Blepharoplasty refers to the removal of excess skin from the upper or lower eyelids. It also includes the possible removal or repositioning of the fatty tissue around the eyes which may be responsible for areas of bulging or puffiness. It is possible to combine surgery to both the upper and lower eyelids at the same time. This surgery is suitable for people who have noticed a laxity of the skin, which is often not apparent until the age of 30-40. It may be that the excess skin causes a problem with the vision, due to the excess upper eyelid skin causing hooding of the eyes or it may be that it is more an issue with the lower lids which give rise to the appearance of premature aging due to wrinkles or bulges. See the bottom of this page for examples and images.
Before surgery it is important to reduce or stop any medications that may make bleeding more likely such as aspirin, indomethacin, neurofen, clopidogrel or Warfarin. Mr McLean will advise you about this nearer to the time of surgery. The surgery can be undertaken using a local anaesthetic, local anaesthetic with sedation or a general anaesthetic. In most cases, local anaesthetic with sedation or general anaesthetic is used. If only the upper eyelids are undergoing surgery then it is possible to use only local anaesthetic, if this is preferred.
Surgery to the upper eyelids involves measuring the excess skin and then removing this. Any areas where the underlying fatty tissue appears to bulge are treated and then stitches are placed to close the incision. For the lower lids, the options for treatment are more varied. In some cases, there is no excess skin but purely bulging caused by the fatty tissue behind the eyelids. In this instance, it is possible to make an incision hidden behind the lower eyelid and then to reposition or sculpt the fatty tissue in order that the bulging is reduced. In other cases, the main problem is a lot of excess skin around the lower eyelids. In this instance, an incision is made just below the eyelashes along the bottom of the eyelids. Excess skin can then be removed and any fatty bulges treated at the same time.
At the end of surgery it is usual to place a pad over both eyes for 30-40 minutes, before returning to the ward. This helps to reduce post operative bruising and swelling. Once the pads have been removed then it is helpful to use 2 hourly ice packs held near to the lids. Ice packs are used at home for 48 hours after surgery. Ointment is used to protect the eyes at the end of surgery and this combined with the tightening of the lids due to the surgery will result in the vision being blurry after the operation. You will be given antibiotic drops and cream to use at home for the first week after the operation. This helps to prevent infection after the operation as well as lubricating the eyes which will feel gritty.
In most cases stitches are used and these need to be removed when you come back to the clinic after one week. In some cases dissolving stitches are used but this is not possible in every case. Bruising around the eyes can take 1-2 weeks to fade. However, post operative puffiness and swelling take much longer to settle. It is not uncommon to see a little residual swelling several weeks after the original surgery and so you must be patient to get the full effect of the operation.
Serious complications associated with blepharoplasty surgery are rare. Complications include: blurry or double vision for a few hours after surgery; watery eyes from irritation; dry eyes as the eyelids will feel ‘stiffer’ and harder to close for 1-2 weeks after surgery; bruising around the eye or more severely a collection of blood within the eye socket (a haematoma). A haematoma can threaten the vision unless drained urgently.
Other complications include: double vision secondary to damage to the muscles that move the eye; a drooping of the upper eyelid due to stretching of the muscle tendon; infection and a sunken looking eye if too much fatty tissue is removed from the eye socket.
Examples below are both upper and lower eyelid surgery (both before and after surgery – drag the line in the image to reveal each image).