What is blepharoplasty surgery?
Blepharoplasty surgery, commonly known as an eyelid reduction, is an operation to reshape the eyelids. An upper-eyelid reduction can improve your vision and make you look younger.
Please note, Mr Kamalarajah no longer offers lower-eyelid blepharoplasty.
Why have an eyelid reduction?
With age, our muscles slacken and the skin loses its elasticity. For the eyelids, this results in folds in the upper lids and deepening creases in the lower lids. Also, the slackening of muscle beneath the skin allows the fat which cushions the eyes in their sockets to bulge forwards to give the appearance of bagginess. In some families there is an inherited tendency for bags to develop during early adulthood. Folds, creases and bagginess often seem worse in the morning, particularly after periods of stress and lack of sleep. This is because fluid that is normally distributed throughout the body when it is upright tends to settle in areas where the skin is loose, such as the eyelids, when a person is lying down. The ageing process can also cause drooping of the eyelids, and folds of skin to gather in the upper eyelids. Sometimes there is so much skin that the upper lids hang over the eyelashes.
What will happen before my operation?
You will meet your surgeon to talk about why you want surgery and what you want. The surgeon will make a note of any illnesses you have or have had in the past. In particular, you should tell them if you have ever had any thyroid disease, high blood pressure, diabetes or eye disorder (such as a detached retina or glaucoma). The surgeon will also make a record of any medication you are on, including herbal remedies and medicines that are not prescribed by your doctor. Your surgeon will examine your eyes, face and skin, and may take some photographs for your medical records. They will ask you to sign a consent form.
How is the surgery performed?
Eyelid reductions can be carried out under local anaesthetic or general anaesthetic (in hospital only). In a typical procedure, the surgeon makes cuts that follow the natural lines of your eyelids – in the creases of the upper lids. These cuts are extended a little way into the crow’s feet (also known as laughter lines) at the corner of the eyes. Through these cuts, extra fat, excess skin and sagging muscle are removed.
All the cuts made will be stitched.
How can I help my operation be a success?
Be as healthy as possible. It is important to keep your weight steady with a good diet and regular exercise. Your GP can give you advice on this. If you smoke, stopping at least six weeks before the operation will help to reduce the risk of complications. Do not worry about removing hair near where cuts will be made, but do have a bath or shower during the 24 hours before your operation to make sure that the area is as clean as possible.
What is the alternative treatment?
Sometimes, a sagging forehead and eyebrow can make the eyelid look like it is sagging. Your surgeon may recommend an eyebrow lift instead of, or at the same time as, an eyelid reduction.
Only wrinkles in the skin which is cut away by the surgery will be improved. Folds of skin extending on to the cheek will not normally be improved. If you have wrinkles and saggy skin elsewhere on your face and neck, it may be useful to have a facelift or necklift (or both) – you may need to consult a plastic surgeon for this.
Botox (injections of the botulinum toxin) can also be used to smooth out fine wrinkles.
What are the main risks and complications of an eyelid reduction?
As with all operations, there are risks involved in having an eyelid reduction. Although the risks are unlikely, it is important to weigh them up against the potential benefit of the surgery. Discuss each of them with your surgeon to make sure you understand the potential complications and consequences.
Complications associated with the surgery
What to expect after the operation
Eyelid reductions for the upper lids, are usually carried out under a local anaesthetic with or without sedation (where the whole area is numbed with injections and you are awake but sedated to keep you calm).
The operation usually takes one to one and a half hours.
You might be given antibiotics to keep the wound clean.
You will go home the same day and a responsible adult should stay with you for the night. You may have an eye pad placed over both eyes so will need to be looked after for the first night.
Simple painkillers should be enough to keep you comfortable.
After the surgery you should not drive or use machinery for at least 24 hours, until you have recovered feeling, movement and co-ordination.
It is common to have watery eyes after an eyelid reduction, partly because of swelling under the conjunctiva (the membrane that covers the front of the eye and lines the inside of the eye socket) and partly because the tear ducts are swollen and do not drain properly. This will last a few weeks. Your surgeon will give you eyedrops to help to ease the feeling of grittiness. After surgery, the eyelids might look and feel tight when closed because of the swelling and because skin has been removed. If you cannot completely close your eyes at night you should apply some eye ointment before going to sleep. This tightness will ease as the swelling goes down.
Dressings
The surgeon may apply some paper suture strips to support the eyelids. They usually fall off themselves.
Cleaning the eyes with cooled boiled water is useful, and the surgeon may advise you to use eye drops or ointment. Sleeping propped up will help reduce swelling and will help you stay on your back. Using cold compresses on your eyelids for one or two days can also help to reduce bruising and swelling. Do not put ice directly onto your skin.
Stitches
The nylon stitches are usually removed after four to five days, and the other stitches at the first outpatient appointment. You will be able to use make-up soon after.
Recovery
You will be out of bed on the same day as your surgery. You may have a little bleeding from your eyelids for the first day or two after your operation. Dab this away gently with gauze squares or a clean handkerchief. Activities that increase the blood flow in your face (for example, bending over, straining, lifting or taking a hot bath) may increase the chance of bleeding, so avoid these for the first week. Sleep with extra pillows to keep your head raised and be gentle with your eyelids for at least another month. You can gently clean your eyes with wet gauze. You will be able to do light activities after one or two weeks. Most patients take at least two weeks off work after the operation, depending on their job. Do not lift heavy things for several weeks, and avoid sex for at least two weeks. With all activities, start gently. Do not drive until you feel safe and are comfortable wearing a seatbelt. Check your insurance documents if you are not sure.
Seeing the results
At first your eye skin may seem too tight and swollen, and you will have some bruising, which can be disguised with make-up and dark glasses. It can take a few weeks for the swelling to settle, and many months for the final result to appear. The scars will be pink for a few months, but eventually they become almost invisible. The scars may also become tight after a few weeks, but this normally settles after four to six months. Most patients are pleased with the final result, but some find their new shape difficult to get used to. This may happen to you.
Photos of patient taken pre-op and up to 5 weeks post-op
Your aftercare
What to look out for
Bleeding after surgery can cause swelling, a change in colour, and pain, usually just on one side. If the bleeding is inside the eye socket it can cause headaches and affect vision. If this happens, go straight to your nearest A&E department. The signs of an infection are pain, redness, swelling and pus in the wound, and you may also have a temperature.
