Blepharoplasty

Eyelid Surgery

Eyelid surgery is one of the most common cosmetic surgical procedures requested on the face. The goals may be for functional improvement or both functional and aesthetic. With age, the brow descends and feels heavier

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The upper eyelid skin also loses elasticity and this excess of skin may droop low onto the eyelid margin and on the sides, may obstruct peripheral vision. The orbital septum, which holds in the periorbital fat (nature’s shock absorber for the eyeball within the bony socket of the skull) may become stretched and the fat can herniate through, worsening the excess skin and heavy appearance of the upper eyelids. This condition (dermatochalasis) may be hereditary. Similarly, with descent of the midface, the lower eyelids may slacken, become puffy and look tired (bags under the eyes).

For purely functional problems, upper eyelid blepharoplasty alone may suffice, and this can be done either under local, or general anaesthetic. However, it is important to remember that the orbital region, comprising the forehead, brows, upper eyelid and lower eyelids, all form one ‘region’. Hence, rejuvenation of ‘tired looking eyes’, frequently require these separate areas of the same region to be addressed. Lower eyelid lifts also allow for lifting of the midface soft tissues, helping to restore the volume from the lower cheeks to the upper cheeks (blusher areas), thus softening the prominent nasolabial folds. This 4-lid blepharoplasty procedure, with or without a brow lift, can only be done under a general anaesthetic.

Your blepharoplasty journey

Consultation

Surgery

Post Surgery

Possible Complications

Consultation

During the consultation, I will thoroughly examine you and make my recommendations.

The site of the Incision: For upper eyelid surgery the incision is designed to sit within a natural fold, the length of this incision depends on the amount of excess skin, and on occasion can run laterally beyond the outer edge of the eyelid.

With lower eyelid surgery, I will discuss the anatomy of your lower eyelid and what tissues need to be treated. If you have predominantly excess skin the incision may be placed just below the lower eyelashes, or alternatively, if there are good lower eyelid skin and more bulging of fat, an incision on the inner aspect of the lower eyelid may be used. This is called a trans-conjunctival incision.

Surgery

Anaesthetic

The local anaesthetic procedure (for upper eyelids only) usually takes about 60 minutes and is usually well tolerated. In a few cases, if requested specifically, the procedure can be performed under a general anaesthetic. 4-lid blepharoplasty takes about 2 hours and a general anaesthetic.

What will happen when I wake up?

Sutures

Dressings

Post Surgery

Recovery

The soft tissues around the eye are extremely thin, meaning any injury or surgery to them will result in temporary swelling and bruising. There are a few things you can do to minimise how much bruising you get, and how long the bruising stays for.

Keep your head up, sleeping with 3-4 pillows under your head for 2-3 days
No excess physical activity or doing anything that gives you a rush of blood to the head for 2-3 days.
Use cold packs, such as a small wet towel kept in the freezer for 30 minutes, then placed over the eyes for 10-15 minute cycles (10-15 minutes on and 10-15 minutes off).

It is common to have conjunctival swelling (the clear film covering the eyeball) around the edges. This is normal and settles of its own accord. I may occasionally give some eye drops to help with the swelling.

Work

Gym

Showering and washing

Pain relief

Driving

Scar management

After 3 weeks, wounds have generally healed. You are advised to gently massage the scars as tolerated as this helps to soften, flatten and desensitise them. You may use any lotion of your choosing, such as E45. 5 minutes morning and evening for about a year. Make this part of your ‘routine’. Secondly, scars tan faster than normal skin. Therefore avoid exposing the scars to the sun, but if you have to, then apply factor 50 sun block daily, for a year. It takes about a year for a scar to fully mature and caring for your scars in this manner will ensure optimal healing. In some cases, I may advise using silicone gel (such as Kelocote), to be smeared onto the scar daily for a year.

Occasionally, once the swelling settles, there may be some excess skin at the very end of the scar (called a dog-ear) which may need to be trimmed under local anaesthetic. This is rare and may occur due to efforts on my part to minimise the extent of the scar at the initial operation. There is usually no additional charge for this.

Possible complications

General anaesthesia

Any operation involving a general anaesthetic carries a risk of developing blood clots in the calves (deep vein thrombosis – DVT), which could break off and move to the lungs causing a pulmonary embolism (PE). Early mobilisation and keeping hydrated will reduce this risk, as will avoiding smoking before and after surgery for at least 6 weeks. There is a risk of allergy to the drugs for anaesthetic and antibiotics / pain relief, and a very small but theoretical risk of major life threatening complication / death related to the anaesthetic (1 in 100,000 risk).

Bleeding and haematoma

This is rare and precautions are taken during surgery to minimise the risk of this. However, there may be a trickle of blood from the sides of the wounds. Place gentle pressure on the wounds with a clean cloth for about 20 minutes and this should stop. In EXTREMELY rare cases there is a chance of a bleed behind the eye (retrobulbar haematoma) which can be sight-threatening. Signs of this are pain, swollen eye, blurring of the vision and pulsating eyeball. If this happens, you must attend your nearest casualty as the haematoma may need to be evacuated.

Infection

Scar

Recurrence

Asymmetry

The scars are extremely well hidden in the natural creases of the eyelids and around the eyes. Over time, these will fade away to leave very little evidence of a procedure at all
The outcome of all cosmetic surgery is highly subjective. Whilst your surgeon will try to give you a realistic expectation, the satisfaction which you feel about your result depends on many things.

Most people are delighted with their outcome. If there are elements of your surgery which fall short of what you had hoped for, you MUST feel free to discuss them with me, as the majority of issues are easily resolved.