Eyelid surgery and LASIK: What’s the right timing?

Eyelid surgery and LASIK: What’s the right timing?
Eyelid surgery and LASIK: What’s the right timing?

By Dr. Elliot W. Jacobs

Perhaps you’ve reached the point in life where you’re not sure which bothers you more: changes in your vision that impact your ability to see well, or changes in your eyelids that impact how others see you.

If this sounds familiar, you may be considering LASIK to restore clear eyesight and blepharoplasty to open up your eyelids and bring back a vibrant, youthful appearance. But how should you time the procedures?

Here’s some basic information to help you think through your decision.

The procedures should not be done at once. You may hear different input about scheduling from each surgeon you ask, but chances are every one will agree that LASIK and blepharoplasty should not be done at the same time. Both procedures manipulate very delicate structures and involve making changes measured in millimeters—it’s just not safe to perform the two together.

Many surgeons say that for the average patient it doesn’t matter which procedure is done first. An important consideration to keep in mind is that both LASIK and blepharoplasty tend to interrupt the normal tearing process that keeps the eyes bathed in fluid. That’s why those little bottles of eye drops are critical healing tools after either surgery.

Whether you choose LASIK or eyelid surgery as your first operation, you need to allow several weeks to a few months for recovery to be complete, and consider other aspects of recovery involved. In the case of LASIK first, you need to be sure that corneal flaps created during the procedure are fully healed before the area is manipulated again. In addition, it’s important for your blepharoplasty surgeon to pursue a conservative surgical plan, making sure not to overcorrect saggy lids.

In the case of blepharoplasty first, a completed healing process is also essential. You need to be sure that your eyes are not too dry for LASIK, all swelling is resolved and your lids open and close properly. Complete healing will also aid your LASIK surgeon in making precise measurements.

When surgeons do state a preference for which procedure is first, most choose LASIK before eyelid surgery. Some point to the fact that LASIK tends to stretch the eyelids to some extent; therefore they feel blepharoplasty should be performed as the second procedure. Others mention that dry eyes can persist for a time after either procedure—and in rare cases patients’ eyes are permanently drier than in the past and benefit from daily eye drops. Some surgeons view this as possibly problematic for a prospective LASIK patient.

The fact that there’s no definitive answer about which procedure should be first means that in most cases, the choice is up to you. Something to think about is which procedure is most important to you. Should you experience a complication that might influence whether the second surgery is advisable, it makes sense to have prioritized the procedure you want the most. (Be assured that complications are very rare for both LASIK and blepharoplasty, but it is still wise to consider the possibility.)

The best way to make an informed decision is to consult both a LASIK surgeon and a plastic or oculoplastic surgeon before settling on your strategy. Make sure both are highly experienced surgeons with excellent credentials, listen to their input carefully, and then create a plan that puts safety first.

You will soon be seeing and looking better.