Eyelid reduction (blepharoplasty)

What is a blepharoplasty?

Blepharoplasty is a procedure for removing excess skin and fat from the eyelids. The aim is to give a more youthful appearance.

Who may consider a Blepharoplasty?

Folds of skin in the upper eyelid can be removed surgically. Skin is usually the greater problem in the upper eyelids although fatty bulging can also be a problem. In the lower eyelid the bulging of the fat behind the skin is usually more significant compared with the upper eyelid.

How is a blepharoplasty done?

Upper eyelid

The skin is removed in the line of the natural crease in the upper eyelid. A strip of muscle may also be removed from behind the skin. If there is excess fat bulging forward this can be removed. In the upper eyelid the greater problem is usually excess skin.

Lower eyelid

The scar runs just below the edge of the eyelid and extends out into the natural lines next to the eye. Usually much less skin is removed from the lower eyelid as compared with the upper eyelid. Excess fat is removed where it bulges forward.

Brow lift

The brow may drop with age and this will cause the skin of the upper eyelid to appear folded. Re-positioning the brow may improve the appearance of the upper eyelid.

How should I prepare for surgery?

Firstly you must be sure that you understand what is involved with the surgery. You must understand what the surgery can achieve for you and be sure that this is right for you. You must know how long it will take for you to recover and know about possible complications. If you have doubts or further questions you should ask your surgeon well before your operation. This may be possible over the telephone but usually it is better to return to the clinic. Smoking. Smoking increases the risk of complications from surgery. If you stop smoking 4 to 6 weeks before your surgery the risks are reduced. You should avoid aspirin type drugs for 10 days before your surgery. This type of drugs can increase the risk of bleeding.

What does the surgery involve?

You will come into hospital on the day of surgery. The operation is usually carried out under a general anaesthetic (asleep). Simple upper eyelid procedures can be performed under local anaesthetic if you prefer. You will normally stay in hospital for 1 night after the operation or it may be possible to go home the same day as the procedure. You will be prescribed regular painkillers and be given extra painkillers if you need them. Modern anaesthetic techniques help to reduce or even prevent sickness following surgery. A single suture (stitch) running under the skin is usually used for each eyelid. This is removed one week after the operation.

How long will I need to recover?

Immediately following surgery there is some swelling and bruising. The bruising and swelling improves over 14 days after the surgery. There may be some residual bruising and swelling for 3 or even 4 weeks. People vary in the time they need to recover following surgery. Most people will want to take at least 2 weeks off work and 4 weeks would be preferable for office type work. Generally you can start driving when you feel able but this is likely to be 5 to 7 days after the operation. It is illegal to drive with in 48 hours of a general anaesthetic. Obviously you must be able to drive comfortably and safely. Light exercise can start from 4 weeks building up to normal exercise after 6 to 8 weeks. Swimming should be avoided until the wounds are well healed which is usually about 4 weeks. A full recovery will usually take 6 weeks.

What results can I expect from a blepharoplasty?

The majority of women who undergo an eyelid reduction are very pleased with the results. It is important to understand that you will look quite bruised and swollen for 2 weeks after the surgery. There may be some temporary difficulty in closing the eyelids fully. This normally settles quite quickly. It may be sensible to use lubricating eye ointment at night for the first few days. The upper eyelid scar runs along the natural fold of the upper eyelid and extend out into the natural crease lines (laughter lines at the corner of eyes). The lower eyelid scar runs just below the eyelid and out into the natural crease line. These scars settle nicely in most people and are difficult to see. However it is possible to make poor scars which can take time to settle. Loose skin below the eyelids (where the eyelid meets the cheek) called festoons are not removed by a blepharoplasty. These can be removed but care must be taken to avoid pulling the lower eyelid down. Blepharoplasty is usually successful in reducing the excess skin in the eyelid and reducing fatty bulges.

What are the complications of blepharoplasty?

The following describes the principal complications of blepharoplasty type operations; it does not cover all possible complications. Serious complications are rare in healthy individuals however very rarely it is possible to have serious complications which can even be life threatening. Patients who smoke, are overweight or have medical problems such as diabetes are more likely to suffer complications and may not be suitable for this type of surgery.

Complications from the anaesthetic

Modern anaesthetics are very safe and serious complications are very rare in healthy people. You should discuss concerns about your anaesthetic with your anaesthetist. Your anaesthetist will give you drugs to control pain and sickness during your recovery.

Bleeding and haematoma (build up of blood under the skin)

Occasionally bleeding does occur after the operation and a second operation may be necessary to remove the build up of called a haematoma. If this does occur a normal recovery usually takes place after the blood has been removed.

Infection and wound break down

Infection may complicate any operation. It is unusual in facial operations as the facial skin has an excellent blood supply.

Poor scarring

Scars can stretch, be lumpy, stay pink or become brown (pigmented). Usually blepharoplasty scars are good.

Asymmetry

Asymmetry of the face is common and so may exist before the operation. Surgery is not an exact science and asymmetry may exist after surgery even where it was not present before hand.

Lid retraction

It may not be possible to control the exact position of the eyelid with surgery. The lower lid in particular may come to lie lower than the most desirable position.

Dry eye and irritation

Patients with eyes which suffer dryness and irritation before surgery may find that this is aggravated by surgery. If you suffer with dry eyes it may be better to avoid surgery.

Chemosis and watery eyes

Chemosis is swelling of the lining of the eyelid. Normally this settles with over time. There may be watering of the eye in the early period following surgery.

Ectropion

Ectropion is where the eyelid pulls away from the eye. This may affect the normal flow of tears. Usually it will settle as the eyelid swelling settles following surgery.

Blindness

Blindness is an exceptionally rare complication of blepharoplasty. It is thought to be due to removal of fat from behind the eyelids causing damage to blood vessels behind the eye.

Deep vein thrombosis (DVT) and pulmonary embolus (PE)

Deep vein thrombosis is a blood clot forming in the veins and a pulmonary embolus is where one of these clots breaks off and travels to the lungs, which can be fatal. This is a rare complication of surgery. Risk factors include, obesity, and the oral contraceptive pill. You can help to protect yourself by getting up and walking around as soon as you can following your operation.

What are the alternatives to a blepharoplasty?

You should consider if any of the alternatives to surgery may be able to achieve the desired result for you.

No surgery

Not having surgery is an option for most people as it is unusual for excess skin to cause a functional problem.

Topical creams

Minor wrinkling of the lower eyelid may respond to certain creams (eg topical retinoids).

Skin peels

Skin peels may improve the appearance of fine wrinkles on the lower eyelid.

Laser resurfacing

Laser resurfacing improves fine lines around the lower eyelid and may cause some tightening of the skin.

Where can I get further information

Speak to your General Practitioner

Your General Practitioner has a broad knowledge of medicine. Your GP will be able to examine you to decide if you should have any investigations. Your GP may recommend a surgeon or a hospital where they feel you will get good advice about surgery.

Outpatient consultation with a Consultant Plastic Surgeon

An outpatient consultation with a Consultant Plastic Surgeon will enable you to discuss what result you would like to achieve. They will also be able to make recommendations as to how best to treat you and whether there are any special considerations for you.

Department of Health (England and Wales):

www.dh.gov.uk search under – Cosmetic surgery and non-surgical cosmetic treatments. Independent and objective advice on cosmetic surgery from the department of health.