Eyelid Surgery - Blepharoplasty

What is a Blepharoplasty?

Blepharoplasty literally means ‘refashioning of the eyelid’ and is an operation to improve the appearance of the skin around the eye. As we age, our skin can become thinner and less stretchy. Our muscles can weaken and fat that cushions the eyeball moves forward through spaces in the muscle around the eyes, causing "bags". Sagging upper eyelids may result in a “hooded” appearance over the eyes. In severe cases of eyelid hooding, vision can be affected.

It is often our eyelids which show the signs of ageing first which is why this can be the first cosmetic treatment which a man or a woman might choose. Eyelid surgery can help restore a more youthful appearance by tightening droopy or hooded eyelids, restoring the smooth line of the eyelids, and removing or moving fatty pouches beneath the eyes.

Some people suffer from eyebags, caused by pseudohernias of fat (which is fat pushing through the wall of the eye muscle) at a young age. This tends to be hereditary (an inherited condition from within the family) and can be corrected with a lower eyelid blepharoplasty.

Blepharoplasty, however, cannot remove dark circles under the eyes caused by dark pigmentation of the skin or by very thin, translucent (“see-through”) skin. It does not smooth fine lines and wrinkles around the eye or "crows' feet". It cannot lift sagging eyebrows either.

How is blepharoplasty performed?

Prior to surgery our doctor will discuss with you what you wish to achieve, what is achievable and the risks and benefits of surgery.

Upper eyelid blepharoplasty is performed commonly as a daycase procedure. The procedure itself will have slight variations depending on the patient.

For upper lid blepharoplasty, the surgeon will draw some marks the upper eyelid. Surgery can be performed using either general anaesthetic or local anaesthetic. The vast majority of patients opt for local anaesthesia since it is quicker and very acceptable. Sometimes the anaesthetist may administer some sedation through a vein in the back of the hand to make relax the patient further. Removal of the excess skin is then performed using radiofrequency cutting. For those patients with bulging fat in the upper eyelid, the fat is then sculpted away. Any additional procedures can then be performed if necessary, for example, correcting a droopy eyelid with eyelid ptosis surgery. The wound is then closed with sutures.

Lower eyelid blepharoplasty is performed slightly differently to upper lid blepharoplasty. Again, depending on the nature of the cosmetic defect, different techniques may be used. For patients with eyelid bags due to bulging fat and excess skin causing wrinkles, the incision can be made in the skin just below the eyelash line so that the excess skin can be removed after the excess fat is addressed first. In those patients where skin excess is not an issue, the incision can be made along the inside of the lower eyelid.

Again, the surgery performed will be individual to that patient. For example, eye lid tendons may need to be tightened, the bulging fat may be excised or redistributed, the midface may be lifted, etc.

What is the recovery period after blepharoplasty?

If procedure is a day case procedure, it is advisable to have someone accompany you on the day of surgery. After the anaesthetic wears off, your eyelids can feel tight and sore, but this wears off quickly and is usually easily treated with simple painkillers.

If the postoperative pain is severe, this may indicate a serious problem and patients should get in touch with their surgeon immediately.

You will often be advised to sleep upright and apply regular compresses to the lids to reduce the postoperative swelling. It is especially important to keep your eyes clean. Eye drops and ointments will be provided to help lubricate the eyes since often the eyes do feel slightly dry due to temporary impairment of the normal blink reflex after surgery.

Bruising is normal and peaks about a week after the procedure. The bruises may last 2-4 weeks but may be camouflaged with makeup, which is quite safe to use from the 10th postoperative day. Most patients return back to work 7-10 days after the procedure. In most cases any swelling usually lasts one to two weeks but in some cases can last months.

What are the risks of eyelid surgery?

As with any cosmetic procedure, the patient’s role of developing a realistic expectation of the outcome and understanding the potential complications is very important. The surgeon will spend time to discuss with you at length, so that you have a good understanding of what to expect and what is realistically achievable. Patients who have unrealistic expectations are likely to be disappointed no matter how skilled the surgeon.