Blepharoplasty is an operation to remove excess skin from the upper and/or lower eyelids and to redistribute the fat that may have herniated (bulged out), where applicable. The aim is to restore a more youthful appearance to the eyes and ultimately the face.
As we age there is a loss of bone and soft tissue volume around the orbits of the eyes, resulting in several effects all of which, alone or combined, age the face and can give you a near permanent look of tiredness:
- Hollowing of the orbits leading to sunken eyes
- Loosening of the soft tissue capsule around the orbits leading to fat herniation (bulging)
- Loose, hanging skin (mainly on the upper eyelids)
- Dark ‘bags’ under the eyes
- Wrinkling of the skin of the lower eyelids
- Decreased skin quality
The above effects are exacerbated by other factors including:
- animation of the face over the years
- brow ptosis (droop)
- damage to the skin from sunlight and smoking
- Have excess skin on the upper eyelids that hangs down and may be blocking peripheral vision
- Bulging ‘bags’ under their eyes
- Want to improve self-image and esteem through trying to achieve a more youthful appearance. Blepharoplasty does NOT rejuvenate wrinkles to the side of the eyes (Crows feet) or between the eyes (Glabellar lines or 11’s). Chemical peels can be applied at the time of surgery to help with the fine lines and wrinkles around and between the eyes. Blepharoplasty is often performed with fat grafting/lipofilling around the eyes and to the cheek bones at the same time to help correct volume deficiencies.
Upper blepharoplasty can be performed both under a General Anaesthetic (you are asleep) or local anaesthetic (numbing injection) with/without sedation. The duration of surgery is around an hour.
Excess skin is removed, sometimes with a small strip of the underlying muscle and then repaired with dissolvable stitches on the inside and removable stiches on the outside – these are removed approximately 6 days after surgery. The scar is in the natural crease of your upper eyelid and can sometimes extend out in to your crows feet if there is a lot of skin to remove towards the outside of your eyelid (laterally). If restoration of fat volume is required at the same time then this again can be done either asleep or awake (under local anaesthetic).
Lower eyelid blepharoplasty is a little more complex in that it often requires no skin removal and when it does it is only a minimal amount. More commonly it requires re-draping of the fat bulging out in order to smooth the contour of the lid-cheek junction where the eye socket meets the cheek. Sometimes what is required is restoration of volume that is best done using your own fat (fat grafting/lipofilling) but can be done with HA fillers and no surgery to the actual eyelid. Small amounts of loose skin and wrinkles can be corrected by a number of methods, including chemical peel, with the most notable results achieved with the Bensipeel (Croton oil peel). Surgery can be done both asleep or awake, but is more commonly performed asleep. Fat grafting can be performed simultaneously and the chemical peel is more commonly done awake with oral sedation.
The best results are often achieved through a combination of surgical removal of the excess skin, fat grafting to restore the volume loss and peeling the skin to improve fine wrinkles and texture.
Fat grafting involves removing fat from one part of the body, usually the tummy, and injecting the fat around the orbit and on the cheek bones.
If you have either your upper or lower eyelids corrected then it is usual to go home on the same day as surgery, unless you have travelled a long distance. If you have both upper and lower eyelids corrected, then it may be advisable to stay one night in hospital as there is a chance that your eyelids can swell shut.
Immediately after surgery you will be asked to wear a cool pack to minimise swelling and help with comfort and potential bruising. This is something you can continue to do in the comfort of your own home. You will be encouraged to shower the next day after surgery, however you are to dab your wounds and dressings dry, let them dry naturally or to use your hairdryer on a cool setting to blow them dry – you are NOT to rub your wounds for one month after surgery. You are also to not wear contact lenses for 1-2 weeks after surgery.
You will be sent home with a couple of different eye drops to be used twice daily for 5 days to minimise the risk of eye symptoms such as sore, dry eyes and infection.
You will come for a wound check 5-7 days after your surgery and, if applicable, to remove stitches with Mr Davis. You will then be asked to return to see Mr Davis in clinic between six and ten weeks after surgery – earlier if required. Further follow-ups will be arranged at around six months after surgery or as necessary.
Bleeding & Haematoma
Bleeding can occur at any time in the first 10 days or so after the surgery so you should therefore avoid any trauma to your eyelid area and avoid strenuous exercise or anything that is causing your eyelids to be moving vigorously in any direction.
Your eyelids will usually become swollen and tender with a bleed and may develop bruising – if this occurs you should return for review as you may require a return to the operating theatre to explore and stop any bleeding vessel(s)and remove any blood.
This is a collection of clear/pale yellow fluid that essentially leaks and collects from the tissues as part of the normal reaction to surgery/injury. This nearly always resorbs over a period of weeks, but is occasionally large enough to warrant it being aspirated with a needle and syringe in clinic.
Whilst not common, should it occur your eyelids may be swollen, red, warm/hot and tender – not to be confused with the inflammation of healing. You may also feel unwell in yourself. This is treated with a 5-to-7 day course of oral antibiotics. Very occasionally an infection can result in part(s) of the wound coming apart – this is managed by a regular change of dressings and showering, and will be allowed to heal by itself over the subsequent four-to-six weeks.
Swelling &/or bruising
Swelling will almost certainly occur naturally and can take months to fully settle down. Bruising can be treated, unless contraindicated, with the use of Arnica or other such products should you wish.
Very occasionally a blood clot may form in one of the deep blood vessels in the leg (Deep Vein Thrombosis). Blood clots have the potential to break bits off that can travel up to the lungs resulting in a pulmonary embolus. As a way of reducing the risk you will be required to wear compression(TED) stockings on your legs from admission on the day of surgery until 2 weeks after surgery. You will also be encouraged to keep as mobile as is possible and to stay well hydrated.
Scars are by definition permanent, so will always be there. Initially scars can be red and with time should fade through pink to ultimately be pale and flat. Occasionally scars can become hypertrophic or keloid whereby they are raised, red, lumpy, itchy and unsightly or can stretch to become wider.
No two eyelids are ever completely symmetrical – they are “sisters not twins”. Despite best efforts to make the eyelids as symmetrical as is possible, minor asymmetries will remain after surgery. Very occasionally a notable asymmetry can occur that requires further surgery.
Very rarely the blood supply to the skin of the eyelids can be compromised resulting in skin dying – this is most common at the T-junction where the vertical element of the scar meets the horizontal aspect of the scar. This is managed, should it occur, with dressings until healed. Very occasionally the scar requires revising.
Very occasionally some of the wound can come apart for a multitude of reasons. This is almost always small enough to manage conservatively with dressings, allowing nature time to heal the area. Should any scar that forms be unsightly or an issue then this can always be revised at a later date, often under a local anaesthetic such as those used by the Dentists if putting your teeth to sleep for a filling etc.
These are little areas of skin and underlying fat/tissue that cause skin at the ends of your scars to sit a little proud. Often these settle with time and massage however occasionally they require removing under a local anaesthetic.
Further surgery in the future
This is likely to incur more costs