Curious what awake eyelid surgery actually looks like? Dr. Jonathan Zelken walks through a real upper and lower pinch blepharoplasty, performed entirely under local anesthesia in the office. Whether you've been researching awake blepharoplasty broadly, or specifically awake droopy eyelid surgery, this video offers a real look at the technique from start to finish.
I'd like to start off by saying that this is a graphic video, and for those of you who are nervous about watching graphic videos, please stop watching.
Now, today I'm talking about awake upper and lower eyelid surgery. Eyelid surgery can be performed awake or asleep, but typically when we perform the operation awake, there is a limitation of what I'm able to achieve. Today's video shows an awake surgery of a patient undergoing upper and lower pinch blepharoplasty.
Why Perform Eyelid Surgery Awake?
When a patient is awake, I can numb them up, and it's usually a little bit like Botox needles going in. But once you're numb, I can actually cut through the skin without you feeling a thing. I use a very, very gentle dissection technique, and this allows me to do everything that I need to do for upper eyelid surgery in the comfort of the awake office setting.
Removing Upper Eyelid Skin
When I remove the upper eyelid skin, I am very, very delicate about making sure that there is no additional bleeding, because that not only causes bruising, but it can create visible scarring as well. Once the skin, and the skin only, is removed in most cases to avoid debulking the upper eyelid, then we can make sure that the field, the bed that is left behind, is completely dry and that there's no blood.
The Medial Fat Pad: The One That Grows With Time
Most patients also have fat excess on the inner aspect of their upper eyelid. With very meticulous dissection in this area, I can excise precisely the excessive amount of fat in this region without over-resecting this tissue. The medial fat pad in the upper eyelid, in fact, is the only fat pad that grows with time. Every other fat pad seems to go away.
Pinch Blepharoplasty for the Lower Eyelid
For patients with mild crepiness of the lower eyelids, a pinch blepharoplasty is a very subtle but attractive way of achieving some improved appearance of the lower eyelid without significant visible scarring or risk of lower eyelid malposition. Using specialized instruments and under local anesthesia alone, I can excise up to 2 to 3 millimeters of skin safely in this area to improve the crepey texture of the lower eyelids. Although this is not as exhaustive of a procedure as traditional fat transposition and removal in the lower eyelid, for patients with mild excess skin in the lower eyelid, it is a great awake alternative.
Closure and Scarring
I am particularly meticulous with my suture closure, and the technique that I use has been refined over years to make sure that key areas of tension are reinforced, and that for the rest of the closure, sutures are removed in about one week. I take special care to make sure that the patient looks like they don't have a scar as soon as they are off the table. However, with time, there is some redness and swelling that goes along with the healing process, and final results and scar maturation may take up to 3 to 4 months to complete.
Thank you so much for taking the time to watch this video. And if you're interested in learning more about blepharoplasty surgery, please don't hesitate to reach out to us.
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