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Blepharoplasty (Eyelid Surgery)

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As one ages the skin loses its elasticity and muscles slacken.

For the eyelids this entails an accumulation of loose skin which collects as folds in the upper lids and deepening creases in the lower lids. At the same time there is slackening of the muscles beneath the skin allowing the fat, which cushions the eyes in their sockets, to protrude forward to give the appearance of bagginess.

Blepharoplasty is a surgical procedure to remove excess skin and muscle from both the upper and lower eyelids along with underlying fatty tissue. Blepharoplasty can improve drooping skin and bagginess. It can also improve vision in older patients who have hooding of their upper eyelids.

Blepharoplasty surgery is customised for every patient depending on his or her particular needs. It can be performed alone, to the upper, lower or both eyelid regions, or in conjunction with other surgical procedures of the eye, face, brow or nose. Eyelid surgery cannot stop the process of aging. It can produce a more alert and youthful appearance and diminish the look of loose skin and bagginess in the eyelid region.

The Operation

I carry out upper blepharoplasties under local anaesthesia, but combined upper and lower blepharoplasties under general anaesthesia in the operating theatre. In a typical procedure an incision is made following the natural lines of the eyelids: in the creases of the upper lids and just below the lashes in the lower lids. The incisions are extended slightly into the crow’s feet or laughter lines at the corner of the eyes. Surplus fat is removed along with excess skin and sagging muscle.

Following surgery the patient is asked to sleep sitting up slightly and to rest with the head elevated a few days to reduce swelling. Cold compresses help. The sutures, and any steristrips used to support the eyelids, are removed after a few days. Sometimes steristrips are reapplied to support the lower lids for a further week or so. Make-up can be applied after a couple of weeks. It is not unusual for the eyes to feel tight after surgery for a few days because of swelling and because of the skin removed. If the eyes feel dry eye drops can be applied. Sometimes the eyes may actually be watery after surgery because the tear ducts may be swollen and not drain as readily; this can last a few weeks. There will be some bruising, which can readily be disguised with make-up and dark glasses. The scars will be pink for a few months but settle down eventually.

Risks of blepharoplasty

Every surgical procedure carries a certain amount of risk and it is important that you understand the risks involved. Although the majority of patients do not experience the following complications, you should understand the risks, potential complications and consequences of blepharoplasty

Bleeding. It is possible to have a bleeding episode during or after the surgery. Do not take any aspirin or anti-inflammatory medications for ten days before surgery as this may contribute to a greater risk of a bleeding problem. Hypertension (high blood pressure) that is not under good medical control may cause bleeding during or after surgery. Accumulations of blood under the eyelids may delay healing and cause scarring.

Blindness

Blindness is extremely rare after blepharoplasty. However it can be caused by internal bleeding around the eye during or after surgery. The occurrence of this is not predictable.

Infection

This is very rare after surgery. Should it occur additional treatment including antibiotics may be necessary.

Scarring

Although good wound healing is expected, abnormal scars may occur both within the eyelid and deeper tissues. These may be of a different colour than surrounding skin.

Dry eye problems

Individuals who normally have dry eyes may be advised to use special caution in considering blepharoplasty. Temporary or rarely permanent dryness of the eye may occur.

Ectropion

Displacement of the lower eyelid away from the eyeball may rarely occur. Further surgery may be required to correct this condition.