Blepharoplasty

 

Introduction

As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing “bags” above and below.

Blepharoplasty is a common procedure to remove this excess skin and fat from the upper and lower eyelids. This gives a refreshed, alert and youthful look to the eyes. The upper eyelids no longer droop and the skin under the eyes is smooth and firm.

The procedure is normally done for cosmetic reasons but occasionally the excess skin on the upper eyelids is so much to cause obstruction of vision.

The procedure is usually done under local anaesthetic or sometimes under general anaesthetic. It takes about an hour to two hours depending the amount of work that is required or if both upper and lower eyelids are being corrected.

The incisions are well hidden in the creases of upper and lower eyelids.

Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift. It is best suited for men and women who are healthy, non smokers and usually above 30-40 years old.

 
Consultation  

In the initial consultation a complete medical history is discussed. Especially relevant facts are allergies and any on-going medications and history of smoking.

Most important are any conditions that may affect the eye i.e. dryness, excessive irritation or watering of the eyes glaucoma etc. Any information from the ophthalmologist should be provided. You should carefully consider your goals and expectations for this surgery.

 
Preparing for your surgery

Specific instructions are given regarding smoking and avoidance of certain medications prior to surgery. It is especially important that aspirin, non-steroidal medications like Ibuprofen, naproxen, nurofen are avoided at least a week prior to surgery. These drugs can lead to increased risk of bleeding and haematoma formation.

This operation is usually performed as a day procedure. However driving immediately afterwards is unsafe and arrangements should be made for transport prior to going home and maybe for a few days later.

A request for clinical photography will be made prior to surgery.

 
The Operation

Blepharoplasty can take up to three hours. This depends on the degree of surgery and if both upper and lower eyelids are being corrected.

This incision lines are marked prior to anaesthetic infiltration. These are placed in the natural creases of the upper and lower eyelids.

Underlying fat, along with excess skin and muscle, is removed during the operation.

 
Anaesthesia

This is usually a local anaesthetic infiltrated with a very fine needle.

 
Postoperative care

An antibiotic ointment will be prescribed to be used twice daily.

There is moderate bruising and swelling of the eyes. It is advisable to keep the head elevated for a couple of days especially at night by using a couple of pillows. Cold compresses also help to ease the swelling. There may be some dryness of the eyes and sensitivity to light. This is due to the slight tightness of eyelids and inability to close the eyes properly. This rapidly settles. The regular use of the prescribed eye drops and medication help ease the symptoms. Wear sunglasses and a sunblock when going out.

You should be able to read or watch television after a couple of days. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

The stitches will be removed seven days after surgery.

 
Scars

The incisions for blepharoplasty are placed in the upper eyelid folds and just below the eyelashes on the lower eyelids. On the outer aspect of the eyes they blend into the crow’s feet creases. Healing is a gradual process, and the scars may remain slightly pink for several weeks or more after surgery. In most people they fade to a thin, white line.

 
Risks

All surgery carries some uncertainty and risk.

Complications are infrequent and usually minor. These include blurred vision for a few days, transient swelling of the eyelids, and a slight asymmetry in healing or scarring. Occasionally some whiteheads (milia) appear in the line of the incision. These can be easily corrected with needling.

There may be an inability to close the eyes at night. Rarely this may be permanent. Another infrequent complication is ectropion, a pulling down of the lower lids. This is usually temporary but further surgery may occasionally be required. Blindness has occurred on exceedingly rare occasions following blepharoplasty.

A few medical conditions make blepharoplasty riskier. They include thyroid problems such as hypothyroidism, thyrotoxicosis, and dry eyes. A history of detached retina or glaucoma is also reason for caution and you may require an ophthalmic opinion before surgery.

 

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