Plastic Surgery 2: My Eyelid Surgery

In my last article about plastic surgery I mentioned that I was interested in more aggressive and permanent changes to my appearance than injections could provide. It took me six or seven months, and a lot of wavering but I finally had surgery yesterday afternoon! I will write about it in some detail here since I know that many of you are interested in it.

Before and after photos are always interesting. I struggled with this, but I decided to be brave and share pre-surgery and post-surgery photos. These are graphic, there is also no makeup and I look ugly. This is not the Pammy you know. Consider this fair warning if you are squeamish about surgical stuff.

What I Wanted Changed.

I have always had "hooded" eyes. "Hooding" happens when the skin above your eyelid crease falls over the crease onto the eyelid. This skin covers the crease like a hood and makes the eyelid smaller. Having hooded eyes is a mixed blessing. On the one hand, hooded eyes can be sexy. Our gorgeous SheDaddy has them, and there is no one with more beautiful eyes! On the other hand, having hooded eyes makes some makeup techniques trickier, and others impossible. Winged eyeliner is a classic example. You draw a perfect wing only to discover a black spot of makeup above your crease when you open your eye. This happens because the overhanging hood contacts the winged eyeliner when your eye is open, showing as a flaw when you close it. There are ways around this and with a little bit of makeup razzle dazzle anyone can sport most looks.

Most people with hooded eyes just live with them and enjoy them enough that they don't consider surgery. That only works for a while, because the hood tends to grow bigger with age. In my case, it became quite extreme, covering most of my eyelid and almost totally obscuring the crease. My eyes are well past the point where the hooding could even remotely be considered sexy.

I wish I could say that was the only problem, but I don't care much for my lower eyelids either, which sport gigantic bags. Basically, they are gross without makeup. Here's a pre-op picture:

Upper and lower pre-op eyelids.

I'm facing you here, so my right-eye is on your left. Arrow "A" points to the crease. The skin above the crease has grown to such an extent that it now covers almost all of my upper-lid, including my lashes as well as most of the crease as shown at arrow "B." The hooding of the left eye is even worse, although it's a bit hard to see from this cell-phone selfie.

"C" points to the lower boundary of my humongous lower eye bags. The lighting is a bit favorable to them in this photo. They usually do not look even this good. Yeuch.

Many people I have talked to about this say they have never noticed these problems from meeting me or seeing my Gallery Photos. If that's true (and they are not just being lovely), all I can say is "Thank you, so much!" I worked hard to acquire the makeup skills to be able to minimize and hopefully defeat both of these problems. But it has become a nightmare for me. And there are some looks I would love to try, but can't because of the excessive hooding. This will be true no matter how much makeup skill I manage to acquire. That's why I crave eyelid surgery.

How it Gets Changed.

The surgery to correct these defects is called a "blepharoplasty". (Greek "Blepharon" meaning "eyelid" and the surgical suffix "-plasty" from Greek "plaston" meaing "to form.") Subdivided into upper and lower blepharoplasty, depending on which you want repaired.

To repair the upper eyelid issue, the surgeon must cut away the excess skin and stitch the rest of the parts together. The "bags" on the lower lids are caused by fatty pads just under the skin. Many surgeons just remove the pads altogether. This was the usual approach when this surgery was first pioneered and is still quite common. The problem with this is that those pads are there for a reason: the skull has depressions right below your eye, and if there is no fat there at all, you swap eyebags for sunken eyes. It is hard to decide which is less attractive - indeed neither one is desirable. I discussed this issue with my surgeon before the procedure, and we agreed he would trim and move the pads in an effort to get a more natural result.

Decision Making

I've never really liked my appearance as a man. I think Pammy is gorgeous, but my boy-look, not so much. (This might indicate that I have a mild form of gender-dysphoria. Pursuing this thought is tempting, but something for another time and place.) As the appearance of my eyes got worse, I just shrugged and accepted it as yet another flaw in an already flawed picture.

Enter Dom De Luxury, AKA SheDaddy, and my inevitable transformation into her creation, Pammy. As she has helped awaken my inner woman, things like overly-hooded eyes, skinny lips and not enough cheekbones have gone from things I tolerated with an unhappy shrug to things that I can't live with anymore. So I decided last year to look around for a surgeon for eyelid surgery, but it has taken quite a while to find one.

I had managed to narrow the list down to a few candidates but had no good way to decide among the finalists. That's when a minor medical problem provided the surprising answer. I developed a small case of what is known as 'entropian'. This is when your lower eyelid curls inward and rubs against your eyeball. This causes incredible eye irritation and can even be dangerous to your eyesight, so obviously, I needed to get it fixed. This is covered by insurance, and fortunately one of the best guys to take care of this is on my plan and in my town. (For those of you who don't know, I live in one of the most dysfunctional healthcare cities in one of the most dysfunctional healthcare countries in the world.) In my initial visit to consult about the entropian, I brought up the issue of my cosmetic unhappiness. As we talked about it, I was very impressed with him and we decided to have all these procedures done at the same time. Why spread out the misery?

SheDaddy never pushed me to do this, but she agreed with me and was so beautifully supportive of my decision. She understood everything so well, the desires, the fear, the worries. It is so amazing to have someone like her mentor me on this path. Without her on my side, I am sure I wouldn't have found the courage to go through with it.

When and How Much

Post surgery, you look awful. Therefore, you need to find a two or three-week window where it won't matter that you look like you just got mashed to potato pulp in a bar fight. Or wear dark sunglasses a lot. Or both.

"How much" is a lot. Technically, it is four procedures: two top lids and two bottom lids. With my entropian on each eye, that makes six. If you think that will be quite the price-tag, you are right. Average costs in my area are $6,000/eye for the upper lid and $4,000/eye for the lower lid. That's $20,000 (woo) and could be even more if your surgery is more complicated or your doctor more expensive. But costs vary widely by geography, so check in your area. It would be very unusual if the costs in your area aren't lower than the ones here.

To help deal with the expense, my surgeon suggested I get a visual field test. It turns out that if your eyelid is extremely hooded, it can interfere with your vision. This turns what is usually a cosmetic procedure into a necessary corrective one. The advantage to this is that insurance will never pay for elective cosmetic surgery, but it will pay to correct your field of vision. I flunked the visual field test, which was a good thing since it meant that my insurance company would cover the cost of the upper blepharoplasty. Insurance was also paying for the correction of the entropian. That left the lower lids. There was no way on earth to turn this into anything but a vanity surgery, but my doctor agreed to do both lower lids for a total of $4,000. An awful lot of money, but a lot less than the $20,000. Who says it's never good to flunk a test? Would I have still done it if I had to pay the full cost? I can only say: Maybe. I'm just grateful I didn't have to make that decision.

Pre-op, OP, and Post-op

The pre-op preparation is pretty much the same as it would be for any surgery. You need to get surgical clearance, which may involve blood work, an EKG or other things. The details may vary with surgeon and hospital. You need to avoid anything that is a blood thinner, such as aspirin. If you have heart meds, you need to consult with your doctor about what is best to for you.


I was surprised to learn that they don't use general anesthesia for this surgery. This isn't as awful as it might sound. In fact, it isn't awful at all. They inject local anesthesia around the eyes and use intravenous sedation to keep you calm, but you will be awake. They place opaque contacts over your eyes, so you won't see a sharp scalpel as it works on your eyes, and gently cocoon your arms and legs on the surgical table. I found the whole experience not only very comfortable but interesting, as I could hear the surgeon talking about stuff as he went along.

I know this will freak some of you out. If you want to be asleep for the whole thing, you can probably get it. But before you go that route, consider all the reasons this is a bad idea. Your surgeon is shaping your eyes based on how you look when you are awake. You want to maintain some muscle tone around your eyes, and the surgeon may even want you to look up or to the side at various points of the procedure. This won't be possible if you are knocked out with a general anesthetic. Your muscles will be completely slack which is a horse of a different color. All the surgeons I talked to or read about agree that using general anesthesia will work against having the best possible outcome.


It won't surprise you to hear that you are going to hurt and be quite bruised after your surgery. Here's a photo of both of my eyes about one-hour after surgery:

One-hour after surgery.

A rare chance to see Pammy without makeup, so enjoy it. Note the sexy Charles Manson Vibe, courtesy of the surgeon who placed surgical marks above the eyebrows. Woo.

Even though the lids are swollen, you can see they are quite a bit back from where they were originally. Let's all cheer. There is some bruising. At this point, I was in some pain and took a few Tylenol to control it. I had no problem sleeping.

Here is a photo from this morning:

Morning after surgery.

I haven't needed any pain meds today. The swelling has gone down considerably, but the bruising has increased. This is typical. The redness in the left-eye (on your right) is also common and nothing to worry about. I happen to know this because I worried enough to send this pic to the surgeon. The stitches will be in until about Thursday or Friday.

Post-op care is not that difficult. You have an antibiotic cream and some antibiotic pills you apply (for the cream) and take (for the pills) twice a day. You cold-pack your eyes every two hours (no need to do it if you are sleeping) to help reduce swelling. No exercise, bending from the waist, sex (ouch) or lifting weights greater than 5 lbs. After a few days, you switch from cold compresses to warm.

Was it worth it?

It's a bit early to answer this question. I'll have to keep you posted. Initially, I am quite optimistic. Looking at the photos, I already wish he had taken off more eyelid from the top, but this is already so much better. And truthfully, with the swelling, it is hard to say what it will look like in a week or two. So today, the answer is a very hopeful "yes".

Tracking my Recovery

If you're interested in tracking my recovery, check back here. I will add more photos and (if necessary) comments. I'll add a date to the article title, so you'll know when there's something new. Having this surgery was a huge decision and a huge step for me, just as I know it would be for you. I want to give you as much data as possible to help you make your own decision.

Meanwhile, you can't wear makeup for three-four weeks after this procedure, and I will be quite busy after that, so I don't know when my next photo-set will be out. But maybe I can finally find a chance to do more articles on the web-page. I have a ton of requests for more details on makeup, tutorials and looks. That takes a lot of time, but maybe I can find that now. Hair requests are a close second, so I will try to find time to do something about that too.

UPDATE: Stitches Out!

So the stitches are out, and I look less bruised. In some ways, I look worse than before the surgery. According to the surgeon, this is because of swelling that will reduce over the next few weeks. He is very happy (I'm glad one of us is) and expects a good outcome. I am just hoping and waiting. Here's an updated picture:

After stitches were removed.

The yellowing is from the anti-bacterial ointment. Check back in a week or more for another update, and thanks for all the kind wishes!

UPDATE: Four-week check-up!

So it's been four weeks and I went to see the surgeon today. I really like this guy. He thinks things are going well but has a few concerns. These were the same things I was worrying about. Unlike many physicians, he is not pretending everything is perfect. Particularly on the lower left corner of my left eye, there is some swelling. It's not clear at this point if this is still post-op swelling, or if there needs to be more corrective surgery. He assured me that he would be very happy to go back and fix anything that he didn't get right.

Meanwhile, there are no more restrictions. I am free to resume my normal activities and as you can imagine, I'm eager and curious to experiment with makeup once again! Meanwhile, here's an updated picture. I'm sure you'll agree things are much better now!

Four week checkup

If you've had similar experiences, or have thoughts you'd like to share, feel free to