Eyelid Surgery (Blepharoplasty)
What is Blepharoplasty?
Blepharoplasty is an operation whereby the appearance of the eye is rejuvenated by removing excess skin or fat to remove bags. It can be an excellent operation because it ‘refreshes’ the eye area and the scars usually heal really well and are almost invisible after 3 months.
Who will Blepharoplasty help?
Upper lid blepharoplasty aims to correct the excess skin which falls forward onto the eyelashes. This excess skin produces a very aged appearance. Women often complain that this excess skin interferes with applying makeup so that it ‘cakes up’ underneath this fold, or cannot be seen. Sometimes the skin excess can be so great that the skin falls forward onto the eyelashes pushing them downwards and interferes with peripheral vision, which may affect driving or reading. A further group of patients who request upper blepharoplasties are Asian patients. About half of all Asians lack a fold in their upper eyelids. This is quite normal but some prefer to have a ‘double eyelid’ rather than a ‘single’ eyelid. This can be created quite simply and is the most popular cosmetic procedure amongst Eastern and South Eastern Asians.
Lower lid blepharoplasty is usually done to improve the ‘puffy’ lower eyelids or ‘eyebags’ and also to reduce the wrinkling of the lower lids.
What is the best age for blepharoplasty?
There is no ideal age to undergo this surgery. It should be considered when you do not like the appearance of the eyelids, or feel that they are starting to make you look old.
A lot of patients worry that if they have a blepharoplasty done too soon they will need it doing again at some point. However, in my experience, the eyelid operation is usually only undertaken once, it is uncommon to require a second procedure.
What are the limitations of this procedure?
There is a limit to how much skin can be removed from the eyelids. If too much is removed from the upper eyelid, the eyelid may not close fully when asleep and this could lead to a dry, sensitive eye. The idea is to remove just enough skin to allow the eyelid to fully close.
Lower lid surgery aims to reduce the bulging fat pads and tighten the skin. However if too much skin is taken, the lower eyelid can be pulled downwards, which exposes the eyeball making it very sensitive. For this reason, a blepharoplasty will never remove all of the wrinkles from the lower eyelid.
Is Blepharoplasty available on the NHS?
Generally speaking blepharoplasties are considered cosmetic and as such are not usually available on the NHS.
How is the operation done?
An upper blepharoplasty is a relatively simple, safe straightforward procedure and can usually be done awake under local anaesthetic. However, it can be done asleep too and some nervous patients will prefer this. Blepharoplasties are usually performed through small incisions placed along natural lines on the eyelids. On the upper lid we use the small crease found about 8-10mm above the eyelash margin. The excess skin is removed and any bulging fat pads (usually found close to the side of the nose) can be reduced. The wound is usually closed with buried dissolvable stitches, although one or two removable stitches may be placed at the outer corner of each eye – to ensure a neater scar.
A lower blepharoplasty is a little more involved and generally it is better to be asleep for this procedure, although it can be done awake under local anaesthetic if you would prefer. The incision is usually placed on the lower lid in the small crease immediately below the eyelashes. The skin and muscle layers are undermined to reveal the bulging fat pads. I do not usually remove any fat, as the fat serves a purpose in the orbit and removal of this fat can lead to an unpleasant hollowing of the upper orbit in later years. The membrane which bulges forward is tightened to prevent the fat from bulging and the excess skin and muscle is carefully trimmed. The wound is closed with buried dissolvable stitches, although again, one or two removable stitches may be placed at the outer corner of each eye – to ensure a neater scar.
How long does the operation take?
Blepharoplasty usually takes about 60-90 minutes
How many days in hospital?
Upper lid blepharoplasty is usually done on a day case basis, though occasionally patients having a general anaesthetic in the afternoon may stay in hospital overnight and go home on the day after surgery. Combined lower and upper lid blepharoplasties are often done on an overnight basis to ensure the eyelids are not too swollen before discharge.
Postoperative period in hospital
When you wake up you may have gauze pads and icepacks on your eyes, so be prepared not to be able to see anything when you first wake up. I will have injected long acting local anaesthetic around your eyes so you will not feel any pain or discomfort for 6 hours. It is very unusual for patients having a blepharoplasty to report any significant pain, but you will be given regular painkillers to ensure you remain comfortable. You should sleep with some extra pillows to minimise postoperative swelling for the first week. You may use ice packs on your eyes intermittently for the first 48 hours to limit swelling.
Postoperative Follow Up
After discharge you will be provided with written information to explain the postoperative course. An appointment will be made to see my Cosmetic Nurse one week after your operation. She will remove any stitches and inspect your eyes. There will be bruising and swelling, so do not expect to see perfect eyelids at this stage! She will give you advice on wound care at this stage. You will probably experience bruising and swelling, and a feeling of ‘tightness’ for 10-14 days after surgery. You should avoid wearing contact lenses until your eyelids have fully settled down.
You will be given an appointment to see me six weeks after your operation. At this appointment I will be checking on the early outcome of surgery; if all is settling satisfactorily I shall arrange to see you for a final visit six months later.
What are the possible risks?
All surgery carries the potential for complications. Blepharoplasty is generally a safe procedure but occasionally, specific complications that may occur with a blepharoplasty are:
- Ugly scarring: although most scars settle very nicely to leave a pale flat line which is well hidden in pre-existing skin creases, occasionally scars may become red, raised, wide, itchy or ugly (called hypertrophic or keloid scarring). This happens in about 2% of people and is mostly seen in younger, darker skinned individuals.
- Infection; fortunately infection is rare, but can cause swelling, redness and tenderness up to 3 weeks after surgery. This usually responds well to a course of antibiotics.
- Bleeding: bleeding is fairly rare (2%) but can occur at any time over the first ten days after surgery, and therefore it is wise to avoid anything which could raise the blood pressure in your head, for example bending over, lifting anything heavy or strenuous exercise.
- Skin numbness: the skin over the eyelids can be numb after surgery. This usually improves with time, but can occasionally be permanent. As the nerves begin to regain function you may notice occasional sharp shooting pains which could be described as being like a small electric shock. This is a good sign indicating nerve recovery and can continue for up to 18 months after surgery.
- Eye sensitivity; the eye can become quite sensitive for several months after surgery with feelings of dry grittiness or excessive watering.
- Lid retraction: swelling in the lower eyelid tissues, and subsequent contraction of underlying scar tissue can pull the lower eyelid downwards. This is uncommon but does occasionally happen. The solution is usually to massage the lower eyelid outwards and upwards to reduce the swelling and encourage softening of the scar tissue whilst pushing the eyelid upwards into its normal position. Occasionally the eyelid may need to be taped up to support it until the swelling subsides. Reoperation is rarely necessary.