Eyelid Surgery (Blepharoplasty)

Blepharoplasty (upper or lower eyelid surgery) is an operation to achieve a rejuvenated, more wide-awake look around the eyes. It can be performed on upper and/or lower eyelids.

As we get older, our skin loses some of its shape and tone. This loss of elasticity allows the skin around the eyes to sag and fat appears to bulge out. In the lower eyelid this causes bags and in the upper eyelid it manifests as a saggy, tired appearance.

In upper eyelid surgery, small incisions are made within the natural crease of your eyelids. Through the incisions, skin and sometimes fat or muscle is removed. The incision is then closed with a fine suture, hiding the scar in the natural fold of your eyelids. The ends of the suture will be kept long to avoid tying knots that possibly cause problems. They are held securely with small pieces of tape and the suture will be removed at your first follow-up appointment.

In lower eyelid surgery, the incision is placed just underneath the eyelashes. The excess skin is excised and the fat can be removed or repositioned as necessary.

The surgery takes between one to three hours depending on whether it is upper or lower eyelids, or both.

Eyelid surgery can be performed either with a general anaesthetic (when you are fully unconscious) or with a local anaesthetic and sedation (you are awake but drowsy). The choice depends on how much surgery is being performed and your personal preference.

When you wake up there can be a slight throbbing or tenderness around the eyes. However, blepharoplasty is a fairly comfortable procedure and most patients require minimal pain relief.

Upper eyelid surgery is often performed as a day case procedure, whilst lower eyelid normally surgery requires an overnight stay.

As a precaution, you should arrange for someone to take you home and stay with you for the first night if you have had a general anaesthetic.

Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of possible complications.

Scarring – scars on the eyelids tend to settle remarkably well, so that the scars are barely perceptible. However, some patients heal with thick scars and this can make them more noticeable.

Bruising and swelling – this is very common and bruising may take a couple of weeks to settle. Many patients wear dark sunglasses to conceal this.

Watery/dry eyes – following surgery, your eyes may be watery or blurred for the first two days and then dry and gritty for two to three weeks. If this happens you will be prescribed artificial tears to use during the day and some ointment to apply at night. Patients who have a tendency to have dry eyes or blepharitis may find that blepharoplasty can make this worse and this will possibly become permanent.

Ectropion – this is pulling down of the lower eyelid which can lead to dry or watery eyes and may need further treatment. Patients with lax lower eyelids are prone to this and part of the surgery is to try to prevent this by tightening the lower eyelid.

Lid lag – if too much skin is excised from the upper eyelid then this could cause problems with shutting the eye at night. This may require further treatment.

Scleral show – this is when the white of your eye can be seen above your lower eyelid. This can occasionally occur following lower lid blepharoplasty and may require further surgery to correct the problem.

Milia – sometimes, tiny, white cysts appear along the stitch line. However, if this does happen, they can easily be removed with a fine needle at your clinic appointment.

Infection – this is rare as the eye area has good circulation.

Retrobulbar haematoma – this is an exceptionally rare complication, however, it occurs when fat behind the eye bleeds and places pressure on the optic nerve. If this is not recognised and treated then it can possibly lead to blindness.

Asymmetry – scars are never exactly identical under each eye. This is because our faces are asymmetrical and the scar is tailored to each eye.

DVT/PE – following any surgical procedure it is possible to develop a blood clot in your legs, which could potentially break off and move to your lungs. If the blood clot is large enough it could prove fatal. In order to reduce any risks of this we give you special stockings to wear in bed and a blood thinning injection if you are not mobile.

All risks will be discussed in detail at the consultation. However, if you have further questions or concerns, do not hesitate to discuss these further with me. Decisions about cosmetic surgery should never be rushed and be based on sufficient research and understanding.

Before you leave the hospital, you will be given a follow up appointment in the nurse clinic at 1 week to check that everything is healing well and that you are not experiencing any problems. The sutures will be removed. If you have dry eyes then we will prescribe you lubricating eye drops for the first 2 weeks. I will see you between 3 and 5 weeks or sooner if required.

After a general anaesthetic or sedation, you must not drive or operate any machinery for at least 24 hours. Even with a local anaesthetic, there may be some temporary blurring of vision due to the swelling. If you have increasing pain or sudden blurred vision then please contact me or the hospital for advice. In the unlikely event of an emergency, you are to visit your local NHS Accident and Emergency Department.

Recovery times vary from one person to another. Most patients return to work after one to two weeks. It takes approximately 6 months to get your final result, as eyelids are very prone to swelling.

Anne Dancey

I hope you find this information useful. If you have any questions or require a little more information then please do not hesitate to contact me.

Anne Dancey

Plastic and Reconstructive Surgeon FRCS(Plast), MBChB(Hons), MMedSci(Hons) and MCh(PASP)