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Eyelid lift (blepharoplasty)

Introduction

Eyelid surgery (blepharoplasty) is a very commonly requested plastic surgery operation, which is unsurprising given the prominence of the eyes in the face, and the success with which the tell-tale signs of aging can be addressed by surgery. As we age, skin loses elasticity and muscles become more lax. This allows the fat that cushions the eye in its socket to bulge forwards, giving the appearance of eye bags as well as excess skin. A blepharoplasty procedure is designed to remove excess skin, tighten muscle laxity, and deal with bulging fat by either replacing it in its rightful position, or removing it completely. Where excess skin in the upper lids is impacting on vision, this will also be improved (by improving the visual fields). The result of the surgery is a more rested, alert appearance of the eye area, with scars that usually settle to the point of being unnoticeable.

Upper blepharoplasty may be performed alone, or in combination with a lower blepharoplasty. When performed alone, a local anaesthetic is used, and when combined with lower eyelid surgery, either local or general anaesthetic can be used. Similarly, a lower blepharoplasty may be performed under either local or general anaesthesia. If volume loss in the cheek area and/ or hollowing of the undereye area is an issue for you, I may suggest combining a lower blepharoplasty with some lipofilling. During this procedure, a small amount of fat is harvested from elsewhere on your body (usually the outer thigh), processed, and injected into the under-eye/ cheek area. More information is available on lipofilling here.

UPPER EYELID LIFT/ BLEPHAROPLASTY

  • Type of anaesthetic
    Local or general anaesthetic
    Length of surgery
    40 minutes – 1 hour
    (longer if combined with lower blepharoplasty)
    Nights in hospital
    0 nights (day case)
    Scars
    Upper eyelid

  • Recovery
    1-2 weeks off work
    4 weeks gentle exercise
    6 weeks strenuous exercise
    Follow-up
    5 days (dressing clinic)
    6 weeks
    6 months
    1 year

My approach

I will examine your eye area in the context of your entire face. I pay particular attention to the position of the eyebrow, as it is not unusual for patients to seek eyelid surgery, when the real issue is with the position of the brow: in these cases, an upper blepharoplasty is the wrong procedure to perform, and will not have the desired impact on your appearance. I also evaluate your facial structure in terms of volume, and advise you as to whether replacement of lost volume could enhance your result. I will also go through other options such as botulinum toxin injections, or laser resurfacing, if I feel that they will help achieve the result you are looking for. As is always the case with any cosmetic procedure I perform, I aim to produce a natural, reviatalised result that is balanced and proportionate with the rest of your features.

The surgery

The incisions are made in the natural lines of your eyelids, extending slightly out to the side in one of the natural creases that exist there. Depending on what is required in your individual case, excess skin and/ or fat is removed, the muscle tightened, and any additional procedure such as fat injections performed. Depending on the exact surgical plan and your preference, the procedure may be performed under either local or general anaesthetic.

Following the surgery, you will have some paper tapes (steristrips) at the corners of the eyes, and I will advise you on the use of eye drops and ointment. Your sutures will be removed approximately 5 days following surgery. Immediately after the procedure, you will have cold-packs over the eyes, and I advise you to continue using these at home, as well as sleeping with the head elevated in order to reduce swelling. The closure of the eyes will feel tight immediately after surgery, because of this swelling, and this can be expected to reduce over the week following surgery. Many patients notice that their eyes are very watery after surgery, which is partly due to swelling of the conjunctiva (chemosis), and partly because the tear ducts are also swollen and don’t tend to drain as readily. Bruising is normal after surgery, and can be disguised with make-up once your stitches have been removed.

Consequences and limitations

Your scars will be pink to red initially, but will fade in the months following surgery. These scars usually settle very well, but on occasion, unfavourable scarring may occur. Over and under correction may occur, and dry eyes may be a problem for some patients. You should let me know if you have a history of dry eyes when you see me at your initial consultation, as this may mean that this operation is unsuitable for you. Some grittiness is normal, and can be expected to settle with the use of eye drops and ointment. Ectropion (drooping of the lower eyelid away from the eyeball) is a complication that may occur with this procedure, particularly when too much skin is removed from the lower lid. Further surgery may be necessary to correct this problem. Damage to the small muscles that move the eyeball within the socket may rarely occur, resulting in double vision. A haematoma (blood clot) may form beneath the skin in the hours following surgery, and may require a drainage procedure. Blindness is an exceptionally rare problem (1 in 30000 cases) following this procedure, but obviously devastating should it occur, which is why I will always warn you of the remote possibility of this occurring. Any visual loss or severe pain should be reported as soon as it occurs.