Blepharoplasty

What is blepharoplasty?

Blepharoplasty is an operation to remove excess tissue from hooded upper and puffy lower eyelids.  Surgery is done for functional reasons to improve vision if there is marked hooding, with extra skin folds overhanging and impairing the vision or causing fatigue.  Surgery is cosmetic if the excess tissue removed is to restore a more youthful appearance.

NB  In some patients with hooded upper eyelids and overhanging skin, that causes an eyebrow droop, blepharoplasty may not be the first line of treatment and could worsen the appearance of the eyebrow droop.  A brow lift operation to raise the eyebrows may be more appropriate.  This will be discussed with the patient after the face and eyelids have been examined.

Are you a candidate for blepharoplasty surgery?

The oculoplastic surgeon will examine the whole of the face, forehead, eyebrows and eyelids, to determine the appropriate surgery. They look especially at the relationship between the eyelids and the brows and the surface of the eyes to exclude dry eye.  The vision is measured, eyelid and brow measurements made, and photographic documentation taken.

What happens at blepharoplasty surgery?

Upper eyelids: Upper eyelid blepharoplasty is usually done under local anaesthesia, as a day case.  Local anaesthetic drops are placed on the eye and a small bleb of local anaesthetic is given into the upper eyelid to numb the area.  The amount of excess tissue to be removed is carefully outlined, a short skin incision is made in the natural skin crease and around the area of tissue to be excised, delicate layers of muscle and fat are shaped out.  The aim is to remove the excess tissue without damaging eyelid function and eye comfort.

Lower eyelids:  Lower eyelid blepharoplasty may be done under local anaesthesia or general anaesthesia (asleep).  Only very small amounts of skin muscle and/or fat are removed from the lower eyelids.  There can be the addition of a chemical peel or laser to the skin.  

Protruding fat and excess skin are removed usually through a small incision made just below the lower eyelashes (subciliary incision).  It is also common for the surgeon to remove fat bulges from inside the eyelid (transconjunctival) without taking any skin.  The scars that result from these incisions are usually inconspicuous once healed.

NB Many patients do not need any fat at all removed during surgery or they will get a sunken looking eye.

What happens after my blepharoplasty surgery?

The eyes may be padded for the first 1 to 2 hours to reduce bruising and swelling.  The eyelids will usually appear swollen for a few days after surgery.  Ice packs are recommended, and sitting upright and sleeping with four pillows will help reduce excess swelling around the eyelids.   Your surgeon will give you lubricant drops and ointment to reduce the sensation of grittiness and dryness.  

Blepharoplasty is not a very painful operation, but you may take Paracetamol, if need, but should avoid Aspirin based components which can cause increased bruising.  Most forms of light exercise and a normal work pattern may be resumed within a few days of surgery and eyelid make-up worn from about two weeks after surgery.

What are the risks and side effects of blepharoplasty surgery?

Complications in the hands of an experienced surgeon are few and precautions are taken to minimise the risks.  Possible complications after blepharoplasty surgery include:

• Bruising (common and often unpredictable).
• Local swelling, which is temporary.
• Swelling on the surface of the eye (chemosis) for 1 to 2 weeks after lower eyelid blepharoplasty.
• Slight blurring of vision immediately after surgery from local drying and the ointment.  If the blurring persists for more than 24 to 48 hours your surgeon must be informed.  
• Dry, gritty eyes for 2 to 3 weeks helped by lubricant eye drops.
• Infection is rare.
• Bleeding around the eyelids or behind the eye, which may cause loss of vision if not managed rapidly or appropriately.
• Lower eyelid malposition or eyelid sag (ectropion) with an inability to completely close the eye, causing soreness, dryness and an unsightly appearance, due to excessive skin removal from the lower eyelids.
• Poor blinking, inability to close the eyes completely and eye surface problems due to excessive skin and muscle removal can aggravate a pre-existing dry eye problem.    
• Hollowed look if excess fat is removed from the lower eyelid.