Eyelid Rejuvenation (Blepharoplasty)
Eyelids involve an area of the face which often shows the signs of aging first. With time it is common to develop hooding of skin on the upper eyelids and sometimes bulging of fat in the inner or outer aspects of the upper lid. Skin excess on the upper lid is caused by the tendency of the forehead and brow to drop over the years due to the effect of time and gravity.
Gravity affects tissues of the lower eyelid even more by causing a descent of the cheek fat down, away from the lid. This further aggravates age weakened, slack structures of the eyelid resulting in wrinkling of the skin and bulging of the lid itself. There is a tendency for the lower lids to develop shadowy rings with the junction of the cheek and give an impression of tiredness.
Surgical solutions for upper lid ageing changes vary from patient to patient. In the simplest cases, effective treatment can be achieved by removing skin only, without resection of the fat excess (Pic 1 below). For some patients with dramatic descent of the brow and very marked skin excess on the upper eyelid, the best results come from a combination of repositioning the brow and also upper lid blepharoplasty. Similarly, in the lower lid, surgery can address skin and/or fat, but also other deeper structures like the septum, muscle and the very edge of the lid, all of which can loose its tone essential for youthful eyelid appearance.
Upper lid blepharoplasty on its own can be performed under local anaesthesia and is typically a day case treatment. General anaesthetic can be administered too, as per a patient’s preference. Surgery involves resection of skin excess from across the upper eyelid (Pic 2 below) and closure of the wound using very fine sutures. Scar are hardly noticeable 2-3 weeks after (picture 5 below).
Lower lid blepharoplasty is however typically and prefereably, performed under general anaesthesia. The operation involves making an incision just below the eyelid margin (Pic 3 below), which extends out to the side of the eye. Surgery addresses fine wrinkles by cautious excision of the skin excess. This however, often need additional excision and repositioning of the fat excess and/or tightening of the fine, inner septum of the eyelid.
Brow lifting is carried out as an endoscopic procedure through a series of small incisions made within the hairline. Using endoscopic instrumentation, the brow is released and elevated and then held in its new position by suspensory internal sutures. Brow lifting is an effective way of elevating the brow and also of smoothing out forehead creases if these have contributed to the ageing changes of the upper face.
A restful, physically calm schedule for the first 5-7 days after surgery is important to initiate good wound healing and prevent unnecessary rise in head pressure. It is also advisable and often more comfortable, to sleep on higher pillows for the first few days. Within the first 2-3 days, patients should spend several hours each day resting with moistened, cooling eye pads to help swelling and bruising resolve. Swelling and bruising as shown in Pic 4 is only evident during the first 3-5 days post operation.
Lower lid blepharoplasty and/or endoscopic brow lifting normally require a one-night hospital stay.
Risks and Complications
Recovery after blepharoplasty is usually very straightforward, especially if only upper eyelids have been operated upon. As with any surgical procedure, there are general and procedure (blepharoplasty) specific risks which patients must be aware of:
General Complications (especially if operation is carried out under general anaesthetic):
- Adverse reaction to general anaesthetic
- Clots in the legs/lungs
- Vein trombosis / inflammation (trombophlebitis)
- Bruising and swelling in the operated area (especially in patients on aspirin or anti-inflammatory drugs)
- Skin/wound infection
- Hypertrophic (lumpy and itchy) scars
- Delayed healing
- Numbness, alteration in sensation
It is typical for the lid margins to become bruised and swollen but this usually settles over 5-10 days. The eyelid margin can feel numb for several months following surgery and recovery of sensation may be accompanied by a pricking, tingling feeling, which settles with time. Scars from eyelid surgery typically heal extremely well although no guarantee can ever be given about the final quality of scars in any given case.
In the first few days after surgery it is common that the eyes feel watery. This is typically due to swelling and settles without any specific treatment. Occasionally the watering (and sometimes accompanying discomfort) can last somewhat longer, which may be due to persistent oedema of the conjunctiva over the front of the eye (chemosis). The latter usually responds very well to treatments with drops and ointments, but can in some cases symptoms can last for several weeks and occasionally requires more active management.
Infection is very uncommon the eyelid surgery, and typically present with redness, swelling, pain/grittiness in the eyes, fever, feeling unwell and ultimately discharge from the wounds. Most infections would respond to early treatment with oral or topical antibiotics.
Post-operative bleeding is a risk after any surgery. Following blepharoplasty the concern is of a bleeding into the wounds, which can tend to cause significant swelling, discomfort and difficulty opening the eye. Minor haematoma (blood collection) can often be dealt with by simply removing one or two sutures and re-dressing the wound, whereas more significant haematoma may require further surgery to remove any blood collected from the wound and to arrest any active bleeding occurring (this is extremely uncommon). Severe bleeding which develops in the deeper tissues and spreads behind the eye is a very rare but can cause blindness.
In older patients, with relatively poor support to the lower eyelid, surgery carries a greater risk of lid falling away from the eye or dropping down causing so called ectropion. Ectropion may in turn, require additional surgical treatment.
- Anticoagulation medication (Aspirin, Brufen, Warfarin, Clopidrogel) should ideally be stopped few days before the operation to reduce the risk of bleeding, but advise from the clinician who prescribed them is wise beforehand. I would strongly advise you to stop smoking prior to surgery as this can badly affect the outcome of surgery and increase complication rates.
- Please make sure that you arrange to be collected from the hospital as you will not be able to drive after the surgery.
- Plan your time off school / work / sports.
- Allow at least few weeks after surgery before considering a holiday.
I am keen to show patients schematic illustrations about the blepharoplasty and engage my patients with planning of their forthcoming surgery. I do believe that it is important to help patients gain basic understanding of what and how things will be done and where possible risks lie. During the consultation, I can show you the pictures on pre and post operative results achieved in some of my patients if this would be of interest to you.
This leaflet provides only basic and generic information. Full details and explanations are provided at the consultation as no two patients are the same and personal circumstances are highly individual. Patients will be provided with detailed leaflet, comprehensive informed consent on risks and complications associated with this operation, few of which are mentioned above.
If you have any concerns following your surgery please contact:
|Hospital stay||Day care for upper eyelids, one night stay if lower eyelids are operated|
|Anaesthetic||General for 4 lids; Local for upper lids only|
|Surgery time||1.5-2 hours|
|Wound healing||7 days|
|Shower / Bath||from week 1|
|Time off work||2-3 weeks|
|Sports and exercise||from week 2|
|Full recovery||2-3 weeks|