Cosmetic Eyelid Surgery or Blepharoplasty

Blepharoplasty or cosmetic eyelid surgery can rejuvenate your eyes. It removes excessive upper or lower eyelid tissue, which can give your eyes an aged or weary look.

This is an operation to remove excessive upper or lower eyelid tissue which can impart an aged or weary look. When assessing for a blepharoplasty, there are a number of important factors of which to be aware. Importantly, various forms of eye conditions must be excluded such as dry eyes, the effects of hormonal diseases and ptosis (sagging) of the eyelid itself rather than the skin above the eyelid. Although an upper eyelid appears baggy, it may be in fact a ptotic forehead that has descended making an eyelid appear to be the problem. This problem can only be corrected by a form of brow elevation and not surgery to the eyelid. The preoperative assessment of the clinical state of the eye is of utmost importance.

Immediately preoperatively, the amount of skin and tissue to be excised is assessed and marked with a marking pen. Surgery can be undertaken under local anaesthetic, with oral or intravenous sedation or under general anaesthetic. The excessive tissue is then removed and this includes at least skin, possibly muscle and most frequently the removal of some fat is required. The greatest of care is undertaken to ensure that the eye itself is not injured. Incisions are undertaken in the skin crease of the upper eyelid to disguise the scar. The incision may be undertaken just below eyelashes of the lower eyelid or through the inner surface of the eyelid (transconjunctival) route for surgery to the lower lid. At the completion of surgery, non-dissolving sutures are used to close the skin and these require removal at 5-8 days following surgery. Immediately after surgery, cooling is applied to ensure that bleeding under the skin and therefore postoperative bruising is kept to a minimum. It is advisable to remain as inactive as possible 24-36 hours following surgery. Any concerns you have should be reported to me.

Postoperative course

Smoking should be avoided at all costs as it worsens wound healing and increases the likelihood of most complications. Usually, there is some discomfort on the night following surgery and this can be controlled using paracetamol (avoid aspirin). You will be given cooling to hold over your forehead and orbit but the pack should not contact the skin directly. These should be used for approximately 72 hours. When lying down, your head should be elevated above the level of your heart.

Complications

Postoperative bleeding is the most common and concerning complication and this along with increasing pain should be reported to me immediately. Haemorrhage into the eye socket is extremely uncommon but the greatest fear following blepharoplasty as it can result in visual loss. It is important preoperatively that no anticoagulants such as aspirin or herbal remedies are taken for two weeks before and after surgery. High blood pressure also needs to be controlled preoperatively. Bruising is a normal occurrence after this procedure and can be present for 7-10 days. The amount of bruising can be minimised by using cooling prudently even on the days following surgery. Avoid blood thinning agents such as aspirin and all herbal remedies pre-and post-operatively.

The risk of complications is greater in those who continue smoking before and after surgery.

The cornea of the eye can be damaged during surgery and this can lead to considerable discomfort but every effort is made to ensure that your eyes are protected and that instruments kept well clear of the eye.

Very rarely, nerves around the orbit can be injured with the major nerve of concerned being the supraorbital nerve. Less likely the nerves supplying the muscles to your forehead can be damaged causing a paralysis if a forehead lift is undertaken in conjunction with a blepharoplasty.

It is possible to excise too much tissue from the eyelid and this results in the inability to close the eye properly.

Infection of the wound is extremely rare as the blood supply to the surroundings of the eye is extremely good. Both infection and the wound edges separating occur very uncommonly.

Every attempt is undertaking to minimise the scar of the incisions.

Very rarely, too much fat is excised from the upper eyelid resulting in a hollowed out appearance.

Postoperative scarring following this approach is very uncommon as the incisions are usually well concealed in the creases of the upper eyelid.

In cosmetic surgery it is difficult to achieve exact symmetry and if studied carefully, even in the normal person there is some difference between sides.

Infection is an uncommon but possible complication. On occasion, a second refining surgical procedure is required.

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