A lower eyelid surgery for puffy eyes is a highly individualized procedure, which entails meticulous physical examination to determine the factors causing the problem. Excess deeper fat, loose skin, abrupt transition between the lower lid and cheek, cheek descent, or a combination of these might be the culprit.
It is important to note that factors such as lack of sleep, allergies, and fluid retention and other causes of intermittent swelling must be ruled out prior to surgery.
Simply put, eyelid surgery for puffy eyes only applies when there is a true excess skin and/or fat around the lower eyelid.
California Surgical Institute medical director Dr. Tarick Smiley says that some patients have lower lid puffiness caused by deep fat, with no or very little loose skin. For these individuals, a transconjunctival approach in which a small incision is made inside the lower lid, thus the risk of visible scar is almost zero.
The incision allows the surgeon to remove the deeper fat, which becomes herniated due to aging (i.e., tissue laxity/weakness). But for a more rejuvenating and natural result, Dr. Smiley says he almost always complements it with fat injection to create a smooth transition between the lower lid and upper cheek.
Unlike the deeper fat along the lower lid that becomes more prominent with aging, the superficial fat “shrinks,” a condition referred to as soft tissue atrophy, thus resulting in an abrupt transition between the lid and cheek. Further contributing to the problem is the cheek fat pad descent.
Dr. Smiley says fat injection or transfer involves collecting just a few teaspoons of unwanted fats in the tummy area, which are then processed before injected around the lower lid.
Most patients will only need small amounts of purified fat (less than 1 ½ cc) to correct the abrupt lid-cheek transition and eliminate the appearance of deep tear trough.
Meanwhile, some patients have puffy eyes that are not just caused by excess fat, but also by loose skin. In this scenario, a small linear incision is made very close to the lower lash margin to remove some excess skin and thus achieve a tighter, more youthful appearance.
The resulting scar from the external incision technique is expected to fade into the background, particularly when it is hidden by the patient’s lower eyelashes.
Preventing or at least minimizing the risk of rhinoplasty infection should be one of the most important goals of any prudent surgeon performing nose-reshaping surgery, according to California Surgical Institute website.
The list below shows the basic guidelines on how to minimize risk of rhinoplasty infection.
Anyone with uncontrolled medical condition linked to higher risk of infection and poor healing is discouraged to undergo any elective plastic surgery.
Prior to rhinoplasty, judicious surgeons require all their patients to pass lab screening to ensure that they can handle the surgery and the ensuing recovery.
- Achieve one’s optimal health
Achieving one’s optimal health generally includes eating healthy, avoiding smoking and too much alcohol and caffeine, and discontinuing aspirin and aspirin-like products for at least 2-3 weeks.
- Accredited surgical facility or hospital
This is the safest surgical venue. Being accredited means the surgical facility adheres to the highest patient safety standard.
Moreover, an accredited surgical facility has the necessary equipment, building design that promotes sterilized environment, and highly trained staff to reduce risk of infection and contamination.
Many surgeons today recommend prophylactic (preventive) antibiotics to help ward off infection, which must be taken on time and their full course completed.
The patient must be informed of the telltale signs of infection such as elevated temperature, unusual skin changes, and poor healing.
If the patient notices anything unusual, he must notify his surgeon right away than wait for his next scheduled appointment. Some individuals might be apprehensive contacting their surgeon thinking that they might bother them over some trivial thing.
Furthermore, the patient must understand that his full commitment is necessary to minimize risk of complications. For instance, smoking even just a single stick a few weeks leading up to the surgery or during the initial healing stage is enough to drastically increase one’s risk of poor healing, infection, and less than optimal results.
It is important to leave the nose alone to heal. No picking at the incisions, blowing hard, wearing eyeglasses, or anything that might compromise healing.
Rhinoplasty bleeding is often minimal provided that the surgeon uses meticulous techniques, which can also lead to shorter social recovery (no outward signs of the surgery), and natural results that can last a lifetime, according to California Surgical Institute website.
Rhinoplasty, or nose job in layman’s term, typically results in 1-2 weeks social downtime, which is closely linked to the amount of postop bruising and swelling.
The list below shows the “core principles” in minimizing the amount of rhinoplasty bleeding.
- The patients should be in their optimal health.
Hypertension, blood disorder, and other chronic medical conditions can lead to increased bleeding. Hence, rhinoplasty or any other elective plastic surgeries require all patients to pass a rigorous lab screening.
While some of these conditions can be controlled through medications or healthier lifestyle, it is important to note that some factors are not within the patient or surgeon’s control. For instance, older individuals often have more fragile blood vessels than younger ones and so they may experience more bleeding and postop bruising.
All drugs and supplements with blood thinning properties are discontinued for at least 2-3 weeks before surgery and about a week afterwards to prevent bleeding and excessive postop bruising. The same rule may also apply to smoking and alcohol.
However, some doctors recommend Arnica montana (homeopathic remedy) and some “special” diet known to promote healing.
- Use of drugs known to constrict the blood vessels
The use of local anesthesia combined with epinephrine—a drug that results in the constriction of blood vessels and thus reduces the amount of bleeding—is known to promote healing.
Decongestants like Afrin may also minimize the amount of bleeding by constricting the blood vessels.
- Keep blood pressure low at the time of surgery
Board-certified plastic surgeons only work with board-certified anesthesiologists to ensure patient safety.
Qualified anesthesiologists know that keeping the patient’s blood pressure low during surgery under general anesthesia can reduce bleeding. Also, one of their tasks is to monitor the patient’s vital signs to prevent serious complications.
- Avoid certain activities during the initial healing stage
Sneezing and blowing one’s nose should be avoided for 2-4 weeks because doing so can trigger bleeding.
It is important to note that despite best efforts, some patients remain susceptible to bleeding and thus they are required to use nasal packing while they recover.
Dermal fillers such as Radiesse, Juvederm, and Restylane are sometimes referred to as volumizers as they work by plumping the skin. They are different from Botox injection. Although both procedures involve injection, Botox relaxes the muscle and so it will no longer contract, eventually smoothing out the appearance of wrinkles.
With proper examination of the anatomy and meticulous injection, dermal fillers results are supposed to look natural, according to California Surgical Institute website.
The list below explains how natural results are achieved from dermal fillers.
The ideal filler will depend on several factors such as the treated site and the patient’s expectation. It is important to note that some materials can last for 4-6 months (hyaluronic acid-based products), while others can persist for about two years (Poly-L-lactic acid fillers).
Thicker fillers, i.e., they have thicker consistency, generally suit patients with markedly deep facial wrinkles or significant depression. Thinner fillers, meanwhile, favor areas with thin skin such as the lower eyelid to prevent visible bumps and other surface irregularities.
- Going the conservative route
Over-correction or over-injection can lead to unnatural look, which the media has referred to as the pillow face or chipmunk cheek. Hence, some doctors will start with only one syringe and then ask their patients to wait 2-3 weeks (or until their swelling has subsided) so they can decide for themselves if additional treatment is needed.
Dermal filler injection must only be performed by a qualified doctor. It is important to note that some states are somewhat lenient that they allow nurses and aestheticians to perform the procedure.
A good rule of thumb is to have the procedure done by a board-certified plastic surgeon or dermatologist who performs it on a regular basis.
The right injector can prevent asymmetry, “done” look, and other dead give-away of dermal fillers.
The success of dermal fillers results boils down to precision. For instance, it is critical to inject the medial aspect of the nasolabial folds or laugh lines to prevent cheek ptosis/sagging.
Patient cooperation will also determine the final results. A good rule of thumb is to avoid extreme heat or cold, massage or pressure on the treated area, and strenuous physical activities for at least two days.
The postop-injection management mentioned above prevents inadvertent shifting of the fillers, asymmetry, and excessive bruising and swelling.
- Simultaneous Botox (only if warranted)
Some patients need Botox to further achieve natural results from fillers. In such cases, the consensus is to inject Botox first, then proceed to fillers after about a week.
Each doctor has a specific set of rhinoplasty recovery tips. Nonetheless, they all boil down to controlling the amount of swelling and bruising, and preventing injuries during the healing phase to achieve optimal results from the surgery.
Most patients already know the basics of rhinoplasty recovery tips—the drugs and supplements to avoid a few weeks before and after surgery, the foods and drinks to limit, and the activities that could jeopardize their results. Hence, the list below explains the not-so-popular guidelines that can promote healing.
Chronic stress can put a toll on your immunity. For this reason, a longer time off from work might be more ideal than returning to office just 10-14 days after surgery, or once the outward signs (bruising and swelling) are gone.
If a longer leave of absence is not possible, you may ask to work part-time until you regain your pre-surgery energy level, which often takes 4-6 weeks after surgery. The goal is to control your stress level, according to experts at the California Surgical Institute.
Of course, managing stress also boils down to adapting a positive attitude in life.
- Use of bed wedge pillow or recliner bed
Head elevation all day long and during the night can keep swelling to a minimum and can also promote healing. Many patients have noted the convenience of using a bed wedge pillow or a recliner bed, as opposed to the soft standard pillows.
You may want to sleep alone in your bed and avoid pets and small children for the time being because even the slightest bump may cause bleeding or interfere with healing.
Other things to avoid while not yet fully healed include wearing eyeglasses, blowing your nose, making excessive facial expressions, and applying too much pressure when brushing your teeth. Moreover, it makes sense to wear button down shirts or wrap-around dresses during the initial healing stage to avoid accidental bumps on the nose.
Aside from consuming more fiber-rich foods and lean protein, it is important to follow a low-sodium diet. It is important to note that too much salt causes water retention, which can aggravate the amount of postop swelling.
Empty calorie foods laden with sugar and fats can also suppress your immunity and aggravate constipation, which is not uncommon after any type of surgery due to narcotic painkiller use.
Sun protection is one of the most critical rhinoplasty recovery tips. It is important to note that after surgery the nose is extra sensitive to UV rays and thus the risk of discoloration or hyperpigmentation is perceived to be higher.
If you cannot stay away from the sun, try to slather on sunscreen with at least SPF 30 or use a wide-brimmed hat.