Monique Ramsey (00:02):
Welcome everyone to The La Jolla Cosmetic Podcast. I'm your hostess, Monique Ramsey, and today I have in our podcast studio Dr. Kiersten Riedler, she's a board certified plastic surgeon and focuses on facial plastic surgery. And today we're going to talk about blepharoplasty, which is the fancy word for eyelid lift surgery. And we're going to talk about recovery for eyelid lifts and how much time can you expect to be down, et cetera. So welcome again to the podcast, Dr. Riedler.

Dr. Riedler (00:33):
Hi. Thank you for having me.

Monique Ramsey (00:34):
Thank you. So eyelid surgery, while it kind of sounds like it would be a painful experience, it's not necessarily that way. And so I want to sort of maybe go through and we can debunk maybe some myths or things that people say to you or what are the things that they're worried about, because we want patients to feel as comfortable as possible during that recovery period. And we want you to go into surgery feeling like, okay, I know what's going to expect. So how long, I think the first thing people might want to know is anesthesia related. So how long are they typically under anesthesia for an eyelid lift?

Dr. Riedler (01:13):
So if you're undergoing only upper blepharoplasty or lower blepharoplasty, because there's both upper eyelid surgery and lower eyelid surgery, if you're having one of those surgeries, you can expect to be under anesthesia for about an hour and a half. So it's fairly quick.

Monique Ramsey (01:27):
Okay. And if they're going to have both, do we double it to three hours?

Dr. Riedler (01:31):
Yeah. Two and a half. Yeah, two and a half, three.

Monique Ramsey (01:33):
Okay. Well, that's not too bad. Now, do people experience, let's say you're in the recovery room and is there a lot of pain right afterwards or in that first 24 hours?

Dr. Riedler (01:45):
Usually not. Patients are typically very comfortable when they wake up in recovery, and our recovery nurses always make sure that they're comfortable. And then during the first 24 hours, or even over the first few days, patients don't have a whole lot of pain. Usually their kind of maximum pain level is maybe a three out of 10, which ist too bad. Yeah, it's more discomfort, swelling, bruising, some pressure. Those are the main kind of symptoms during recovery, but it's really not that painful.

Monique Ramsey (02:21):
And for anesthesia, how does it feel or how do you describe it for people who maybe they've never undergone an anesthetic procedure or where they're under general, how does that feel to recover from?

Dr. Riedler (02:34):
Yeah, I mean everyone reacts differently to anesthesia, but recovery from anesthesia is typically pretty easy. We watch you in the recovery room for about an hour while you wake up completely, and it's totally normal to feel kind of sleepy or groggy for several hours. Occasionally patients get nausea, so we always give medications during surgery and sometimes in recovery to prevent that. But overall, it's just kind of like you go to sleep and you wake up and it's like you just, nothing ever happened and it's all over.

Monique Ramsey (03:12):
Isn't that funny? It's like that there is no sense of time, at least when you wake up in the morning in bed, you're like, you know, slept. There's some time, but that anesthesia is the weird. They're like, okay, count backwards from a hundred and you get to 98.

Dr. Riedler (03:26):
Yeah. If you're lucky. They're like, did we start yet? Then they are like, it's over.

Monique Ramsey (03:30):
You did so good.

Dr. Riedler (03:32):
Exactly.

Monique Ramsey (03:34):
So now anytime a patient has had anesthesia, they can't obviously drive themselves home, nor do we let you Uber home, you need to have a friend. So tell me a little bit about what you recommend for people as far as having somebody there to help them.

Dr. Riedler (03:52):
So you definitely need a ride home from the surgery center with preferably a family member or friend. And we also have aftercare services that we're happy to arrange as well.

Monique Ramsey (04:03):
And then what is that in that first 24 hours, is there anything they have to do with their eyes?

Dr. Riedler (04:10):
So for the first week or so, I have patients use a Q-tip dipped in hydrogen peroxide, just to kind of clean along the incision lines and then put antibiotic ointment on. And then for the second week they'll do kind of a similar thing just with Aquaphor ointment. The most important things really to do are to keep your head elevated, to reduce the bruising and swelling, to not be really active or do anything that's going to make your blood pressure jump up because we want you to heal as well as possible and as quickly as possible.

Monique Ramsey (04:42):
Yeah, people don't realize, I think that you can really, even doing something kind of minor that doesn't seem like it's not working out, but anything that elevates your blood pressure, you're right, that'll be like, that puts pressure and swelling gets worse and then you feel bad. And I think it's not, I agree because I had my face and neck and brow and lower eyes done, but it's been almost 20 years, so it's a long time ago, but so I didn't really have pain, but yeah you have a little discomfort. I think that's a great way to put it. I think talking about keeping your head elevated if you don't have an adjustable bed at home, which is like the best thing I've ever bought in my entire life.

Dr. Riedler (05:21):
I know, same here.

Monique Ramsey (05:21):
But if you don't have an adjustable bed, find those wedges or something that's going to keep you comfortable because definitely, and probably this is true for all the surgeries you do, all the head and neck surgeries, keeping that elevation so that your back doesn't hurt while you're trying to prop yourself up. So I think that's a great thing to think about pre-surgery to, okay, what can I use that's going to be comfortable? So I am again keeping the swelling down. Do they need to put ice packs or anything like that?

Dr. Riedler (05:52):
Yeah, definitely ice packs and cold compresses help a lot as well. So I have patients do that at least for the first 24 hours, preferably for the first two to three days.

Monique Ramsey (06:02):
Oh, okay. And then are their eyes going to be swollen shut or are they open? I mean I'm assuming you could see, but what does that look like in terms of what for them to expect?

Dr. Riedler (06:18):
I mean, the eyelids get pretty swollen. I'm not going to lie. I wouldn't say that they're swollen shut, but they are. I mean, they're pretty swollen. So definitely you don't have your full field of vision for at least several days because of the swelling. And you want to definitely be careful moving around and have somebody with you. The last thing we want you to do is hurt yourself. So it can be, what I tell patients is that you look a lot worse than you feel. You don't feel that you don't feel that bad, that there's discomfort. It looks like maybe you should be in pain, but you're really not.

Monique Ramsey (06:54):
Yeah. Well, I think that's probably true when you do facelifts too, right? They have more, you get all the bandages and the,

Dr. Riedler (07:02):
Yeah. It's pretty much true with all of the surgeries I do. Even with rhinoplasty, you look worse than you feel too. Yeah, it's kind of standard, which I mean I think is probably a good thing to look worse than feel worse.

Monique Ramsey (07:13):
Yeah. Yeah. And I'll tell you a funny story. So way back in the day, my dad had his eyes done and they did it, I think they did it under a local with sedation or something. So he didn't even have a general, he went to a Christmas party that night.

Dr. Riedler (07:29):
Oh my gosh.

Monique Ramsey (07:30):
I mean he didn't mind telling everybody. It was his brother-in-law who did the surgery, but he wore sunglasses and it was a talking point and he was super gregarious, so he didn't care. But it was like to your point, and probably that was not the best idea, but I don't think he stayed long. But it was just funny that it really was. He sort of looked a little funny, but yet he did feel okay. And while we don't condone that behavior, it does kind of speak to the point of you look worse than you feel. So now do they have, I'm trying to remember for my dad there was maybe some steri strips or there's what is put on and are there any sutures on the outside?

Dr. Riedler (08:13):
Yeah, so there are sutures on the outside. Those stay for about a week and then I don't put any bandages or wraps around the eyes or anything like that. But usually I'll put a few little steri strip tapes next to the eyelid or under the eyelid and those just stay there for a few days until they fall off.

Monique Ramsey (08:29):
Oh, okay. Well that sounds kind of easy. So let's get past the first 24 hours. When do they come back and see you again?

Dr. Riedler (08:37):
So I have patients come back about a week after surgery and at that appointment I remove the sutures, just see how they're healing, take photos, go over the next steps and all that.

Monique Ramsey (08:50):
Now you mentioned earlier some bruising. Is it typical for upper or lower or both? And how much bruising is it? Does it look like somebody punched you in the face or is it just sort of black and blue a little bit?

Dr. Riedler (09:04):
It honestly varies a lot from patient to patient, but you can count on some degree of bruising, whether it's a little or a lot. Like I said, it kind of depends on the patient, what you've had done. But the bruising, bruising and swelling, both kind of peak around two or three days after surgery. And I would say the bruising typically lasts about 10 to 14 days. The swelling lasts a little bit longer, so the majority of the swelling goes away within two to four weeks after surgery, but it really takes at least six months for all of the swelling to go away.

Monique Ramsey (09:41):
Interesting. And now is that, what would you say as far as being noticeable if you were thinking, okay, I'm going to a wedding and the wedding's in three weeks, are they going to know that I had something done?

Dr. Riedler (09:54):
They might not know, but I wouldn't recommend going to a wedding in three weeks just because that's a little close.

Monique Ramsey (10:00):
Okay. So if they're planning ahead for an event, let's say let's just stick with a wedding analogy or high school reunion or something like that. How much time would you say in the perfect world, if that event is on August 1st and we're in April, are we having surgery now or when would you want patients to really have the time to recover?

Dr. Riedler (10:23):
Soon. I would say you're having surgery soon because if you have an event that you know is coming up, I recommend patients try to have surgery about three months beforehand at least so that they can look their best. That said, even at a month and at two months, your eyelids are going to look better than they do before surgery. So it isn't necessarily a bad idea to have surgery a little bit closer if you're in a time crunch, but to be conservative and plan ahead the best way possible, I would say three months ahead is a safe period.

Monique Ramsey (10:59):
When could they wear, let's say some concealer to maybe, I don't know, once the stitches are out and if they have some areas that they feel like aren't quite, they're not going to be, I mean things will be red at the beginning, I'm assuming. So when could they put a little makeup on to cover up if they have anything to cover up?

Dr. Riedler (11:19):
You can put makeup on your face away from the incisions at about a week, but you can put it on the incisions or around the eye area itself at two weeks after surgery.

Monique Ramsey (11:32):
So a couple weeks. That makes sense. Now, what things do you recommend in the perfect world, if I was going to say, okay, I want to set myself up for a great result, what things do you want them doing? Maybe skincare wise or diet wise or medication wise prior to surgery? And then afterwards, what do you recommend that they do?

Dr. Riedler (11:55):
So before surgery, again to minimize bruising and swelling, it's really important not to take anything that can make you more prone to bleeding for two weeks. So that includes aspirin, Advil, Gingko Biloba, fish oil, things like that. That goes for before and after surgery. Other things that you can do to be proactive are like taking Arnica, which is a homeopathic supplement that if you start taking a few days before surgery, that can reduce bruising and swelling also. And then skincare wise, I have my patients use an Alastin skincare regimen, and that includes for eyelid surgery, enhanced serum after surgery, and that has several ingredients including arnica, that helps reduce the bruising and swelling around the eyes. And it's also good to have things on hand like cold compresses or ice packs, the wedge pillow that Monique expertly mentioned, and Q-tips, hydrogen peroxide, Tylenol, Aquaphor ointment, things like that. I also tell patients ahead of time, it's a good idea to have audio books or music or something you can listen to so that you're not reading and using your eyes a lot or even watching a lot of TV or movies. It's optimal to be listening to something instead of using your eyes as you're recovering at least the first few days.

Monique Ramsey (13:19):
Another question that people might have, so because you were talking about that field of vision being a little bit closed, when might be a good time that they can expect that they could drive again?

Dr. Riedler (13:30):
So driving, you can drive as long as you're not taking narcotic pain medications and you can see clearly. So usually that's about five to 10 days after surgery.

Monique Ramsey (13:41):
So that sounds pretty easy. And you know, here's the thing, people, with Instacart and all the things that deliver Uber Eats, I mean, you can get your groceries, you can get something from CVS, it all can come to you. So I think that is a really wonderful little side benefit, especially if you live alone that you're not having to worry about.

Dr. Riedler (14:01):
Use it as an excuse to take a little mini vacation and let people wait on you.

Monique Ramsey (14:05):
Well, and I love the idea of having audio books that what a great idea or podcasts you could catch up on all the podcasts that you missed from La Jolla Cosmetic Podcast. So now let's think about work and depending, obviously, it's very dependent on what you do for work. If you are a package sorter at the mail or a UPS driver or Amazon, if you're lifting, that's going to be a lot different than if you do what I do, which is sedentary desk work. What do you give the patients as a guideline for getting back to work?

Dr. Riedler (14:38):
So in general, I recommend taking two weeks off of work to be conservative, but you can often resume working if it's working from home or desk work after about 10 days. However, you really shouldn't be lifting anything heavy, bending over a lot things like that for three to four weeks. So it really depends on what you do for work. But as far as anything that's sedentary, usually by 10 days people are okay, but I recommend taking two weeks off just in case they're not feeling up to going back to work full-time, right away.

Monique Ramsey (15:12):
Okay. And let's talk about traveling because some people travel a lot for work or maybe they come to you from, we have patients come from over all the time to have surgery with us and let a little rejuvenation vacation as it were. So if they were, let's say, when would you want them to say, okay, yeah, if you're in town or you need to go on a plane, how long until they could do that?

Dr. Riedler (15:36):
I mean, it kind of depends on the situation. If they're just coming into town and then flying back home, I have patients do that right after their sutures come out like eight, nine days, eight to 10 days. But if you're thinking about going on a big vacation to Hawaii or something like that, that's a little different. I would say wait a few weeks, if it's just a quick business trip. I mean the flight itself isn't really an issue. The issues with flying are the number one with the reduced barometric pressure when you're on the flight you can swell more, but usually once you come back to earth then it kind of goes away. It's not a huge deal unless you're going to somewhere at high altitude like Denver. The other issue is lifting luggage and suitcases. So try to have somebody help you with that.

Monique Ramsey (16:28):
Yeah, for sure, for sure. And they've moved, the last few times I've been on a plane, they've redesigned the plane so much that the interior space, now that the overhead baggage compartments are higher, which gives everybody more headroom and everything, that's great. But for short, people like me, it's impossible to get anything up there. And then once it's up there, I still can't find it to see it. It's so funny and people don't think about that. Yeah, sure, you can be in a plane, but you have to be super careful with exertion, so.

Dr. Riedler (17:00):
And not letting the luggage fall on your face as people are getting it out. That's one of my biggest fears for patients.

Monique Ramsey (17:06):
Yeah. Oh yeah, it would be terrifying. Now when we talk about working, getting back to work, what about working out, when could they go back in the gym and what do you recommend?

Dr. Riedler (17:15):
So you can go back to the gym and vigorous exercise at about three to four weeks, but it's kind of a gradual getting back to activity. So I encourage patients to walk around the house for the first week several days a week, and then the second week taking maybe longer walks, increasing their activity and then gradually easing back into physical activity after that. And then by three to four weeks you can basically go back to your usual physical activity in the gym.

Monique Ramsey (17:47):
Now a lot of times patients want to combine eyelid surgery with something else. Maybe it's facial fat grafting or a brow lift or a facelift or some chin lipo. I don't know. How does getting multiple procedures affect your recovery time?

Dr. Riedler (18:05):
So getting multiple procedures at once just means it'll probably take a little longer to recover fully because you have swelling in multiple areas and then depending on what procedure you have, the specific instructions and the follow-up visit schedule might be slightly different. But other than that, it doesn't dramatically change of anything.

Monique Ramsey (18:24):
Okay. Yeah, when I had that facelift, the prior thing that I told you about earlier in the episode, I was at a wedding in three weeks and nobody knew. And obviously you're using makeup and doing that, and I told some people they were like, really? But I was able to sort of cover things up between makeup, my hair, nobody really had a clue. And I knew I looked puffy and funny, but nobody else. People don't care.

Dr. Riedler (18:51):
You're always the most sensitive to it, more so than other people.

Monique Ramsey (18:57):
Absolutely. Yeah. They don't think about you as much as we think they do.

Dr. Riedler (19:01):
That's true.

Monique Ramsey (19:02):
So let's talk a little bit about complications. What are possible complications that could happen after eyelid surgery or during recovery and maybe how are those complications managed?

Dr. Riedler (19:15):
So the most common complications are dry eyes, temporary, blurred vision, bleeding, swelling, complication versus normal recovery. It's sort of a continuum, but those are the things that, that's why I follow up with my patients really closely. And I would say bleeding is the most urgent type of complication that we want to look into and manage as soon as possible.

Monique Ramsey (19:45):
And, how can that happen? They're at home, let's say in that first 24 hours, the first two days. And can that bleeding happen because of the straining that maybe they're doing?

Dr. Riedler (19:58):
I mean, often high blood pressure, a lot of people have high blood pressure or straining or anything like that can make the blood pressure rise. The other thing that can make blood pressure rise is pain. So it's important to manage the pain and keep on top of pain control. Like I said, there usually isn't a whole lot of pain after eyelid surgery, but that's something to look out for. Also, if all of a sudden you're having a lot of pain, it might mean something's wrong and you need to call me.

Monique Ramsey (20:29):
Yeah, and that's what I was just going to ask, who do I call if something goes wrong? And it's really wonderful that being in a group that we're in, even if you happen to be, you were just saying right before the episode started that you're going to be going to Mexico for a service trip, and so they can't call you, but maybe you've got five other surgeons with you who are going to take care of your patients in that you're almost never gone. I feel like you're always here. I know, but the other thing is sort of like, who do I call? Oh my gosh, she's in Mexico on this service trip, but it's okay. We've got somebody for you and your nurses and.

Dr. Riedler (21:10):
Yeah, I mean, you can always call the office. I might be in the operating room or busy with the patient or something like that, but if something urgent is happening, I always tell my patients, call me first. If you can't reach me, then call the office, call my nurse. But rather than just going to the emergency room or something like that, I want to know what's going on and try to care for my patients myself.

Monique Ramsey (21:41):
And then as far as final results, final I guess is also a moving target in a way, or not a moving target, but everybody might interpret final results differently. But how would you say kind of like, okay, that everything's healed, the scars are mature that you would call that final?

Dr. Riedler (22:00):
So, about a year is a good, in a lot of the surgeries we do about a year is when you can expect to have final results with the scars are fully mature, all of the swelling's gone, you have your final result that said you probably have 95% of your final result at six months.

Monique Ramsey (22:20):
Got it. And do those results last forever?

Dr. Riedler (22:25):
So you will continue to age, unfortunately.

Monique Ramsey (22:28):
Darn it.

Dr. Riedler (22:29):
I know, but your results won't disappear. So eyelid surgery will turn back the clock, but it doesn't stop the clock. I would say most patients wouldn't be a candidate or be interested in another eyelid surgery for about 15 to 20 years. So it has pretty good longevity.

Monique Ramsey (22:49):
And really, like I said, it's one of those things that I think people notice first about you. The eyes are windows to the soul, but it is sort of like having, if they have puffy bags underneath or there's that drooping of the upper eyelid skin that really you can get kind of a new takeoff, I don't know, 5, 10, 15 years by just fixing that area around the eyes. And I know you work also in the med spa with injectables, and are there certain things that you would say, okay, maybe the plan is to make your face more youthful and eye the lift and then some other things that are in the med spa?

Dr. Riedler (23:32):
Yeah, actually that's a good question because I mean, Botox is something, Botox and Dysport and Xeomin, the neurotoxins are a great adjunct to surgery. They can definitely delay aging, but they aren't going to stop you from getting excess skin or bulges on the lower eyelids. At the same time, surgery alone isn't going to prevent you from getting crow's feet or completely take away crow's feet. So I think for the best results, I really like my patients to get neurotoxins regularly before and after surgery in addition to the surgery itself.

Monique Ramsey (24:15):
And could they have Botox a month before surgery? Does it change anything what you're doing?

Dr. Riedler (24:22):
No, and in an ideal world, I like my patients to get it about two to four weeks before surgery so that it's kicked in. Because one thing Botox does is it reduces any pull along the incision lines. So it's actually been shown in some studies to improve scar outcomes.

Monique Ramsey (24:42):
That's kind of cool.

Dr. Riedler (24:43):
Yeah.

Monique Ramsey (24:43):
I never knew that. I love learning new things. One more thing I was thinking about, whereas we were talking about getting ready for surgery, what about, we're doing the skinny shot now here at La Jolla Cosmetic, and a lot of people are on some form of the ozempic ros that bound all the things out there, the compounded ones. And I know that that is something, because so many people are on it that you might want them to stop how much before surgery you might think, oh, that's my diet thing, why would that affect my surgery? But talk a little bit about that.

Dr. Riedler (25:18):
Yeah, that's a good question. So usually we have patients stop that at least one week before surgery. And the reason is because, so when you're undergoing general anesthesia, we don't want you eating or drinking anything after midnight, usually the night before surgery. And basically we want your stomach to be empty so that when you go to sleep, you don't have reflux or aspirate anything like that. And the semaglutide, tirzepatide, those medications, they delay gastric emptying. So you basically have food in your stomach longer. We want that to kind of be out of your system enough so that your GI system is kind of functioning normally and we don't have to make you not eat anything for like 24 hours.

Monique Ramsey (26:06):
Yeah, yeah. So yeah, because kind of a new factor in anesthesia and surgery. So when they have their consultation with you, how can you show them maybe what they can expect for the after? Do you use other patients before and afters? Do you have a way to do imaging on them or what tools?

Dr. Riedler (26:29):
Yeah, so I mean, I take photos of all my patients, but for eyelid surgery, it's hard to simulate in Photoshop or in a morphing program, the outcome. So I think really the best way to show them what they can expect is by showing my other patients before and after photos and try to find somebody who has kind of similar anatomy, similar concerns to them and show them their eventual outcome. And also, I like showing the one month, the three month, the six month result in other patients, because it's hard to explicitly describe how you're going to look different at one month versus three months versus six months, but if you just see a picture, you're like, oh, that's what I can expect. So it's really helpful.

Monique Ramsey (27:20):
Right, right, so that sort of continuum of healing. And then lastly, I think patients might ask, okay, well how much would it be for eyelid surgery?

Dr. Riedler (27:31):
That's a really good question.

Monique Ramsey (27:32):
The good news is we publish all our price ranges on our website, so you can just go look under the cosmetic surgery prices and scroll down and you'll see, and the range is like 7,000 to 12,500 ish. But again, that is dependent and you could think, why is that such a big range? It's really dependent on what procedures you're having. So to get a good idea of what it's going to cost is really having the first step is having that consultation with you because then you can make the plan and the patient coordinator will whip up, here's how much it costs. And because with eyelid surgery, there's skin only, skin and fat, on the upper, the lower, I don't know. All these little things that can do.

Dr. Riedler (28:20):
Yeah, little nuances.

Monique Ramsey (28:22):
And so it's going to be hard for us to give you an idea without Dr. Riedler, you're really taking a look at them.

Dr. Riedler (28:29):
Yeah. That's why we give a ballpark range and then we give you the exact quote when you come in and take a look at you.

Monique Ramsey (28:38):
Now, if the patient is, let's say they're in Atlanta, Georgia and they're going to come to you, can they do a virtual consultation?

Dr. Riedler (28:45):
Yeah, they can. Yeah, I think that's a great option for out of town patients. I do like to see them at least one day before surgery just to examine everything really closely up close and personal and do an in-person exam before the day of surgery. But I can mean, luckily with technology these days, I can see, see a lot and get a good idea of what can help them and what their anatomy is just from a virtual consultation.

Monique Ramsey (29:18):
Okay. Well that's good news. Well, thank you so much Dr. Riedler for coming on and talking about blepharoplasty, eyelid lift recovery. I think it really helps people to get to know you as well as to understand more about what they might be looking at with this. It's a great procedure, and so I might have to have my, now that I'm coming up on 20 years, you and I might have to talk about some things that I didn't do before. Well, you know.

Dr. Riedler (29:51):
Thank you for having me.

Monique Ramsey (29:52):
Yeah, it was fun. It was fun. So everybody, thank you for listening and you can find links to Dr. Reidler's Eyelid surgery before and afters. All of our photos are on our website and there's even more photos that you would see at your consultation because some patients would prefer not to be on the website, but they don't mind Dr. Riedler being able to show you that picture in the office or during a consultation. So there's lots more pictures even than you'll see on our website. But again, thank you Dr. Riedler, and we look forward to seeing you again. We will talk about noses next time, maybe.

Dr. Riedler (30:28):
I'm excited for that too.

Monique Ramsey (30:29):
Alright, thank you.

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