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256-340-5188
1206 Somerville Rd
Decatur, AL 35603

Eyelid and Forehead Lift
All Of The "After" Pictures Are Taken At Approximately 12 Months

The General Purpose of This Operation

The basic goal of eyelid surgery is to improve the appearance of the lids to prevent people from having a "tired" look.  The upper lid operation improves the appearance by removing the lax, excess skin that hangs down toward the eye lashes and obscures the eyelid itself and the natural eyelid crease.  The upper lid operation also removes the fat pads that can create a bulge at the lid and nose junction.  A crisp upper lid makes you eyes appear wider and less tired and also allows eyelid make up to be visible and more attractive.   It must be remembered that the anatomy of the upper eyelids must be evaluated along with the position of the eyebrows and therefore sometimes a forehead lift will need to be discussed.  More information on forehead lifts is available by reading the Forehead Lift section below.

The lower lid operation improves the appearance by removing and/or re-positioning the bulging fat in the lower lids that makes the lids look puffy or swollen.  In most patients I do a specialized technique which does not remove all of the fat, but re-positions the fat in a special way to give a more youthful appearance to the anatomy of the lower lids.   A small amount of skin is also removed to tighten the lids. In some patients the outer edge of the lid will also be suspended to tighten the lid and improve the appearance.   Because of some of these specialized techniques I do not do the transconjunctival approach to lower lid blepharoplasty.

This patient had her upper lids done.

Before

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After

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Cosmetic Or Insurance Procedure

Lower lid surgery is never covered by insurance because it is strictly to improve the appearance of the lids.   Most often upper lid surgery is also considered cosmetic surgery and is not covered by insurance.
Upper eyelid surgery can be submitted for insurance coverage if the degree of the deformity meets certain criteria.  First, the patient must have legitimate claims of obstructed vision from the extra skin.  It usual has more credence if the patient is actively employed and the obstructed vision affects their work.   Second, close up photographs of the lids must show that the skin hangs over the front edges of the eyelashes.  Third, visual field examination by an ophthalmologist or optometrist must show significant obstruction of the visual field that then improves to a large degree when the excess skin is held out of the way.

The plan for the upper lid operation starts with marking the excess skin to be removed.  The upper lid operation is mostly a skin operation.  The two inner fat pads are removed.

The plan for the lower lid operation starts by marking the incision under the lash line.  The lower lid operation is mostly a fat removal operation.  Very little skin is removed. 

Upper Lid Marks

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Two Fat Pads

Lower Lid Marks

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Three Fat Pads

This patient had her upper lids and the lower lids done at the same time.

Before

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After

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Office Consultation And Preparation

During your initial consultation we will discuss all of the aspects of the operation and how it relates to you. We will have a second visit that is the pre-operative visit where I will answer all of your final questions, write the prescriptions for the medicines you will need after the surgery and you will do your pre-operative visit at the hospital.

This patient had her upper lids done.

Before

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After

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The Operation

The upper lid operation is done as an outpatient procedure or day-surgery at Decatur Morgan Hospital using IV sedation anesthesia and local anesthesia.  It is done in the main operating rooms at Decatur Morgan Hospital and takes just over 1 hour to perform.  We do the operation in the morning and you will get discharged to home late in the afternoon.  You will go home with supplies to do cool compresses to the eyes that evening.
When lower eyelids are done alone the operation is done as an outpatient procedure or day-surgery at Decatur General Hospital using general anesthesia.  It is done in the main operating rooms at Decatur General Hospital.   It takes just over 1 hour to perform a lower lid operation alone.
When the upper lids and the lower lids are done at the same time it takes just under 3 hours to do the operation.   We do the operation in the morning and you will get discharged to home late in the afternoon.  You will go home with supplies to do cool compresses to the eyes that evening.
It is crucial that for 10 days prior to your surgery you do not take any aspirin, arthritis or other muscle ache pain medicines.  These medicines will make you bruise more and can lead to other complications.  The ONLY pain or headache medicine that is safe to take is Tylenol (acetaminophen) because this does not affect blood clotting and bleeding.
Remember that eyelid surgery does not improve the fine wrinkles in the lids and the crow's feet area.  Fine wrinkles need to be addressed separately, usually with laser skin re-surfacing.  More information on laser surgery is available by going directly to the Laser Surgery page.

This patient had her upper lids and the lower lids done at the same time

Before

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After

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After

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The skin and fat pads removed from this patients lids.

Postoperative Discomfort

All patients are unique and the response to post-operative discomfort is variable.   Most patients state that eyelid surgery is not that uncomfortable.   Patients say that the eyes feel tight or heavy. Some patients take the narcotic medicine only for a day or two and then switch to Tylenol for pain.  As I said, patients are all unique and their pain tolerance is very different.  When the upper lids are done alone almost all patients feel normal by 2 weeks and when all four lids are operated on they feel normal by 3 to 4 weeks.  I will remove the skin sutures in the office 5 days after the surgery.  Removing the sutures pinches and sometimes can be uncomfortable.

This patient had her upper lids done.

Before

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After

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Time Off From Work

For a desk job that does not require any heavy lifting you should expect to be away from work for 1 to 2 weeks for either type of lid surgery.  For a job that requires physical exertion or heavy lifting you should expect to be away from work for 2 to 3 weeks depending on your exact job description.  For a short time the surgery may have an effect on your abililty to do fine reading, either in print or on a computer screen.
By one week from the surgery you will have some minor residual swelling but no bruising.  You will probably not feel comfortable in contact lenses for 2 to 3 weeks after the surgery.  You may have some light sensitivity and intolerance to windy conditions outdoors.  The recovery for doing surgery on all four lids at the same time is always a little longer then the recovery for just operating on two lids.

This patient had his upper lids done with insurance coverage because of obstruction of his visual fields.

Before

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After

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Postoperative Visits To The Office

You will need to come to the office the day after your surgery for a quick check.  Arrange for someone to drive you to this appointment because you will be on narcotic medications and your eyelids will be swollen and your vision maybe a little blurry.   At this first postoperative check I will just do a quick check of your lids.  You can take a full shower in the evening after this check.  Soapy water will not hurt your incisions, but soapy water may get in your eyes because they may not close fully.  It is a good idea to have a infant/baby soap or shampoo at home for your showers early in the postoperative period.
Your next appointment will be in 4 days so that I remove your sutures 5 days from your surgery.  The next appointment will be in another 5 to 7 days and at that time we may begin some lower lid massage exercises and we will begin discussing issues like returning to work.
Your next appointments will be weekly for a few weeks until I feel sure your lids are doing well.  Then I will see you monthly for a couple of months.  I will see you at approximately 6 months and 12 months after your surgery and do a final assessment of your result, assess the quality of your scars and get your final opinion on the surgery.

Resuming Normal Activities

As discussed in the above sections, you can shower daily beginning 24 hours after your surgery.  You cannot do any strenuous work or heavy lifting for at least 2 weeks after the surgery.

Forehead Lift

There are two places to plan for the incision, either at the hairline or in there hair on the scalp.  A segment of skin will be excised to tighten and lift the skin.
The muscle fibers that create the forehead wrinkles will be excised to weaken this effect.

Hairline Marks

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Scalp Marks

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Forehead lift using the coronal incision.

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After

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Forehead lift using the coronal incision.

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After

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Forehead lift using a direct central forehead excision.  This technique is usually limited to male patients.

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After

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Removed Tissue

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The General Purpose of This Operation

The basic goal of a forehead lift is to improve the appearance of the forehead by lifting and arching the eyebrows, decreasing the horizontal forehead wrinkles and decreasing or eliminating the frown lines in between the eyebrows at the root of the nose.  As discussed on the Eyelid Surgery page, the aesthetics of the eyelids depend in some part on the anatomy of the forehead which determines the eyebrow position.  So a forehead lift can do a great deal to improve the look of the eyes even without eyelid surgery.  However, often we will do upper eyelid surgery in conjunction with a forehead lift.
Since a standard forehead lift allows access to the muscles that cause eye brow frowning and horizontal forehead wrinkling, manipulating these muscles can cause almost permanent reduction in these active dynamic wrinkles.  However, BOTOX® is often still necessary to smooth wrinkles on the forehead.  Click here to go directly to the BOTOX® page.
I do not do the endoscopic approach to forehead lifts for a number of reasons.  First, it my opinion that the various fixation techniques that are described are still not as good in the long term as removing a segment of scalp to re-position the brow and fix it in position.   Second, direct exposure of the frowning muscles allows for more controlled removal of them and the standard open approach allows me to manipulate the muscle that causes horizontal forehead wrinkles and this is not possible in the endoscopic approach.  Third, although a long scalp incision sounds scary, it actually heals remarkably well with no complications. Scalp numbness does occur, but it resolves in approximately 6 months and in my experience has never caused any long term problems.

Cosmetic Or Insurance Procedure

This is almost never an insurance covered procedure, it is considered cosmetic surgery.  There is a very rare situation where this procedure may be combined with an insurance covered upper lid blepharoplasty to alleviate visual field obstruction.

Office Consultation And Preparation

During your initial consultation we will discuss all of the aspects of the operation and how it relates to you. We will have a second visit that is the pre-operative visit where I will answer all of your final questions, write the prescriptions for the medicines you will need after the surgery and you will do your pre-operative visit at the hospital.

The Operation

The forehead lift operation is done as an out patient or day surgery procedure at Decatur Morgan Hospital using general anesthesia.   It is done in the main operating rooms at Decatur Morgan Hospital and takes about 2 hours to perform; longer if we are doing eyelid surgery also.  We do the operation in the morning and you will get discharged to home late in the afternoon.  You will have one drainage tube in place and the nurses will teach you how to care for this tube before you go home.
It is crucial that for 10 days prior to your surgery you do not take any aspirin, arthritis or other muscle ache pain medicines.  These medicines will make you bruise more and can lead to other complications.  The ONLY pain or headache medicine that is safe to take is Tylenol (acetaminophen) because this does not affect blood clotting and bleeding.

Postoperative Discomfort

All patients are unique and the response to post-operative discomfort is variable.  Most patients state that forehead lift surgery is not that uncomfortable.  Patients say that the incision on the top of the head has only mild soreness.  Most patients take the narcotic medicine only for a few days and then switch to Tylenol for pain.  As I said, patients are all unique and their pain tolerance is very different.
I will remove skin sutures and/or skin staples in the office 7 to 9 days after the surgery.  Removing the sutures and staples pinches but is not that uncomfortable.

Time Off From Work

A forehead lift causes minor swelling and bruising in the forehead and the upper eyelids.   I tell patients to plan for 1 to 2 weeks off from work, possibly a few days longer if the eyelids were done at the same time.   By the end of a week you will be acceptable to go in public with make up on although there still can be some residual effects of the operation visible.  For a job that requires physical exertion or heavy lifting you should expect to be away from work for 2 weeks.  Your appearance should be back to perfectly normal by 2 to 3 weeks.

Postoperative Visits To The Office

You will need to come to the office the day after your surgery so I can remove your drain tube.   Arrange for someone to drive you to this appointment because you will be on narcotic medications and your forehead and eyes will be swollen so you will be unable to drive safely.  You can shower and wash your hair 24 hours after your drain has been removed.
Your next appointment will be in 7 or 8 days so that I can remove your sutures and/or staples.   I will see you again in about 1 week and then again in about 1 month.  Then I will see you at approximately 6 months and 12 months after your surgery and do a final assessment of your result, assess the quality of your scars and get your final opinion on the surgery.

Resuming Normal Activities

As discussed in the above sections, you can shower daily beginning 24 hours after your drain is removed.  You cannot do any strenuous work or heavy lifting for at least 2 weeks after the surgery. By 2 to 3 weeks you should be back to normal.

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