Taking care of your eyes after blepharoplasty is critical to proper healing. Dr. Maas discusses many of the post-surgical issues related to upper eyelid surgery.
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“Today we are having a special feature, a thing that’s very important to me and it is “Taking care of your eyes after Blepharoplasty or eyelid surgery especially upper eyelid Blepharoplasty”.
When we do lower eyelid Blepharoplasty, in most cases, I’m going behind the eye lid so I’ll fold it down with special instrument, makes the cut behind the eyelid and I’ll reduce the fat pads that make the bags under the eyes and if we need to treat the skin for fine wrinkles we’ll do some type of resurfacing with the laser, it can be fractional laser, active FF, DF FX or chemical peel.
Upper eyelids are little different so with the lower lids we’re taking skin with the upper eyelids there’s excess skin and I’ve got model Mona here who’s going to help me demonstrate today. She’s not having eyelid surgery because she doesn’t need it but she’s a good model.
When we go to the surgical patient we’re doing this in our pre-opt explanation, a lot of people forget it’s a lot of information so really the reason for doing this is to get the information out there. It’s good for anyone whether you’re having a surgery with Dr. Maas at the MaasClinic or whether you’re having surgery anywhere, it’s applicable to anyone having upper eyelid surgery in particular and the reason for this, when we do upper eyelid surgery there’s a small incision made in the natural crest which is a virtually invisible, virtually invisible as soon as surgery is over because when you open your eyes the incision is in the crest so we used this ovible stitches that come out after 3days and as long as you’re taking care of those we’ll take them out after 3 or 4 days after the procedure and that gives us really an opportunity to get very good results with dirty little down time.
One of the things that affect downtime however is swelling of the eyelid and swelling is mostly effect, there’s normal inflammation on swelling but it’s mostly affected if it extends long term by dryness to the eye and what we want to avoid in eyelid surgery patients is what I described as getting behind the dryness curve. When the eyelid is swollen, it normally comes down over the lid and moistens the cornea and leaves a nice and even layer of the tear film a lot like a windshield wiper would on a car and when you have a bad windshield wiper you [Inaudible [00:02:38.18] the water is not evenly distributed over the windshield, the same thing happens with the swollen eyelids it leaves the tear film unevenly distributed over the cornea which can make it dry out. In addition, when its swollen it’s harder for the eyelid to get all the way close, this is very common I would say 99% plus of patients after eyelid surgery have a little bit of incomplete closure, we call that leg up thalamus, this is not long term, it’s in fact, it’s a complication that have long-term eye closure problems and I’m very careful about that any eyelid surgeon should be, Blepharoplasty is the name of that but the temporary inefficiency in eyelid closure and blinking also is caused by swelling.
Now, the problem is people are bored after Blepharoplasty, you can’t, you know you don’t look right, you have a little bruising on the upper eye lids, you’re not going any social function you kind of hang in around the house, you can go out and do walking and things like that, I encourage our patients to do that but you’re not going to be going to the opening to the opera or in big social event in that first 4 or 5 days and so what do people do, they try to read, watch TV or work on the computer all three of those things screen time and reading causes to blink less and causes to dry out more. So amongst the rules, in general rules that we have are to try to avoid long term screen time and to use lots of methods to moisturize the eyes and if we do those two things keep the eyes rested, icing as much as we can the first 48 hours and then using good methods and moisturization we will not get behind the dryness curve and let me explain that just for a second. Eyelid swelling is caused by dryness and dryness causes more eyelid swelling, so when you had surgery you get a little swelling naturally from inflammation and if you get dry because you’re not taking care of that dryness and the inflammation it causes more swelling and if we gets more swollen then the eye gets dryer. So the key is interrupting that bad cycle of dryness-swelling, swelling-dryness it just keeps going, with good moisture and if you do that and you reduce screen time and you reduce long periods of reading it doesn’t mean you can’t do anything but 15 minute increments of screen time or book reading are really probably as much as anyone should be doing.
So otherwise, we give all of the patients an eye drop of some kind. Now, there’s two kinds of eye drops that you’ll find out, out in the world. One of them eye drops that come in bottles like this or even larger and the downside of bottles like this is that all of them by rule by FDA rule have to have preservatives in them. So if you have a 5 milliliter, 15 milliliter or even a bigger bottle like you’d have with contact lenses wears then there are preservatives and many people that preserves and usually its bends out code name chloride you have something that’s a potential irritant. So I just caution everybody about that and it’s the reason why we use these little individual packages of eye drops and these individual packages, (I’ll hold them here so you can see them) can be torn off and when the cap is open for these little ones you just pop this cap, there are drops that are ready, there’s different kinds of them, some are little thicker and some are little thinner but they’re basically salt water saline, normal saline water and some of them have a little bit of extra oil if you will in them to keep the eyes particularly moist and lubricated and there’s different brand, I’m not promoting any brand here I think they’re all good brands sustain tears is one of them, you see I have blink tears here, all of them are very good if they’re used properly but method of use of this is a one time is we can sometimes get two out of it but you can see there’s a very small amount of fluid in this and once I pop this cap off I’ll be able to treat Mona and I’m just going to demonstrate live how we treat it just to simply put eye drops in. Now, this can be done by yourself, you don’t need to have an assistant, I’m going to demonstrate it now but if you’re doing it at home by yourself then the way to do it is to get in the mirror and where you have good lighting and use one eyelid and pull the lid down and put the drop in. Now, eye drops are easy because you can name and drop them down. The ointment done is usually a little bit harder and we used these eye drops during the day and I tell people 4 or 5 times a day but you can never use too many, if you’re eyes feel tired it means they’re dry anytime you think about it they’re dry, if you’re spending time on the screen, computer screen or TV screen you’re probably out e using them every 15 minutes while you take a break.
So let’s get to the actual technique of using eye drops and using eye ointment and then we’ll conclude with a few comments about making sure you don’t get behind the dryness curve.
We’ve talked about the eye drops that are disposable single use eye drops. Again, these don’t have preservatives in them, if you’re getting a larger vial which is okay as long as you’re aware that there are some preservatives in them that in some people can cause pretty severe eye irritation. So this single use eye little dropper as they sound very simple we pop this little cap off, you can see this one’s already popped off and you want your hands to be clean obviously when you’re doing I’m wearing gloves but you just need to wash your hands and once the eye drops have been popped off they’re ready for use.
Now, anybody that used eye drops and most people have over their life know that you really just sort to lean this over, look up in the sky, look at the drop. Once you got the position well you can (I’m going to just have you lift your chin this a little bit Mona) and then a lot of people and I think this is a good idea just look up above your head and I’m going to try to get it my hand other way, the idea is (she’s just got really long lashes) is just to get one drop on the eye and sort of gives a little jilt, she’s got a little tissue in her hands so if a little runs out it’s fine and that’s really all and I can tell you that for most people we probably don’t use enough of these. This is a little bit like and I’m going to come from the side so you can see again I’m just going to put one drop in looking up above your head makes it a little more comfortable so it didn’t hit the cornea directly and then blinking a couple of times it was good. One drop of a good product like the ones that we give our patients where weeks’ worth to use is plenty and sometimes there’s enough to do a couple of applications with this you just want to be careful about keeping the product clean in the refrigerator if you will. So that’s really that, you can’t use too many eye drops, the eye drops throughout the day after Blepharoplasty are important the wound care and healing part of it is really just keeping the incision area moist with ointment. Now, we don’t use an antibiotic ointment because they have the tendency to melt and run into the eye unless they’re [Inaudible [00:09:30] appointment so I have my own formulation that I use which is like a little bit like an aqua fore type of product there’s got a couple of other healing growth factor types of things that help this accelerate the healing but that’s on the incision above the lid and then we’re doing the drop it’s really keeping the wound moist and clean, soap and water wash is for the face and then lots of eyes and drops during the day.
At night, when we’re talking about keeping the eye moist we’re going to talk about another product here and there’s many different brands on that promoting this particular brand it happens to be what we use but this is actually an ointment and if you can see the bottle it’s got a seal tube on it, they come in very small increments like this is a 3 1/2 gram tube and you don’t need very of this but at night specially after eyelid surgery we’ll have people apply this as I said before the eyelids don’t efficiently close right after eyelid surgery because of the swelling so what we want to do is put a little bit or layer right in the sulcus of the lower eyelid and the sulcus is the (I’ll show in a moment where it is, it’s very easy to apply) after you blink a couple of times it’s a little blurry but the ointment is distributed with the cornea. I encourage people to wait till right before they go to bed to apply the ointment you don’t want to apply it in the evening and watch TV for several hours or do other things that are drying, you want to apply this right before you go to bed brush your teeth to whatever just think about it doing a daily like that and we’ll put a little bit as I’ll show you here in a minute. So we pop a cap off of this thing and it’s obviously a set up to be [Inaudible [00:11:08], there’s a little point on there and for someone doing this at home you have to get in the mirror and do this because the little ointment you need to be able to see where you’re going with it but if you’re looking in the mirror you just simply pull the lower lid down a little bit like this and look up and then you’ll see a little bit of the ointment coming out and this lower part of the lid is not made all sensitive an then I’ll just have you blink so if I just have you blink and now you see model Mona here has gotten the ointment and it will feel a little blurry initially because it is an ointment but that will go away quickly and really if you’re doing it right before bed it doesn’t matter anyway.
Now if you’re using it during the day and in some cases we’ll have patients using the ointment during the day for the first 15-20 minutes it will be a little blurry when you blink but this is a really great moisturizer for the eye in general. For anybody that’s got dry eye I encourage using something like this, a natural tears ointment and in some cases people really very inflamed for whatever reasons that we might use an ointment that has a little bit of steroid or antibiotic in it and those patients as long as they don’t have glaucoma which they don’t use steroids that turns out to be a better source of the product, a better source of improvement is using an ointment that has a little bit of medicine. Typically the natural tears ointment though is just a moisturizer using drops ointment at night keeping the eyes iced minimizing screen time are the keys to success in first of Blepharoplasty care.
Dr. Maas: So Dr. Corey Maas on looking your best and I just in conclusion I just want to say thanks to Mona and then Mona when we did the drops I mean that how would you say that feels? Does that feel painful or uncomfortable?
Mona: It feels fine, just for 1 second it get blurry.
Dr. Maas: With the ointment.
Mona: With the ointment.
Dr. Maas: And the eye drops or some eye drops they can make people feel a little blurry for just one moment but really a couple blinks and its fine.
Dr. Maas: And then a lot of people feel like their eyes are really soothed by the ointment, I don’t know if you felt…
Mona: I feel refreshed.
Dr. Maas: Yeah. It feels nice because people usually don’t notice but just in general most people when you’re eyes are tired it’s because they’re dry, that’s not just true after blepharoplasty that’s true always so I have here some eye drops around is not a bad thing for your eyes in general and I think that’s great. So thanks Mona and really important for blepharoplasty eyelid surgery patients particularly blepharoplasty Upper Eyelid Surgery to use eye drops and ointment to keep the eyes moist and not get behind the dryness curve.
This is Dr. Corey Maas on looking your best.”