. I don’t look tired anymore. My eyes look longer and brighter. I think because I look better, I feel better.”
THE LOWER EYELID LIFT PROCEDURE
People usually seek lower eyelid lifts to improve the look of “bags” under the eyes. These “bags” are usually pockets of fat. Lower eyelid lifts can be performed in one of two ways: Either fat removal alone, or fat and skin removal.
If fat alone needs to be removed, then the procedure is fairly straightforward. The patient is anesthetized and an incision is made on the inside of the lower eyelid. The fat is removed without leaving any scars on the eyelid skin.
The second procedure is performed on people who need both skin and fat removed. An incision is made under the eyelashes along the length of the eye. Excess skin is removed, and fat is excised from the lower lid. The scar usually heals very well, and is difficult to find. If the lower eyelid has laxity, then the outer corner of the eye is tightened in a canthopexy procedure.
This eyelid lift technique is performed under anesthesia and requires about a week off of work for the upper eyelids or the lower eyelids only. Two weeks may be required if both upper and lower eyelids are done simultaneously. The swelling and bruising usually decreases significantly after a week and the patient becomes socially presentable.
At the Bitar Cosmetic Surgery Institute, we take pride in making sure we provide for our patients the best surgical experience possible, anticipating problems or set-backs, and addressing them before they happen. This is a process that includes the pre-operative preparation, the actual surgery, and the after care.
General complications can occur with any surgery. Cosmetic surgery is usually a safe surgery performed on healthy patients and, as all surgeries go, is with low risk. What we do to even lower the risk of complications is to operate at a first class surgery center with board certified anesthesiologists and nurses. To avoid post-operative complications, we advocate early mobilization –patients seen in our office one or two days after surgery- and active participation in their own post-operative care. When we create a partnership, the results invariably improve.
Bleeding with eyelids is a serious matter. There have been few reports in the plastic surgery literature of cases of bleeding leading to blindness in an eye. Fortunately, it is extremely rare. Before surgery, our patients are tested to make sure they do not have any common bleeding disorders by their own physicians, and by lab tests. Furthermore, at the outset of the procedure, we inject the eyelids with a solution that will constrict the blood vessels and minimize the bleeding. The bleeding from this operation with this technique has been minimal and has never gotten remotely close to blindness among our patients.
The most important step in avoiding infections, in our opinion, is to perform the surgery at a first-rate surgical facility with board certified anesthesiologists and nurses. Patients are given the appropriate intravenous antibiotics coverage throughout the surgery. During the surgery, the skin surface of the patient is cleaned properly. After the procedure, our patients are prescribed antibiotics to minimize infection. As a result of these extra precautions, our rate of infection after an eyelid lift is negligible.
Pulling Down of Lower Eyelid (Ectropion)
A risk of this procedure is for the swelling, scarring, and perhaps aggressive skin removal to make the lower eyelids pull down giving a “sad puppy” look. In order to avoid this complication, we resect a conservative amount of skin from the lower eyelid and tighten the outer corner of the eye (a canthopexy) to counter the pull on the lower eyelid, thus having excellent results with lower eyelid lifts.
Inability to Close Eyes Completely
Due to swelling, scarring, and possible aggressive skin resection, especially when upper and lower eyelid lifts are performed simultaneously, the patient may be unable to close their eyes completely. To avoid this complication, we perform a very judicious resection of upper and lower eyelid skin. The inability to close the eyes is usually temporary and resolves when the swelling goes away. Occasionally, we end up resecting more skin a year later to make a patient happy, but that is better than over-resecting skin during the initial operation.
Smoking is an absolute contraindication for eyelid lifts. The carbon monoxide and nicotine in cigarette smoke causes severe reduction in blood supply to the skin during healing. This results in delayed wound healing, wound separation, death of the skin, and a higher risk of infection. Cotinine testing is performed in patients with a smoking history to ensure that they are safe when having this procedure.
Our office will provide a comprehensive post-operative plan to ensure the best possible outcome. The plan will include what to expect postoperatively, such as estimated recovery time, pain management, garments or dressings, and anticipated activity level. For your safety, we require that an adult stay with you at least the first 24 hours after surgery and drives you to your next day follow-up visit. With most facial procedures, you will be instructed to limit activity for the first week or two, which could include restrictions on driving, prolonged travel and flying. In addition, we ask you refrain from exercise until cleared by the physician, usually around four weeks post-op. You are asked to refrain from smoking for a minimum of two weeks. To optimize healing, we recommend that you eat a high protein diet. You should anticipate a variable degree of bruising and swelling, as with any surgical procedure; light make-up may be used to cover bruises starting a week after surgery. We also offer scar creams at an additional cost to optimize results.
To promote healing and minimize complications, you will be seen in a series of post-op appointments, including the day after surgery. These appointments will continue throughout the first year after the procedure to make sure you are healing as planned. For your added convenience, you also have direct access to Dr. Bitar’s cell phone number if you need to reach your physician after hours. The final post-op visit, one year after surgery, is one of our favorites since the results are fully apparent and we love seeing our patients happy. You are always welcome to come back and see us, even years after your surgery.
At the Bitar Cosmetic Surgery Institute, we take pride in providing our patients with the best surgical experience possible, emphasizing patient safety while trying to optimize surgical results. This is a process that includes comprehensive pre-operative preparation and patient education, the development of a personalized operative plan, and a thoughtful post operative care regimen emphasizing patient comfort and promoting recovery.
There are a number of strategies which the Institute has adapted to further ensure patient safety. We are selective and only offer surgery to patients whose general health and lifestyle choices permit healing and facilitate recovery. To minimize risk, we require a preoperative assessment that includes a thoughtful history and physical exam, as well as targeted laboratory tests.
We operate at accredited hospitals and surgicenters that have demonstrated a commitment to the highest standards of care, employing board certified anesthesiologists and nurses. We adhere to well established surgical principles designed to ensure patient safety and have developed policies and protocols to minimize the risk of infection. Dr.Bitar is committed to continuing education, honing his skills and introducing new techniques always with the aim of improving safety and surgical results.
We emphasize patient safety in our peri-operative care plan, advocating early mobilization, optimizing nutrition, and providing detailed care instructions. After surgery, patients are seen in our office frequently and early, starting the day after their procedure, and a staff member is available around the clock for any questions or concerns. Our entire team is committed to our patients’ well being and every measure is designed to minimize potential complications, promote comfortable and rapid recovery, and optimize surgical results.
Our commitment to excellence and exceptional patient care is in every step of your doctor-patient experience. Dr. George Bitar is a distinguished board certified plastic surgeon who exclusively performs cosmetic surgery. The doctor stays on the cutting edge of advancements in cosmetic surgery and technology to offer the best possible results. With a blend of artistry and meticulous surgical technique, he is able to achieve beautiful and natural results for his patients. We provide a high level of patient safety and our experienced and caring staff will be with you every step of the way. Our institute offers a wide variety of surgical and non-surgical options, from skin care, injectables and lasers to in-office or hospital options, to provide a versatile approach to fit individual patient needs. Your aesthetic goals are our priority and each procedure is customized to ensure you receive the best possible outcome.
For more information, call our office at 703-206-0506.
Content on this website is for information only and should not be used to diagnose or treat your plastic surgery or cosmetic surgery problems. Please contact your plastic surgeon with all questions and concerns.