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    Day Of Surgery

    Pre-Operative Marking  

    Prior to your surgery, you will have the opportunity to speak with Dr Motykie about any part of your surgical procedure and/or recovery process. You will be asked to change into a surgical gown and Dr Motykie will place surgical markings on your lower eyes. Marking is always done in the sitting position and the patient is asked to gaze upward and downward to assess the amount of budging of the orbital fat pads (bags) and the laxity for the lower eyelids. Accurate determination of the amount of skin to be trimmed is critical to a successful result from the surgery. Excess skin resection or aggressive lower eyelid tightening needs to be avoided in order to prevent the creation of strange, Asian, or unnatural looking shape of the lower eyelids with possible exposure of the white part of the lower eyeball (scleral show). These preoperative markings are essential to the surgery and are critical to perform accurately even in experienced hands in order to avoid the feared and hazardous “scleral show.” Lastly, wear loose fitting clothing the day of your surgery that is easy to get in and out of such as sweat pants and a shirt that zippers in the front.

    Anesthesia and Operating Facility  

    You can have lower eyelid surgery under local (awake) or general anesthesia (you are asleep). However, for your own personal comfort, safety and surgical ease it is Dr Motykie’s opinion that the safest and most effective way to perform lower eyelid surgery is under general anesthesia. Dr. Motykie uses only Board Certified Anesthesiologists to administer anesthesia and monitor your safety during your surgery. You may be given medication before reaching the operating room so you will feel relaxed before surgery. The surgery takes approximately 45 minutes to perform in its entirety. Every surgery is performed in a fully accredited, state of the art (AAAASF) surgical facility where your safety, comfort and privacy are of the utmost importance.   Deep vein thrombosis (blood clots) precautions are taken with every patient and include a minimum of anti-embolic stockings and sequential compression devices (SCDs) on the lower extremities during the entire length of your procedure.


    With age, the skin of the lower eyelid becomes thinner, the muscles become weaker, bags become more prominent and the supporting framework of the eyes begins to buckle. The shape of the lower eyes can begin to change shape along with drooping of the outer eyelid skin and supporting structures. This creates a dangerous set of conditions to perform surgery in inexperienced hands. Your surgeon must understand that support of the lower eyelid framework may need to be added along with the cosmetic portion of the surgery; otherwise complications can develop that include changing the shape of the lower eyelid and exposure of the white part of the eye.

    In addition, there are two possible approaches to take when rejuvenating the lower eyelid area: transcutaneous (through the skin on the outside of the eyes) or transconjuctival (though the inside of the lower eyelid). The transcutaneous approach to lower blepharoplasty entails the use of an incision along the lash line of the lower eyelid. There is a thin scar along the lower eyelid as a result of this surgery and it takes an experienced surgeon to create a natural result without any complications.  This is one time the eyes should NOT give you away. If too little fat is removed it can lead to residual bags and if too much fat is removed it can lead to hollowing of the lower eyelid area. In addition, a poorly planned surgery can lead to droopy, misshapen or retracted eyelids with possible exposure of the white part of the lower eyeball. It does not seem to make much common sense to perform a lower blepharoplasty utilizing this older external method considering the lower eyelid by nature is not well supported. In addition, with advancing age, which is the group of patients typically seeking this type of surgery, the supporting structures (tendons) of the eyes weaken and stretch which magnifies the potential for lid scarring and retraction after surgery. Therefore, experienced surgeons know that in cases where skin must be removed, secondary support of the lower eyelid should be created with a “suspension” suture placed near the outer eyelid on both sides. However, the potential complications from transcutaneous blepharoplasty can be avoided all together by removing the lower eyelid bags from inside the lower eyelids (transconjuctival approach) and I therefore prefer to perform my lower eyelid surgeries using this more advanced technique. Because there is no external suture along the lash line, there are no resulting incisions/scars on the lower eyelids and the risk of potential complications is very small. The only drawback to this type of surgery is that it does not allow removal of any loose skin from the lower eyelids. With the advent of more effective skin treatments, however, lower eyelid wrinkles and loose skin can often be treated with chemical peels or laser skin resurfacing before, during or after the surgery. In extreme cases in which skin must be removed, new simpler methods of lower eyelid tightening can be performed by an experienced surgeon that gives added support to the lower eyelids and preserves their natural shape and symmetry. No dressings are applied to the eyes after the surgery and only antibiotic ointment needs to be applied to the incision twice a day.

    Recovery Room  

    After surgery you will be brought to the recovery area where you will be allowed to rest and completely recover from anesthesia. Nurses will be on staff by your bedside to make sure you are recovering properly as well as being able to provide you with pain medications and small amounts of water and/or ice chips while you are becoming more awake and alert. After you have fully recovered from anesthesia, you may be released to home with a responsible adult or you may choose to stay overnight in an outpatient recovery retreat where there are nurses on staff 24hrs to assist you with post-operative care and medications. The most comfortable position to recover in after surgery is a reclining chair with your head elevated.  The night following your surgery, you may experience some pain and discomfort that can be controlled with your prescribed pain medication. Temporary bruising and swelling are also common the first night after surgery.

    To find out more about eyelid surgery please contact us at 310-246-2355

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