Postoperative Care

    For 3 hours postoperatively, the patient applies cold compresses to the eyelids. Ophthalmic signs are closely observed. The recovery room staff checks the patient every 15 minutes for the ability to count fingers and to make sure that there is no severe pain or proptosis. If the patient demonstrates either an inability to count fingers or proptosis or complains of severe pain, the surgeon is called immediately, because these problems may indicate a retrobulbar hemorrhage, which has the potential to cause blindness.3
For 24 hours postoperatively, the patient or the patient's family continues to apply cold compresses to the eyelids and checks for the ability to count fingers every hour (other than during sleep). If the patient cannot count fingers or if there is severe pain or proptosis, he or she should immediately return to the surgical facility or other emergency facility for evaluation of a possible retrobulbar hemorrhage.
Six days postoperatively, the 6-0 black silk skin sutures are removed. The polyglactin sutures are usually removed 2—3 weeks postoperatively or are allowed to dissolve spontaneously.

    Postoperative ecchymosis and edema of the eyelid are to be expected. Most patients think that their appearance is acceptable, and they are ready to go out in public a week after the procedure. When an upper eyelid crease has been formed, the patient experiences a slight amount of postoperative ptosis and has difficulty looking upward. These problems gradually resolve over the first 2 postoperative months. Some patients are emotionally depressed several weeks after surgery because their appearance is not back to normal, but this unhappiness commonly goes away at about 6 weeks after surgery. The appearance of the eyelids generally continues to improve over the course of 1 year after the operation.
Figure 7-2 shows the preoperative appearance and postoperative results in a patient who underwent upper eyelid surgery with the skin-muscle flap approach.