Eyelid Surgery (Blepharoplasty)
The ageing process causes the skin around the eyes to lose elasticity and the muscles to slacken which allows any fat to bulge forward and cause bagginess.
Loose folds develop on the upper eyelids and creases deepen on the lower lids. An eyelid reduction or tightening removes excess skin and fat from around the eyes to create a more wide-awake, younger look. We can operate on the upper, lower, or both eyelids.
Only the wrinkles on the area within the margins of your eye sockets can be removed by an eyelid reduction – it will not help reduce the effect or appearance of crow’s feet or laughter lines and you may wish to consider other procedures (i.e. Botox) to deal with them.
Before the operation
The most important thing to do is to talk with Mr Meagher so that there is a clear understanding of your desires and expectations, in light of any biological prerequisites. We want you to be well informed and have realistic expectations of the results.
Before eyelid surgery, Mr Meagher may ask you to see an ophthalmologist (specialist eye surgeon) to test for glaucoma, a disease affecting your eyesight, and problems with tear production.
He will examine your eyes, taking measurements and photographs for your medical records.
You will be asked to discuss your medical history, including information about any medical conditions, drug allergies, medical treatments you have received, previous surgeries including breast biopsies, and medications that you currently take. You will have to stop taking medication which alters blood viscosity, e.g. aspirin. As for all surgery, patients are requested to stop smoking at least 6 weeks prior to the operation.
If you decide to proceed with the operation you will be required to confirm your understanding of all aspects of the surgery and agreement to proceed by signing a consent form.
During the operation
Your surgery will be performed in a major hospital under a local anaesthetic and intravenous sedation for patients undergoing eyelid surgery, although general anaesthesia may be desirable in some cases. This may be the case if you are having surgery to both your upper and lower eyelids at the same time. It can take up to two hours for surgery on the upper and lower eyelids of both eyes.
For your safety during the operation, the attending anaesthetist will use various monitors to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.
During upper eyelid surgery, Mr Meagher will make an incision in the natural skin fold of your eyelid. Next, unwanted skin, fat, and muscle are removed to give the eye more shape. Once the incision is closed, the scar will be hidden inside the natural fold of your upper eyelid.
With lower eyelid surgery, Mr Meagher moves or removes fat from under-eye bags either through a direct incision just below the lower lashes or through an incision made inside the lower eyelid. A small amount of skin may also be removed, but the muscle that closes the eyelid is not touched.
A more recent surgical technique is to remove less fat than the traditional method and part of the fat is instead redistributed to correct the tear-trough deformity (the grooved area under the lower eyelid’s bag). This is to avoid the sunken appearance of eyes that have had too much fat removed.
If you have stitches that need to be removed, you will return to the clinic to have this completed between 3 and 5 days later.
After the operation
You can go home on the same day as your eyelid surgery or the next morning. It takes between 7 and 14 days to recover fully from the operation and the results can last for about 15 years for most patients.
Eyelid surgery is usually not painful or uncomfortable, but it is normal to get some bruising and this usually subsides quite quickly. You may also experience discomfort and swelling of the eye area. The discomfort usually goes away after a few days, but the swelling may last for up to 2 weeks. Contact Mr Meagher immediately if you notice any signs of infection, experience bleeding or a sudden increase in pain.
To speed your recovery and help prevent any complications, you must follow Mr Meagher’s post-op care instructions carefully, which may include:
- Apply cold compresses to the eyes to help reduce swelling
- Bathe the area around the eye to keep it clean
- Apply any eye drops and antibiotic ointment we give you to help with dry or itchy eyes and to reduce the risk of infection in the treated area
- Avoid exercise and strenuous activities for a week or so
After your surgery you may experience blurred vision, dry eyes, excessive tear production, difficulty closing your eyelids completely, lower eyelid sagging or asymmetry (uneven appearance of the eyes during healing). These are all temporary and the vast majority of eyelid procedures don’t create any side effects or complications. However, there are risks associated with any type of operation and this surgery is no exception. Mr Meagher will explain the possible risks, which are rare, but may include:
1. Pain: As with any surgical procedure, pain of varying intensity may occur following eyelid surgery. You will be prescribed some pain medicine to take in hospital and at home after your discharge, if you need it.
2. Infection: Infection does not happen very often and you will be given an antibiotic at the time of your surgery to prevent this. If you do develop an infection, see Mr Meagher as soon as possible. Most infections can be treated with an antibiotic but they can cause serious problems and increased scarring.
3. Haematomas: Haematomas are solid swelling of clotted blood within the tissue and they can happen after any surgery. The risk of infection is higher if a large haematoma or seroma ( a collection of watery fluid within the tissue ) collects immediately after surgery. Mr Meagher may use a surgical drain to help prevent small haematomas but, in some cases, Mr Meagher may need to re-operate to remove a large haematoma.
4. Poor wound healing is uncommon after eyelid surgery, however healing can take longer in cases of:
- Fluid accumulation
- Overly tight stitches
- Improper support during healing. After a blepharoplasty this “support” is usually provided using Steri Strips.
- Pressure against the scar tissue
5. If excessive skin is removed from the lower eyelid ectropion results whereby the lower lis is pulled down leading to a ‘watery eye’. If this is severe repeat surgery may be necessary.
6. Symmetry between both eyes can be difficult to achieve in blepharoplasty surgery.
Wound healing may also take longer in patients who have diabetes, or other medical conditions, or who smoke.
Eyelid surgery carries higher risks for those with glaucoma and dry eyes.
Other potential issues
Because of the very nature of cosmetic surgery, sometimes patients can be dissatisfied with the results.
Upper and lower eyelid surgery can make a dramatic difference in your appearance, especially if you have large bags underneath your eyes. The results of lower eyelid surgery through an external incision are likely to be more noticeable than the results of surgery performed through an incision on the inside of the eyelid. This is because the external incision allows Mr Meagher to tighten the skin and reduce some wrinkling as well. Generally the results of eyelid surgery last for many years.
Occasionally asymmetry between the eyelids can occur postoperativey this is usually subtle, is due to the difference in the amount of tissue removal from each side and seldom needs to be corrected.