Oculofacial Plastic Surgeon
Laura Phan, M.D.
Laura Phan, M.D.
  • 15055 Los Gatos Blvd Suite 320, Los Gatos, CA 95032. (408) 502-5000 0

Laura Phan, M.D.

Where does Dr. Phan operate?
Most eyelid procedures, such as upper lid blepharoplasty, can be performed under local anesthesia (injection of numbing medicine into the skin) in the procedure room in the office. Some cases will be performed at the surgery center under sedation that is given through an IV with an anesthesiologist present. Few surgeries are performed under general anesthesia. Dr. Phan typically operates at the Los Gatos Surgery Center when sedation or general anesthesia is necessary. In rarer instances, surgery is performed at El Camino Hospital.

Are the surgeries outpatient?
Yes. Patients are typically observed in the recovery area for 30-60 minutes after undergoing sedation or general anesthesia and for less time after local anesthesia before going home.

May I drive myself home after surgery?
No. You need a responsible adult driver to bring you in and take you home after surgery. You should not be driving the rest of the day after sedation or general anesthesia. It is also a good idea to have a driver even if you are having surgery under local anesthesia in the office. If you live alone, you need to arrange for someone to stay with you the first night after sedation or general anesthesia.

How often does Dr. Phan perform these procedures?
Dr. Phan performs 4-5 surgeries each Thursday and Friday and other days with advanced arrangement.

What do I need to do before surgery?
Dr. Phan asks that patients discontinue blood thinners such as Aspirin and other NSAIDS (i.e., Ibuprofen, Motrim, Advil, Aleve, etc.), fish oil, vitamin E, and ginseng, gingko or garlic supplement ten days prior to surgery. Dr. Phan also asks patients to discontinue other anti-coagulants, such as Plavix, Aggrenox, Xarelto, Eliquis, Pradaxa, and Coumadin, five days before surgery. Since these medications are usually prescribed to prevent life-threatening conditions, Dr. Phan asks that patients discuss discontinuing these medications with the prescribing physician before doing so.

If surgery is to be performed under sedative or general anesthesia, Dr. Phan requires that the patient sees the primary care physician for cardiorespiratory clearance within one month of surgery. If the patient has a cardiologist, the patient should see the cardiologist in leu of the primary care physician. This clearance must be completed and provided to Dr. Phan no later than one week prior to surgery.

If surgery is to be performed under sedative or general anesthesia, patient must refrain from eating, drinking and even chewing gum eight hours before surgery; otherwise surgery will be cancelled. The exception to this restriction is blood pressure medication. If patient typically takes blood pressure medication in the morning, then patient should still take it with a small sip of water the morning of surgery.

What do I need to do after surgery?
Most patients will bruise and swell for 1-2 weeks. Some patients with thicker skin will swell longer, for a month or more after surgery. Swelling is typically worst first thing in the morning and better as patient is upright and moving around, which help with the drainage of the swelling. Unless specified otherwise by Dr. Phan, patient should apply cold compress on the surgical area 20 minutes on and 20 minutes off while awake during the first three days of surgery. After applying cold compress for the first three days of surgery, patient may switch to warm compress four times daily for 20 minutes each time. When sleeping during the first week of surgery, patient should sleep on the back with head elevated to 45 degrees. Icing constricts the blood vessels and stops bleeding and bruising, and warm compress and head elevation assist in draining the blood cell and serum collection.

For patients' convenience, the office has surgical care kit for purchase prior to surgery. The Basic kit includes items that Dr. Phan frequently recommends for before and after surgery care, such as antiseptic lid scrub, gauze, gel mask, pain relief, and lubricating gel drop. For more delicate skin, there is the Ultra Surgical Care Kit. In cases of Asian blepharoplasty or multiple procedures or eyelids being done at the same time, Dr. Phan strongly recommends the use of Lid Lift Goggle for the first three days of surgery in leu of cold compress. The goggle applies a constant pressure on blood vessels to keep them from bleeding and causing swelling. Please inquire staff for purchase of these items.

For patients who opt to not get the surgical care kit, the followings are suggestions for cold and warm compress. For cold compresses, many patients find frozen corns in snack-size Ziploc bags effective and comfortable while sitting snuggly over the eyelids. It is recommended that clean, wet gauzes or paper towels be placed underneath the Ziploc bags to absorb bloody discharge and discarded as necessary. (Bloody discharge is normal during the first of surgery.) For warm compresses, many patients find tea bags soaked in hot water keep warmth longer than wash clothes. The tea bags should be placed in Ziplock bags to prevent liquid dripping into the eyes. Beware that the tea bags are not too hot to cause burns.

In terms of activities, Dr. Phan asks that patients avoid heavy lifting more than ten pounds, excessive bending or straining and swimming for the first week after surgery. Patients may shower the day after surgery and get the surgical site wet. Patients should gently pat dry the incisions and not rub or pull on the incisions for one month. The skin heals within a week for most patients, but the deeper tissues underneath the skin take at least one month, if not three to four months, to heal completely. Patients may resume work 2-3 days after surgery, as long as they are comfortable with the visible bruising and swelling and can observe the above restrictions.

While many patients find taking Arnica and Bromelain 3-5 days before and a week after surgery help alleviate bruising and swelling, respectively, large-scale research studies demonstrate equivocal results. Therefore, the census is that these herbal supplements likely do not hurt and may help the recovery. Arnica is an herb, and Bromelain is an enzyme found in the core of pineapple. Both have anti-inflammatory properties. The typical dosage for Arnica is 200C daily and for Bromelain is 1000 mg twice daily.

Many patients inquire about scar revision creams. Dr. Phan does not feel strongly that they are necessary for routine eyelid surgery. The skin of the eyelid is the thinnest of the body, and the incision is typically placed in a crease or wrinkle. Therefore, incisions on the eyelids heal very well and hide nicely as well. For patients who have a tendency to form keloid or hypertrophic or hyper-pigmented scar, Dr. Phan recommends silicone-based gel, like Biocorneum or Silagen, twice daily starting two weeks after surgery. These gels are thick and not formulated for ophthalmic use; so a tiny amount is sufficient for the eyelids to avoid contacting the eyes. Silicone-based gels have been shown beneficial in deep scars, but not necessarily thin scars, so they may help and likely not hurt the incisions.

Scars form most actively two weeks to two months after surgery. The incisions may feel tightest during this time. The tightness will subside after the first couple to few months. In some cases where the scar feels thickened, Dr. Phan may have patients massage the scars with silicone gel four times daily to relax the scars or even inject the scars with anti-inflammatory and anti-metabolic agents to help thin the scars.

Dr. Phan strongly recommends avoiding the sun on the incision line to prevent hyper-pigmentation. Patients should wear sunglasses, hat or sunscreen with SPF 30+ that is safe for use around the eyes. SkinCeutical makes a sunscreen with SPF 50 for eyelids. Sunscreen may be started two weeks after surgery.

Make-up around the incisions may be worn two weeks after surgery. However, Dr. Phan continues to advise patients to refrain from rubbing or pulling on the incisions for the first month after surgery. Therefore, applying and removing make-up should be done gently around the incisions. 

Will there be bandages?
Generally, there will be no bandage or patching. In some cases wherein one eye is worked on, Dr. Phan may apply a pressure patch on this eye. The patch may be removed either after 24 or 72 hours. In rare instances, Dr. Phan may apply a Steri-strip tape over a small area of incision after suture removal if that area appears to need more support for healing.

What kind of sutures does Dr. Phan use?
Dr. Phan uses super-fine Nylon sutures, which are less likely to cause inflammation and thus scaring of the skin. Because they are super-fine, these sutures will break if they are pulled on. They are kept clean with antibiotic ointment once daily at bedtime. The ointment is made for the eyes and safe for in and around the eyes, but it will blur the vision as it liquifies and gets into the eyes. Superficial sutures on the skin are removed 7-10 days after surgery. There may be other sutures, depending on the type of surgery, that are removed few weeks after surgery.

Do I need to take any medicine before or after my surgery?
Once surgery is decided and confirmed, prescriptions for surgery are sent electronically to patient's pharmacy of choice. Prescriptions include antibiotic/steroid ointment, called Maxitrol (generic: Neomycin/Polymyxin/Dexamethasone), and possibly antibiotic/steroid eyedrop, called Tobradex (generic: Tobramycin/Dexamethasone). These are to be used the day of surgery. If the eye is patched, the topical antibiotics may be started after patch removal. Most patients do not require more pain medicine than two tablets of extra-strength Tylenol every 4-6 hours. Infrequently, stronger pain medication with narcotic, like Norco, may be prescribed. Dr. Phan asks that all prescriptions be picked up before surgery.

For in-office surgery, anti-anxiety medication, such as Xanax, Valium or Halcion, can be prescribed and taken 30-45 minutes before the in-office surgery. For more sensitive procedures, Norco may be taken 15 minutes before in-office surgery. These are not necessary for surgery under sedation or general anesthesia.

Please be aware of common adverse effects of anti-anxiety and pain medications. These medications can cause drowsiness; so patient may not drive while being under the influence of these substances. Pain medication with narcotics can cause nausea, vomiting and constipation. Please eat something before taking narcotic pain medication and take stool softener if there is history of constipation. Excessive use of these medications can cause dependency.

Is it normal for my eyes to be dry, blurry or teary after eyelid surgery?
Yes. When the eyelids are swollen, they may not blink fluidly or close completely. Therefore, the eyes can become dried from increased exposure to air. Significant dryness, in turn, can interfere with the cornea's ability to focus, causing intermittent blurry vision. Tearing occurs as a compensatory mechanism to the dry eyes. 

Dr. Phan recommends using lubricants immediately after surgery to prevent the onset of dry eye symptoms, which can make the recovery process less comfortable. Dr. Phan recommends starting with preservative-free artificial tears four times daily or using Celluvisc or Blink gel four times daily to every 1-2 hours for moderate to severe dryness. For more severe dryness, Dr. Phan recommends adding petroleum-based ointment, like Retaine PM or Systane Nighttime, in the eyes at bedtime. 

Dry eyes are typically temporary for the first couple to few weeks after surgery. However, in patients who have underlying Dry Eye Syndrome that may or may not have been previously diagnosed, the dryness or increased dryness may become a new baseline, requiring frequent use of eye lubricants. Symptoms of dry eyes include feeling dryness, burning, grittiness, sandiness, or sharp pain; redness; blurriness; or increased tearing, crustiness or mucus.

How often do I return for follow-up after surgery?
Dr. Phan will need to see patients, at least, 7-10 days after surgery and roughly one month to six weeks after surgery. Dr. Phan asks that patients not travel until after the first follow-up after surgery.

Are there before-and-after photos?
Yes. Please go to our Instagram or Facebook page.