Eyelid Surgery: Cost, Photos, Rewiews, Q&A

It is quite common to have some dry eye symptoms after an eyelid lift (blepharoplasty). The inflammation after surgery can lead to reduced tear production and dry eyes. This is temporary in the vast majority of cases

While rarely possible, lasting dry eyes can occur. This may be due to inflammatory changes to the lacrimal gland. In nearly all cases dry eye is temporary and can be improved with lubrication like natural tears and/or eye ointment

By using lubrication in the healing phase you can avoid dry eye symptoms and allow your eyes to return to their normal state comfortably.

Dry eyes OKAY if transconjunctival lower blepharoplasty

Dryness is NOT a contraindication for lower blepharoplasty IF lower blepharoplasty is performed using transconjunctival approach. See an oculoplastic specialist. (Mehryar (Ray) Taban, MD, FACS, Beverly Hills Oculoplastic Surgeon)

Eyelid surgery in patients with dry eyes

Patient with dry eyes can have eyelid surgery but it has to be done conservatively and technique dependent. See an oculoplastic surgeon. (Mehryar (Ray) Taban, MD, FACS, Beverly Hills Oculoplastic Surgeon)

Dry eye with upper lid blepharoplasty

I would say that permanent dry eye syndrome after upper lid blepharoplasty is exceedingly rare to unheard of because there should be nothing done to the tear mechanism or lid closure or function with upper lid blepharoplasty

Temporary dryness or irritation after upper lid blepharoplasty alone is also unusual but could be caused by taking out too much skin or a temporary lack of closure ability of the eyelid. Usually artificial tears and taping the eyelid shut at night would treat this until it resolves

Raises an important point that everyone needs tear production assessed prior to eyelid surgery.

Your dry eye status can be assessed prior to surgery. However, even the driest eye person can have an eyelid surgery tailored to their particular situation

It is helpful to assess and be acutely aware of unusual dry eye situations. If you are relatively young, healthy, and don’t have a preexisting dry eye issue, you are likely to do fine with a properly done blepharoplasty

While there are surgeons who actually take out too much skin and this prevents normal eyelid closure, this type of extreme result is not the most common reason someone might experience long term dry eye after eyelid surgery

The most common reason in my experience is also not preexisting dry eye. The most common reason for persistent dry eye after blepharoplasty is damage to the motor nerve fibers that supply the orbicularis oclui muscle overlying the upper eyelid and lower eyelid tarsus

This is the nerve supply to the part of the eyelid muscles that are responsible for blinking the eyes. WIthout a brisk natural blink, tears are not properly spread over the surface of the eye leading to long term dry eye symptoms

These motor nerves never grow back. Most surgeon who cause this problem have absolutely no insight as to what is causing their patients symptoms. This is primarily because these surgeons are not ophthalmologists but ophthalmologists can also lack appropriate insight into this issue

The answer is to find a surgeon who very much understands these issues and addresses the problem with you at the time of your consult and designs surgery to reduce the risk of this complication

Normal to have dry eye after eyelid surgery?

It is actually very normal to experience dry eye in the early healing period after eyelid surgery. There are a number of reasons for this but the bottom line is that it is usually self-limited and improves over a short period of time

That being said, artificial tears can be quite helpful during this time to alleviate the dryness. Whatever you do, avoid Visine since it can tend to irritate your eyes with repeated use

Dry eye is important to understand for eyelid surgery…

It is completely normal for your eyes to feel dry after surgery because the tear film is thinner and blink reflex is decreased. It is important to use a lot of artificial tears during the post operative period for lubrication

After a couple weeks, the eyes should be feeling better. Pre-existing conditions such as decreased tear production can have an effect on the outcome so if you feel like your eyes are dry before eyelid surgery it is best to have an opthamologist evaluate you prior to surgery and discuss your history with the plastic surgeon

Long term dry eye is usually due to a condition not identified before surgery. Rarely it would be due to having too much skin excised, but the use of a qualified plastic surgeon should minimize that risk

Rare to have permanent dry eyes after blepharoplasty

While temporary drying of the eyes is common after upper (and lower) lid blepharoplasty, it is very rare to have permanent symptoms. Eye drops / lubricating drops are frequently advised for post-operative purposes. It is very important to discuss and undergo evaluation of any pre-existing dry-eye symptoms with your surgeon preoperatively — as many patients have ‘drier’ eyes inherently as it can be a normal process of aging

Despite having dry eyes, one can usually still undergo conservative blepharoplasty as your surgeon can tailor the surgery as appropriate.

How to Avoid Dry Eyes After Blepharoplasty

Permanent dry eyes after blepharoplasty should be very rare. Patients are evaluated before surgery to insure that pre-existing dry eye is not exacerbated. You have done your research very well, all of the reasons that you mention in your question can lead to dry eyes after bleph

Now continue your research and choose your blepharoplasty surgeon most carefully.

Dry eyes after eyelid surgery

The answer depends on how much eyelid lift you get. Usually there is a temporary dryness until the body adjust to increased air exposure from eyelid being more open. However, you should realize that everyone produces less tears as they age, so your eyes get more dry no matter what

Eyelid ptosis surgery and/or blepharoplasty can be done conservatively. There are also various treatments for dry eyes.

Sometimes after blepharoplasty surgery patients experience some dry eye which usually requires eye drops or creams. This usually is temporary.

Dry eyes and blepharoplasty

If this opinion was verified by more than one experienced oculoplastic surgeon, consider cosmetic solutioons such as the glue-on lid fold devices or some horn rimmed glasses. (Sheldon S. Kabaker, MD FACS, San Francisco Facial Plastic Surgeon)

Droopy upper eyelid treatments

I’m assuming that you have already seen an ophthalmologist, but if you haven’t that would be important. In my opinion, you could still potentially have conservative upper eyelid surgery even with dry eyes. In doing the surgery, the surgeon would have to be more careful in not removing too much skin, but if this is done it should not worsen your eye dryness.

It’s possible to have more dryness temporarily after the surgery, but once healed, it should return to your baseline if the surgery is done correctly. Another option would be laser resurfacing of your upper eyelid skin.

This would cause some tightening of the skin there without requiring incisional surgery. If you have some lowering of your eyebrows, another option would be brow lift surgery which will also improve the upper eyelid area. (Michael I. Echavez, MD, San Francisco Facial Plastic Surgeon)

Blepharoplasty effect on dry eyes depends on several factors

Usually a patient with dry eye syndrome needs to be approached cautiously when considering blepharoplasty, as the tearing mechanism can be affected. Patients with borderline dry eye problems can become worse, making them dependent on eye drops and ointment

However, it really depends on what is specifically done as your “quad bleph” procedure, and your surgeon should do a complete analysis of your tearing mechanism, production and drainage, as well as your specific anatomy perhaps with the assistance of an ophthalmologist or optometrist

In general, be more conservative, especially with upper lid skin excision, as you do not want to add lagophthalmos, or inability to fully close the eyelids, to your scenario.

It very well could make it worse! Caution advised.

Discuss this with your surgeon. I would also advise seeing an opthalomologist to get a diagnosis, a treatment if needed, and some advice regarding surgical technique modification. Generally speaking, the lower lid tends to be the most problematic, due it is pulled on by gravity, and swelling

The muscles don’t tend to work well for at least a few weeks. In many cases, eyelid suspension is used to prevent dry eye. You may need silicone plugs in the tear ducts to keep the eyes moist

In some cases, the upper lids may be done separately from the lower lids, depending on your tear production, and condition of the lids.

Need to be careful, but it might not be an absolute contra-indication

There is some data to show that blepharoplasty may not be as contraindicated for patients with subjective or proven dry eyes. Although I agree with previous commentators that caution is the watchword, there is data out (Archives of Facial Plastic Surgery Vol 6 march/april 2004 pg 101-4) that suggests it is not as dangerous or taboo as we have come to think as plastic surgeons. This particular article examined 67 patient who also had dry eyes and underwent blepharoplasty. 25 of these patients underwent both upper and lower blepharoplasty

Of the 67, 5 reported worsening dry eyes, 50 had no change, and 5 had improvement. (the rest were lost to followup). Although extreme caution must be exercised when only looking at one study, it is perhaps something worth further examining and maybe we as plastic surgeons should look at this problem closely

In short, I think the blepharoplasty might well make the dry eyes worse, but there is some data to suggest it might not.

Be careful with blepharoplasty and dry eyes

As mentioned in the previous answers it is difficult to tell whether you are to undergo a blepharoplasty or a ptosis repair. If your description of “droopy eyes” is that you have redundant skin then a blepharoplasty will help.

If you have low eyelid margins ie. the whole lid is droopy then you are likely to need a ptosis repair. Both can be done with dry eyes, but caution is the rule. Be evaluated by an ophthalmologist before surgery and make sure that your surgeon is aware of the condition and will be conservative.

Expect to need more lubricating drops in the initial post operative period. If done with care the procedure can be successful however. (Edward Buckingham, MD, Austin Facial Plastic Surgeon)

It can be safely done, however, no one can completely assure that your dry eyes won’t be exacerbated. You may want to go to an opthomologist and discuss putting in silicone plugs into the tear ducts to maximize your tears at the same time.

The dry eyes are more of a problem with the lower lids, and so do not get them both done at the same time.

(Scott E. Kasden, MD, FACS, Dallas Plastic Surgeon)

Does upper eyelid blepharoplasty cause dry eye?

Dry eye after upper blepharoplasty is rare, but I have heard of it. Blepharoplasty could potentially affect the strength of blinking depending on surgeon technique. It should not hurt the tear glands because that is far from the surgical area.

That would be exceedingly rare. Other major side effects could be excision of too much skin making it difficult to close the eyes, infection, bleeding behind the eye causing vision loss (very rare), eye injury during the surgery, etc.

Choose an experienced blepharoplasty surgeon to decrease these risks. This does not constitute official medical advice. Please consult a physician in person who can examine you and answer all of your questions. (Debra M. Kroll, MD, New York Oculoplastic Surgeon)

Does upper lid bleph cause dry eye?

Blepharoplasty can certainly cause dry eyes postoperatively as a complication. If you already have it, you might find it is a little worse or it could be the same after.

The simple answer to your question is no, it does not cause dry eyes. However, due to swelling and the possibility of the eyelids not properly closing correctly in the recovery period after surgery (2-6 weeks), it can temporarily make dry eye symptoms worse.

The tear glands should not be in any way harmed if you go to someone who has extensive experience in doing the surgery. (Jeffrey A. Sweat, MD, Sacramento Plastic Surgeon)

Dry eyes post bleph

This can occur post op but once the swelling goes down it fades away.soem patients may be borderline dry eye and asymptomatic,get a bleph and now become symptomatic. This has not been my experince. Before your bleph have it checked out.

(Robert Brueck, MD, Fort Myers Plastic Surgeon)

Dry Eyes with Blepharoplasty

It is rare to get dry eyes from upper eyelid blepharoplasty. It can happen in individuals with pre-existing dry eyes. If too much skin is removed and the patient cannot close the eyes completely then it can certainly happen.

The most important thing to do proactively is to get a Schirmer’s test done by an Optometrist or preferrably an Ophthalmologist. It measures your tear film (ability to produce tears). If it is normal then you are safe.

If it is poor then you need to be aware that even with a well done blepharoplasty you might need to use artificial tears or prescription drops daily after your surgery.

The information presented in this posting is for patients’ education only. As always, I encourage you to see your personal physician for further evaluation of your individual case. (Tanveer Janjua, MD, Bedminster Facial Plastic Surgeon)

Avoiding dry eye syndrome following blepharoplasty

If you do not currently have dry eyes and do not use eye drops on a daily basis then it is very unlikely that you would develop dry eyes following only an upper eyelid blepharoplasty especially if the skin resection is done in a conservative manner so as to avoid any exposure of the cornea. (Jeffrey Zwiren, MD, Atlanta Plastic Surgeon)

Dry Eyes and Upper Eyelid Blepharoplasty

Dry eye syndrome is very common after upper eyelid surgery, but tends to be self limiting over the course of days to weeks. Those patients who have the most difficulty are those with unrecognized dry eyes and those unfortunate patients who have excessive upper eyelid skin removed.

Generally speaking, dry eyes can be recognized through a patient’s history or physical examination. Paradoxically, one of the most frequent complaints patients with dry eyes report is excessive tearing. This is because the baseline level of tear production by the conjunctival glands is compensated for by reflexive lacrimal gland tear production.

The ability to wear contact lenses is suggestive that a patient has normal tear production. Patients with dry eyes may have a reddish, irritated appearance of the sclerae and will have diminished tear production on a Schirmer’s test.

Another important test to look at is what is known as Bell’s phenomenon. This represents a normal reflex in which the globes rotate upward when the eyelids are closed. Patients with an absence of Bell’s phenomenon may have more difficulty postoperatively, because this protective mechanism is missing.

The vast majority of patients, even with a temporary dry eye syndrome, do very well with artificial tears and ophthalmic lubricating ointment in the days after surgery. My personal preference is to be conservative in upper eyelid skin removal and to preserve orbicularis oculi muscle in the procedure to minimize the chances of extended dry eye syndrome. (Stephen Prendiville, MD, Fort Myers Facial Plastic Surgeon)

Upper eyelid surgery can increase dryness on a permanent basis, but most of the time it’s a temporary issue after surgery that you can treat with ocular lubricants. Some doctors believe that avoiding muscle excision decreases the risk of developing dry eyes, but this is not proven.

Best to discuss with your physician during a consultation. (Richard W. Westreich, MD, Manhattan Facial Plastic Surgeon)

You can have upper eyelid surgery if you have dry eyes. The symptoms will get worse soon after the surgery but will subsideRegular eye lubrication is necessary for the first 2 – 4 weeks after eyelid surgeryYou should discuss this with your Plastic Surgeon and your Eye Specialist. (Naveen Somia, MBBS, PhD, FRACS, Sydney Plastic Surgeon)

Dry eyes and blepharoplasty

While having dry eyes certainly won’t prevent you from having eyelid surgery, keep in mind that your condition may become worse after your blepharoplasty. Make sure to discuss all of the pros and cons with your surgeon so that you have realistic expectations. (Sheila S. Nazarian, MD, Beverly Hills Plastic Surgeon)

Dryness is not a contra-indication to surgery of the upper eyelids – HOWEVER- you may experience more dryness after surgery and have to use lubricating eye drops on a regular basis.

Though dry eye effects are more common with upper eyelid blepharoplasty, lower eyelid surgery can also cause this. It usually occurs with aggressive skin/muscle excision which leads to lower eyelid retraction. Dry eye symptoms after an internal transconjunctival incision is much less common, though that can still happen on occasion with poorly made incisions that may drag the eyelid down or rotate it inward. Make sure your surgeon is experienced in eyelid surgery. (A.J. Amadi, MD, Seattle Oculoplastic Surgeon)

I’m 60 and Want Upper and Lower Eyes Done, but Suffer from Severe Dry Eye. What Procedures Do You Recommend?

Should blepharoplasty be performed when someone has dry eyes. Oculoplastic surgeons deal with this all the time, both counseling patients before surgery as to whether they are appropriate candidates and dealing with the consequences once surgery has been performed in a previously undiagnosed dry eye.

You really should see an Oculoplastic surgeon to evaluate you and see whether you are a candidate for surgery, and if you are, to see if any prophylactic measures can be performed to avoid a problem. (Sam Goldberger, MD, Beverly Hills Oculoplastic Surgeon)

Dry eye problems with blepharoplasty surgery

You are correct that a dry eye condition can be made worse with a upper and lower eyelid blepharoplasty. It is important that you work with your ophthalmologist to determine the cause of your dry eye and improve it medically prior to considering blepharoplasty.

It may be suggested that you only do one set of lids at a time. Do the uppers first followed in 3 – 4 months by the lower eyelids. All efforts should be made to keep your condition under control and avoid corneal injury. (Jeffrey Zwiren, MD, Atlanta Plastic Surgeon)

Blepharoplasty in patient with dry eye condition

Blepharoplasty is usually possible in patients with dry eye condition. In fact, a cheek lift can often reduce a patient’s dry eye condition, particularly if the dry eye condition is associated with malposition of the lower eyelid, which is often corrected during a cheek lift. (Brent Moelleken, MD, Beverly Hills Plastic Surgeon)

Is blepharoplasty safe in someone with dry eyes?

Blepharoplasty can be safely performed in someone with dry eyes. However, the keys are to be evaluated by an ophthalmologist who can get to the bottom of your dry eyes issue before surgery and begin proper treatment of your condition if it is severe.

During the procedure, I tend to be more conservative in patients who have dry eyes in order to minimize the risk of worsening the underlying dry eye problems. The best place to start would be with a dry eye consultation which would likely take place with an ophthalmologist. (Stephen Weber, MD, FACS, Denver Facial Plastic Surgeon)

While dry eye is not uniformly a contraindication to eyelid surgery, certain eyelid surgeries are much more damaging to the function of the eyelids than others. Unfortunately, many of these procedures are routinely performed by eyelid surgeons.

It is best if you work with a surgeon who has the skills, training and equipment to assess and personally determine how your dry eye status might affect your tolerance to eyelid surgery. Unfortunately this means that general plastic surgeons and facial plastic surgeons will not be a good choice for you as an eyelid surgeon.

These types of specialists lack this training and at best rely on your general ophthalmologist to make this determination. Unforunately, the general ophthalmologist may not really understand the demands eyelid surgery places on an already dry eye.

The best option in this situation is to find an oculoplastic surgeon. This is a board certified ophthalmologist with fellowship training in oculofacial surgery. Please understand that there are times when a dry eye is an absolute contraindication to eyelid surgery because the inherent risk are just too great for a given individual.

You will know you have found the right surgeon when the surgeon examines your dry eye status as part of the initial eyelid consultation. (Kenneth D. Steinsapir, MD, Beverly Hills Oculoplastic Surgeon)

Upper and lower eyelid surgery with dry eyes.

I would not consider having dry eyes an absolute contraindication to having eyelid surgery. It sometimes is possible although the procedure may have to be altered a little. It would be important for you to first be evaluated by an ophthalmologist to determine the cause and extent of your dry eye condition.

Once this is done, it could be determined if you are a candidate for eyelid surgery or not. The dry eye condition is more of an issue with the upper eyelids than lowers..

(Michael I. Echavez, MD, San Francisco Facial Plastic Surgeon)