Our eyes are the most important features on our face and their beauty can be greatly reduced by excess skin creases and eye bags. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat-usually along with excess skin and muscle from the upper and lower eyelids. Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a facelift.

 

The normal aging process involves the stretching of the eyelid skin resulting in excess folds and wrinkles, and sagging of the fat around the eye itself, and appears as bulges in the upper and lower lids. Heredity is often an important factor when young or middle-aged patients exhibit changes that are usually associated with older age. These patients are fed up of comments from their friends that they constantly look tired, despite having had a good night's rest.

 

Although eyelid surgery can correct drooping upper lids and puffy bags below your eyes, it cannot remove crow's feet lines, or eradicate all eyelid creases. Any attempt to do so would invariably require excessive tensioning of the skin, which would result in a downward pulled or staring appearance of the eyelid. Nor does it improve or lift sagging eyebrows. Procedures such as laser skin resurfacing (for lines and wrinkles) and the brow lift (for sagging eyebrows) are designed for these purposes. Dark circles under the eyes may improve a bit following blepharoplasty, if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.

 

A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance. And while it is true that it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Additionally in some patients the procedure might improve vision by removing the excessive skin of the upper eyelids which can hang down and interfere with peripheral vision.

Am I suitable for this surgery?

The best patients are those who are healthy, psychologically stable and well motivated. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age. During your consultation we will ask you about your general medical history to identify any medical conditions that may increase the risk of blepharoplasty surgery such as thyroid disease, high blood pressure, or tear production disturbances.

The operation

Eyelid surgery is performed using either local or general anesthesia depending on the extent of surgery. In the former, the skin around your eyes will be numbed using an injection. This is usually accompanied by some intravenous sedation to make you feel relaxed and insensitive to pain. In the case of a general anesthetic you will be completely asleep. The type of anesthetic suitable for you will be discussed at the time of the consultation.

Whether the decision is for a local or a general anesthetic, it is most commonly performed on an outpatient basis.

 

The surgery usually takes between 45 and 90 minutes depending on the extent of surgery.

After the surgery

Following surgery you will have cool compresses applied to the eye region and be carefully observed for the first 3 to 4 hours, to ensure that no bleeding occurs which may spoil the final result of your surgery. The upper eyelid suture consists of a single very fine line beneath the skin surface. With the lower eyelids there are 3-4 fine individual sutures held in place with a small strip of tape. In both cases sutures are usually removed at around 3 days. In the transconjuctival technique mentioned above there are no sutures in place. You should expect the application of an antiseptic eye ointment postoperatively. This may blur your vision initially but this soon clears. A large pair of sunglasses helps to hide the effects of surgery. After your discharge please read and follow the postoperative instructions carefully.

Potential risks

All surgery carries some uncertainty and risk. When a blepharoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.

Summary

The chances are excellent that you'll be happy with your surgery, especially if you realize that the results may not be immediately apparent. The positive results of freshening your eyes and reducing a tired appearance will benefit your self-esteem and confidence and should last for years. But always remember the procedure can never halt the aging process. The clock can be turned back but you cannot stop it ticking.

On the upper eyelids the incision is carried out in the natural crease line that occurs approximately 1 cm above the eyelashes. The incisions may extend into the crow's feet or laughter lines at the outer corners of your eyes. Surgery here is designed to correct both the excess skin and the excess fat. After making the incisions, the excess skin and muscle is trimmed from the upper eyelids together with any fat, which is usually present on the area adjacent to the sides of the nose. The incisions are then closed with very fine sutures.

 

On the lower eyelids, the technique very much depends on the patient's individual circumstance and requirements. Therefore if the problem is mainly prominent lower bags without excessively loose skin, you may have what is termed as a transconjuctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. Alternatively, when loose skin needs to be trimmed, the incision starts underneath the eyelashes and extends 1 cm or so outwards into the crow's feet area. The skin is then lifted upwards and outwards, gently tensioning the area and overlapping skin removed. Before suturing, any bleeding points are meticulously stopped.

Your eyelids will probably feel tight and sore as the anesthetic wears off and it is normal for this to continue for a few days afterwards. Mild painkillers control this. A number of patients may experience a feeling of numbness in the eyelid region. This is to be expected and normal sensation usually returns quite quickly in a matter of weeks. However, rarely, this may be delayed and may take a few months.

After effects

Following surgery you will experience swelling and bruising around the eyes to varying degrees.There is frequently slight leakage of blood from the incisions, and your eyes may be gummy for a week or so, all of which can add up to a disturbing postoperative picture. The eyelids should be gently splashed with water and not rubbed in any way. The majority of the swelling usually subsides after the first 10 days postoperatively. Bruising however may persist for a longer period, even up to one month. Elevation of the head, avoidance of any stooping and the use of cold compresses reduce the swelling and bruising.

Scars

Scars will form as a result of the surgery. Overall, blepharoplasty scars heal relatively well. However variations in the healing process do occur from individual to individual. The scars along side the eyelashes almost always heal with a near invisible line after several months have passed. Those extending out into the crow's feet area can become a little reddened and lumpy requiring perhaps a little longer to settle completely. Massage of these scars speeds up the maturation process and is recommended in all cases.

Downtime

You should be able to read or watch television comfortably after 2-3 days. Contact lenses should be avoided for 2-3 weeks, and even then may feel uncomfortable for a while. It is advisable to plan on taking it easy for the first week after surgery. During this time get plenty of rest and allow your body to spend its energy on healing.
You should be able to go back to work by 7-10 days. Bruising can be masked with light makeup. You may be sensitive to sunlight, wind and other irritants for several weeks, so you should wear sunglasses and a sun block when you go out. It is especially important to avoid activities that raise your blood pressure, including vigorous sport, bending or lifting.

 

Complications that can occur include hematoma (a collection of blood under the skin that must be drained by the surgeon), minor infections, scar lumpiness or distortion (usually temporary), injury to the nerves of the eyelid and eye, and even blindness (extremely rare- about 1:100,000). Dry eyes or even excessive tearing can occasionally occur (usually temporary). Ectropion (pulling down of the lower lids) can occur as a result of excessive scar tissue formation. Massaging, as instructed, early on diminishes the chance of this happening. If it does occur however then more intense massaging to the lid will help alleviate this problem although in these circumstances it may take a couple of months to correct. Occasionally, if conservative treatment is unsuccessful then surgical correction is required.

 

Tiny whiteheads may appear under the skin at the site of the sutures, after your stitches are taken out. These can be removed easily with a very fine needle in the outpatients department.

 

You can reduce your risks by closely following our advice both before and after surgery.