Blepharoplasty (eyelid surgery)

Blepharoplasty (eyelid surgery)

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The following information is for people who are considering Blepharoplasty (eyelid) surgery
Blepharoplasty, more commonly known as an eyelift or eye lid lift is an operation to remove excess skin, fat and muscle from around the eyes the aim being to obtain a more alert & rested appearance around the eyes. The procedure can be performed on the upper and lower lids, at the same time or separately. Blepharoplasty is the third most popular cosmetic surgery undergone by patients both male & Female in the UK today.

Why Blepharoplasty?

As we age, the skin around our eyes begin to show signs of sun damage and early signs of ageing, the skin around the eye is more fragile than other facial area’s and deteriorates quicker than other area’s of the face as a result. The probability is loose folds of skin on the upper eyelids and deep creases on the lower lids begin to appear. Also the muscles in this area may also slacken so that any fat bulges forward and looks baggy. Blepharoplasty can remove the excess skin, fat, or both, from around your eyes.

It is possible to develop baggy eyes in your 20s before your skin changes or this can be genetically inherited. However it is more usual for people in their late thirties and forties to undergo this type of surgery.

Some patients have developed saggy skin which has dropped over the eye effecting their sight, Blepharoplasty can in cases such as this provide a solution and improve sight.

Blepharoplasty removes wrinkles, but only those in the skin that is cut away in the operation. It will not remove "crow's feet" and cannot change the colour of dark shadows under the eyes.

It is important to discuss with your surgeon what you are hoping to gain from the operation, and the result you can realistically expect.

Alternative options

It is possible for wrinkles around the eyes to be reduced using chemical or laser treatments, or by a forehead, or brow, lift. There is no scientific proof that creams, gels and beauty treatments which claim to be able to tighten the skin around the eyes work, however there are claims that they reduce some signs of wrinkles. It should be noted however they are not proven to work on a permanent basis.

Pre-operatively

Usually you will have a consultation with your surgeon the day before surgery is to take place, you will discuss the surgery what to expect and discuss your realistic expectations. Please remember this is your opportunity to confirm any questions you have at this time.

Your surgeon will examine:

• your eyelids 
• your vision
• your tear film (a layer of tears covering the surface of your eye) 
• the front of the eye 
• your retina - an area on the rear wall of your eyeball
• your whole face to see the condition of your skin 
• the position of your eyebrows and eyelids, which will be measured

What happens at the hospital?

At the time of consultation you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

During your pre-op examination the surgeon will examine your eye’s and you will possibly have a photograph taken of your face before the operation so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow Nil by mouth instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand, this will confirmed during your pre-op.

Pre-operative Instructions

One month before the operation, do not use any medications containing acetylsalicylic acid (Aspirin, ibroprofen, etc.). It can increase bleeding during and after the surgery. 

It is assumed that no acute illnesses occurred in the period of at least three weeks before the planned operation (viral illness, cold, etc.). Report any and all illnesses to the hospital/clinic.

Drink two to three litres of mineral water daily three days before the operation, however, 6 hours before the operation do not drink, eat, or smoke.

Have a good night’s sleep the night before the operation; you should be well rested before the operation. No alcohol may be consumed the night before the operation.

Wash your hair the day before the operation and do not put any facial cream, milk or make-up on the day of the operation. Any jewelry, including earrings, should not be worn.

We recommend for you to be accompanied by a close person in the time of your stay at the clinic and in your hotel/suite. Immediately after the operation, you must not drive any vehicle by yourself.

The operation

Normally the operation takes up to three hours, this time is reduced if only upper OR lower eyes are operated on. Often the surgery is undertaken as a day case, which means that you can have the operation and return to your hotel the same day.

The surgery is normally completed under a local anaesthetic, in which case the area around your eyes will be numb but you will be awake. It can also be done under a general anaesthetic, which means that you will be asleep throughout the procedure, the patient is sedated during the operation. The price of the operation is increased with these anesthesia options, and overnight hospitalization is mandatory.

After the face is disinfected and draped with sterile sheets, the plastic surgeon measures the exact amount of skin to be removed and marks this on the skin.

The next step is administration of local anesthesia starting at the outer aspect of the eyelids and continuing towards the inner eyelids. Following, the skin sectioning is conducted, the excess skin is removed and the fat pads are exposed and also removed.

Lastly, the incisions are sutured with very thin and disposable thread and small adhesive strips are placed over the sutures. These are generally removed two days to a week after surgery.

For surgery on the upper eyelids, cuts are made:

• into the natural lines and creases in your eyelid 
• into the laughter lines at the corner of your eye 

For surgery on the lower eyelids, cuts are made:

• just below your eyelashes, which means the scars will run along your eye's natural folds, hiding them as much as possible
• If only fat is being removed, the cut can be made on the inside of the lower eyelid, leaving no visible scar. This is called a transconjunctival Blepharoplasty or posterior approach lower Blepharoplasty.

Compressive bandages are administered in the patient’s room, where she/he has to rest for a few hours before being discharged from the clinic.
Your surgeon may use either conventional or laser techniques.

 
Post operatively

After the operation, your eyes may be covered with gauze pads. The surgeon will apply some sterile paper tape to support the eyelids after surgery, which is normally removed after three to five days. Sometimes you will be advised to use the support for the lower eyelids for a week or so. An ointment will be applied to your eye area to prevent it from drying out.
You will be given painkillers to help with any discomfort as the anaesthetic wears off.

If the operation has been planned as a day case, most people return to their hotel once they have made a full recovery from the anaesthetic. Before you leave hospital, a nurse will give you some advice about how to care for the eye area and you will usually be given an eye ointment to use at home.

                       Before                                             After

Recovering Post operatively

Once you are home, you may take further painkillers if you need to. Follow the hospital's advice.

Eyelid swelling and bruising under the eyes are common post-operative syndromes. A resting regime and careful cold compresses applied with pressure are recommended for ten days. Applying a cold compress, such as ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an "ice burn".

The stitches are removed on the fourth to sixth day after the operation.
After 14 days, the patient can apply cosmetics, including make-up, and return to sports and physical activities after three to four weeks. However, we strongly recommend avoiding direct sun light. Patients should wear sun-protective lotions, sunglasses and hats for six to eight weeks.

There are some important things to remember while recovering from cosmetic eyelid surgery.

-Keep your head higher than your body by lying propped up on pillows,

-avoid bending over for a few days. This will help to reduce swelling and bruising.

-Clean around your eyes and use any ointment that the hospital staff gave you as    they instructed.
 

- Avoid wearing eye make-up until a couple of days after the stitches have been removed, or for as long as your surgeon tells you to.

- Avoid wearing contact lenses for two weeks (they may still feel uncomfortable for a while after that).

-Avoid driving until your vision has returned to normal and your eyes have stopped watering.

Most people are able to read or watch television within a few days. People usually feel like returning to work after a week to 10 days.

How to decide if Blepharoplasty is right for you

Why we have cosmetic surgery is personal to each individual, however it is advisable to discuss your decision with your GP.

Cosmetic eye surgery is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having cosmetic eye surgery can also expect:

• soreness around the eyes, which can be helped by taking painkillers
• bruising and swelling for up to a month after the operation, which might make your eyes feel tight and difficult to close when going to sleep
• sticky, dry and itchy eyes for the first week
• watery eyes for a few weeks
• double or blurred vision for a few days - you should contact your hospital or a GP if this lasts longer than three to four days 
• sensitivity to light for a few weeks
• tiny whiteheads along the line where the stitches were - your surgeon can remove these with a very fine needle
• pink scars for a few months, but eventually they become almost invisible

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection, or an unexpected reaction to the anaesthetic.

Specific complications of cosmetic eye surgery are uncommon but can include:

• a haematoma where a pool of blood collects under the skin around the eye, which may need to be drained in a second operation if it doesn't disappear on its own or if it is large 
• swelling that pulls the lower lid away from the eye, which usually settles on its own after a couple of days, but occasionally another operation will be needed
• damage to the surface of the eyeball or the surrounding muscles
• acute glaucoma, an eye condition requiring treatment by an eye specialist
• unusually red or raised scars (called keloid scars) which some people have an inherited
• tendency to form sunken appearance if too much fatty tissue is removed 
• a difference in appearance of the two eyes - they may not be identical 
• partial or complete blindness, but this is very rare     

The chance of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your doctor will be able to explain how these risks apply to you.