Eyelid Surgery (Blepharoplasty)

Blepharoplasty is surgery that addresses age-related changes of the eyes to give a refreshed, rested and ore youthful appearance.

Blepharoplasty can be performed on the upper lids, lower lids or both to give a refreshed and rested appearance that makes you look more bright-eyed and alert.

In the upper lid features of aging include loose, sagging skin with an additional upper lid fold that hangs over the eyelid and interferes with the natural contour and in some cases may even impair vision. In the lower lid extra skin, fine wrinkles and puffy bags can develop beneath the eyes. In some cases Festoons (enlarged puffy bags of skin) develop in the lower lids. All of these features can be corrected by blepharoplasty. A blepharoplasty however will not address dark circles beneath the eyes nor the lines around the eyes (crow’s feet) and it will not correct drooping eyebrows.

The dark circles sometimes seen with aging result from loss of volume in the lower lid and thinning of the skin in this area that is part of the aging process. The crow’s feet lines result from continual contraction of the orbicularis oculi muscle coupled with loss of elastin and collagen in the skin. Dark circles and crow’s feet lines can both be treated by non-surgical treatments such as Botox and fillers (see non-surgical section). Brow droop requires a brow lift to correct it and may be offered to you as a complementary treatment if your anatomy requires it.

The aim of a blepharoplasty is to reduce the signs of aging to produce a bright and refreshed look to the eyes. It does not change your appearance or make your eyes look unusual. I aim to create beautiful, subtle and natural results with a rejuvenated look that is not immediately obvious to others, and yet eye brightness that is apparent to all.

Who is a Good Candidate for Blepharoplasty?

Good candidates include women or men who are healthy, in good physical shape, and are troubled by the features of aging described above. Candidates for eyelid surgery should be emotionally stable, have the support of their surrounding friends and/or family members, and be fully educated about the procedure.

Who is not a Good Candidate?

Smokers, patients with multiple or untreated medical problems, and individuals who are psychologically unprepared for surgery are not good candidates for a facelift. Individuals with a personal history of eye disease (including dry eyes, glaucoma, exopthalmus, Graves disease and detached retina) may not be suitable for this type of surgery. Those who have been encouraged by others to change their appearance should not consider cosmetic surgery. Candidates with unrealistic expectations should not have this surgery.

An example of eyelid surgery.

What Are the Different Types of Blepharoplasty?

Upper Lid Blepharoplasty

In upper lid blepharoplasty an incision is made in the natural fold of the upper eyelid from the inner upper lid along the crease and ending beyond the upper lid crease in a natural pre-existing line. As the incision sits in the natural contour of the upper lid, it is inconspicuous and with time fades to be nearly invisible. Excess skin is removed from the upper lid and excess fat may be removed.

The eyelid muscles can also be tightened and the upper lid is given a refreshed and more youthful appearance.

Lower Lid Blepharoplasty

Lower lid blepharoplasty is usually done with an incision below the lower lid lashes (subciliary method). The method used to rejuvenate the lower lids depends on your anatomy and the amount of excess lower eyelid skin but often involves removal of excess skin and repositioning of the muscle around the eye, which lifts the central part of the face to create a youthful contour.

An upper lid blepharoplasty, lower lid blepharoplasty or four-lid blepharoplasty may be recommended to you depending on your individual anatomy, skin quality and eyebrow position. In some cases I may also recommend some non-surgical procedures to complement the surgery and enhance the overall result. Once I have assessed you I may recommend any combination of the above with a plan that is individually tailored to treat your particular features of aging and your unique anatomy.

What To Expect During Your Consultation?

At your initial consultation I take a full medical history including all details of current and past illnesses, medications (prescribed or otherwise), lifestyle and past history of any previous surgery. I need to know specifically about and history of eye injury or eye disease, thyroid disease and connective tissue disorders. We will discuss what it is that you do not like about your features and what you are hoping to improve. It is important to be open and honest at this stage with regard to what troubles you and what your expectations are so that we have a shared vision of what you are hoping to achieve.

I will assess you clinically, examine your entire eyelid and forehead area and take a number of measurements both at rest and with animation. It can be quite disconcerting to have someone stare at you face for a period of time and analyse it but this is an important part of assessment so please bear with me! We will discuss what is and what is not possible for your individual anatomy and the potential outcomes, risks and complications of the surgery. I will also advise if any additional procedures such as mid-face lift or brow lift are likely to enhance the results. I always see you a second time before proceeding to surgery to answer any questions that you may have.

Preparing For Blepharoplasty Surgery

You should be physically fit and at a healthy weight which should be stable prior to embarking on facial plastic surgery. Your health will be assessed pre-operatively and you may need some tests that will be arranged if required. You should stop smoking at least 6 weeks ahead of surgery to reduce the risk of wound healing problems. You should stop aspirin, anti-inflammatory medications and any non-prescribed medication at least a week before surgery. If there is any change in your health prior to your surgery date you should let me know. Your health and general well being are my primary concern when I am treating you therefore if you are unwell for any reason it may be necessary to postpone surgery.

Eyelid surgery results.

Eyelid surgery results.

What to Expect on The Day of Surgery

An upper lid blepharoplasty alone may be done under local anaesthetic but lower lids or adjunctive procedures require a general anaesthetic. It usually takes 1-2 hors depending on the extent of your surgery. Blepharoplasty is performed with surgical loupe magnification to enable precise and meticulous alignment of the tissues. The area is injected with local anaesthetic with adrenaline to minimise bleeding and bruising. The eyelid skin is separated from the underlying tissues, and excess fat or muscle is repositioned or removed as necessary. Meticulous haemostasis avoids bleeding during and after surgery. Excess skin is removed and the incisions are closed with sutures that will be removed a few days to a week after surgery.

To protect your eyes during the procedure I use ophthalmic ointment therefore your vision may be a little blurry when you first wake but this settles down quickly as the ointment clears.

You will return to the ward around an hour after the operation and will be able to eat, drink and mobilise. You will go home later the same day.

What to Expect on Discharge

You will need someone to pick you up from the hospital and give you some minimal support at home for the first few days. The procedure is not normally very painful and can be managed with basic pain medication. You may however feel tight and swollen. Using cooling packs on the area every couple of hours for the first few days can help this to settle. Sleeping a little propped up with an extra pillow also helps to reduce swelling. You should avoid stooping and hot baths for the first week.

At one week post-op you will be reviewed in clinic, your eyes checked and stitches removed.

In the immediate post-op days you may also notice tearing, eye irritation, light sensitivity or dry eyes these are often helped by lubricating ointment. You should avoid wearing contact lenses for at least the first 2 weeks for upper lid blepharoplasty and 4 weeks for lower lid blepharoplasty.

As the swelling and bruising resolve, the improvements of your eyelid procedure will appear over the next few weeks. You will start to look brighter and rested with a smoother more defined eyelid.

The incisions tend to heal very well with good quality scars due to the nature of eyelid skin and the good blood supply of the face. The final results however can take several months to become apparent.

Lifelong sun avoidance helps to minimize sun-related aging and it is especially important to avoid direct sun exposure to the eyelids during healing. Dark sunglasses with a good UV protection rating will help to protect the delicate skin of the eyes during healing and promote comfort. Once the scars have healed you should use high factor (SPF 30 or above) sunblock on the scars until they have faded to prevent hyperpigmentation.

What is the Recovery After Blepharoplasty?

After any type of facial surgery, swelling and bruising is expected. This may be more on one side or settle sooner on one side giving a temporary period of eyelid asymmetry. Swelling may also cause an uneven appearance of the skin. As the swelling settles both of these usually normalize. The wounds will usually be healed at one week post-op and you can wear make-up once the sutures are removed. After approximately two weeks, obvious signs of surgery such as puffiness or discoloration should dissipate.

You should arrange to take at least a week off work but possibly longer depending on your job. Once the stitches are removed you can return to gentle exercise but should avoid anything strenuous for 3-4 weeks and avoid contact sports for at least 6 weeks.

Potential Risks and Complications of Blepharoplasty Surgery

When you are considering any type of surgery you should be fully educated about potential risks and complications. The majority of patients are delighted with their results. Common complaints are numbness, bruising, swelling and a dry or watering eye. Chemosis and conjunvitis can occur especially with lower eyelid surgery but usually resolve in a few weeks. Uncommon complications include infection, haematoma, bleeding, delayed healing, skin necrosis and thickened scars. It is very uncommon to have drooping of the eyes (ectropian) and although permanent changes to vision such as double vision or blindness have been described they are extremely rare. Patients with Graves disease or exophthalmos (bulging of the eyes) are at higher risk of complications from blepharoplasty and should avoid cosmetic eyelid surgery.

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