I was informed the night before surgery there should be no eating or drinking after midnight. What about taking  my medications the next day?

The morning of surgery it is necessary to take ones medications in the morning with a small sip of water.

Are there any medications that I should not take before surgery?

Any medications that are blood thinners specifically aspirin, coumadin, plavix, pradaxa, xarelto, elequis should be held before surgery. In order to weigh the risk of holding the blood thinner if someone has a medical condition necessitating it versus the benefit of hold it before surgery, this usually cleared by the patient's primary doctor or cardiologist. Below is a list of common length of times to hold these blood thinners. Blood thinners if not held can promote bleeding which can be catastrophic before surgery.

Aspirin         2 weeks but can be as short as 1 week depending on surgeon

Coumadin    5 days

Plavix          1 week

Xarelto        1  week

Pradaxa      1  week

Elequis        1  week

 

There are herbal medications that can also thin the blood. It is best to hold all herbal medications for two weeks before surgery to prevent their interaction with anesthetic medications and also with blood clotting.

 

Why do I have to come early for my surgery?

 

Before any surgery where anesthesia is going to be administered, there are certain things that done to check to make sure the patient is ok for the procedure. First, they will make sure the patient has had nothing to eat or drink  8 hours before the procedure. This is usually after midnight the night before for most patients. Secondly, the doctors and nurses will check the vital signs (blood pressure, heart rate, breathing) of the patient to make sure they are ok for the procedure. There are administrative things such as filling out the consent form and other paperwork that needs to be done. This takes time so the patient usually comes an hour or two hour before the procedure depending where the eyelid lifting surgery will be done.  

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Do I need someone to come with me on the day of surgery or a procedure?

 

The answer to this is yes.  There are several reasons for this. When one gets anesthesia (IV sedation or general), the medicine that is administered is analogous to giving someone a six pack of beer. Not only is it unsafe to drive but patients  may find it difficult to ambulate (walk) up their stairs, get into their house etc. They generally need someone to be with them to get them to and from their procedure. It is required if one has general anesthesia that someone stay with them overnight as per medical safety guidelines. 

 

Will my eye be patched after the procedure?

 

The answer to this is “usually not”. After blepharoplasty procedures, there is no eye patch that is placed  on our patients in Denver. All surgeons are different so some may have preferences to patch the eye. 

 

Can I “use” my eye after the surgery?

 

There is no harm in using the eye by reading or watching tv after the procedure. Commonly, patients may feel their vision is blurry for a couple days especially if antibiotic ointment is used and gets in the eye. They may feel their vision is not great to read or drive but there is no “restriction” against reading, watching tv or using the eye.

 

Will I have pain after the eyelid procedure?

 

It is possible for patients to have discomfort after the procedure. Often a narcotic pain prescription is given after the procedure for the patient to use at home. Often for oculoplastics procedures, patients feel that they did not need the narcotic pain prescription and that Tylenol alone will suffice. That is ok. The important thing is for the patient to NOT be in pain. Pain increases the blood pressure and increases the risk of bleeding which is bad after surgery. I let patients know that they should take the pain prescription if they are having discomfort but if they don’t have pain, they don’t need to take it. For minor touchup procedures in our Denver office, a pain prescription is usually not given unless  a patient requests it. 

 

Will my vision be blurry after my blepharoplasty surgery?

 

The answer to this is yes. Often after blepharoplasty the eye itself gets irritated. Blood and fluid can rest on the eye surface and distort the vision. Antibiotic ointment which is often prescribed can get into the eye and distort the vision as well. If a patient has a sudden decrease in vision after the procedure, it is important for the patient to come in and be seen in the office. This could mean that they are having a new onset sudden hemorrhage behind the eye.

 

Can I shower after blepharoplasty?

 

Patients can shower after a procedure. It is usually recommended that they do not let the direct spray of water get on their face.

 

How do I care for my wound or stitches after my blepharoplasty?

 

It is possible to gently clean the stitches with a q-tip with hydrogen peroxide to clean the blood off the wound or stitches. Often less is more, so the less manipulation of the stitches the better. If there is dried blood on the face away from the stitches it is possible to clean them. Antibiotic ointment is placed with a small qtip. A very small thin layer is all that is needed. Patients commonly feel the need to slather a large amount of antibiotic ointment on the wound which is wasteful and unnecessary. 

 

The antibiotic ointment got into my eye and my vision is blurry. What do I do?

 

When antibiotic ointment gets into the eye, it takes time for it to melt and dissolve. The vision will be blurry until that is done. It usually takes a hour for the ointment to wash out of the eye on its own. Often putting artificial tear drops in the eye will not be effective.

 

What is the normal bruising and swelling expected after eyelid lifting surgery? 

 

I inform patients that after surgery, it is expected for the eyelid, face to be swollen, red and bruised. Patients will often say, “I look like someone hit me in the face with a baseball bat”. That is totally normal. There are patients who will have less swelling and that is normal as well. Often swelling and bruising will be worse 24 to 48 hours after surgery. The swelling and bruising often go away within a week to 14 days but can continue. The good news is that is always goes away. It just needs a tincture of time. Sleeping with the head elevated on a couple pillows will decrease bruising and swelling.

 

Common bruising and swelling that patients do not expect are often on the surface of the eye. The clear “skin” of the eye surface which is called the conjunctiva can become swollen and even red. There can be blood that deposits underneath the conjunctiva and the white of the eyes can appear red.  This is called a subconjunctival hemorrhage. This is normal and will slowly go away with time. 

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It is also normal for patients to have trouble opening their eyes after blepharoplasty for a couple days after the surgery. With time this gets better. 

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How do I sleep after blepharoplasty?

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The first night after surgery can be difficult. If patient sleeps on a couple pillows or in a chair to keep their head at a 30 degree angle, it can reduce bruising and swelling for the first week. The key is to keep the head above the heart.

After some procedures done with blepharoplasty surgery, we will give a plastic shield for the patient to place on the eye. This is placed with a small strip of paper tape. The purpose of this shield is to reduce the risk of inadvertent  rubbing of the eye, eyelid or stitches.

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What are my activity restrictions after blepharoplasty?

 

After eyelid surgery, it is important to rest and take it easy. Walking to the bathroom, or moving about the house is ok but there should be no heavy lifting, bending over or straining. Those activities increase the risk of bleeding behind the eye or causing a hemorrhage. Heavy lifting is defined as greater than 10 pounds. Certain tasks such as bending  your head down over to wash ones hair or tying shoelaces are not recommended. This can raise pressure in the head and also cause bleeding behind the eye. 

 

Do I need to ice the area? How often and How long do I do that?

 

Icing the eye is recommended 20 minutes on and 20 minutes off the wound site for the first 72 hours. Many patients use two frozen bags of peas. One bag is used on the wound site while the other stays in the freezer. It is not necessary to ice while sleeping.  It is also important not to leave the ice on the wound for greater than 20 minutes. The reason is that the ice can freeze the skin which obviously can damage the tissue or eye.

What is something to look out for after blepharoplasty?

 

The biggest risk or catastrophic complication we worry about after any surgery near the eye or face is vision loss. This is usually via a hemorrhage behind the eye or retrobulbar hemorrhage. A retrobulbar hemorrhage is usually characterized by  sudden bleeding and/or bulging of the eye. There may or may not be vision loss at that time. Additionally, there is usually sudden strong pain that is different than the normal pain after eye surgery. This is an emergency and  the patient should be seen immediately in the office or after hours.

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