Cambridge Plastic Surgery

Plastic and reconstructive surgery, hand surgery and aesthetic surgery


Blepharoplasty
(eye lid surgery)

The skin and muscles around the eye become progressively looser with advancing age. The upper lid can form a fold of skin (called dermatochalasis), the lower eyelid can crease and bulge causing an obvious step-off between the lower eyelid skin and skin of the cheek. Cosmetic blepharoplasty is surgery to reduce these changes.

Blepharoplasty surgery

In the upper eyelid, a strip of skin, and varying amounts of fat are removed to reduce the upper eyelid fold. This can be performed under local anaesthetic, as day case surgery. The incision and the eventual scar, is hidden in the upper eyelid crease, but can extend onto the lateral orbital margin (the skin adjacent to the eyelids).

In the lower eyelid, excess skin is removed, bulging fat is either removed or repositioned. This is often combined with upper lid surgery, and can be performed under local or general anaesthesia. An upper lid blepharoplasty can take from 45 to 75 minutes, dependent upon the relative complexity of the procedure. A lower lid blepharoplasty takes from 60 to 90 minutes. It can be performed as day case surgery, provided the patient has a responsible friend or relative at home with him or her on the first night after surgery.

The incision and eventual scar is usually immediately below the eyelashes, but can extend onto the lateral orbital margin.

Upper eyelid ptosis

Patients with excessive drooping of the upper eyelid have a condition called ptosis. This is often caused by age related weakness in the muscle responsible for lifting the upper-lid, or disruption of the normal attachment of this muscle. Patients can report some loss of part of their visual field, or may find that they tilt their head backwards, or hold their eyebrows elevated (using their forehead muscles) in-order to lift their upper eyelids adequately. Ptosis will not be corrected by a simple upper lid blepharoplasty and can require a different operation (most commonly carried out by an oculoplastic surgeon) to tighten the upper eyelid muscle.

Botox®, and fillers.

Some patients considering blepharoplasty will achieve good results without surgery. Small creases around the edge of the eye and between the eyebrows can be corrected with Botox® injections. Creases in the “tear-trough” area can be treated with the injection of a filler.

Post operative care

Patients should sit or lie down, head up, for the first few hours after surgery. The intermittent application of cold compresses onto the eyelids may reduce the bruising and swelling. Patients should be able to comfortably open their eyes within a few hours of surgery, but should have someone responsible staying with them for the first night after surgery.

Eye ointment should be applied to the wounds twice per day for five days. Patients should expect some bruising and swelling for about one week after surgery. In rare instances this can persist longer.

Patients should expect some watering of their eyes, the local anaesthetic and swelling after surgery interrupts the normal drainage of tears. This usually settles after two or three days. Blepharoplasty surgery produces some bruising around the eyes, for most patients this is reassuringly modest, and settles in about one week.

Patients should expect some mild blurring of their vision, this may be related to the eye ointment or perhaps to swelling associated with the surgery. This usually settles over the first two weeks.

Sutures are removed by myself, or the plastic surgery nurse at about 1 week after surgery.

Recovery

Recovery time after any surgery can vary, most patients in clerical or managerial roles can return to work at about 9 days after surgery.

Risks

Bleeding after blepharoplasty could produce a collection of blood below the surgical wound, in rare cases this would need to be released by the removal of several sutures. Uncorrected and excessive bleeding has in exceptionally rare instances caused blindness (a risk estimated to be less than 1/10000).

Removal of excess fat can produce a sunken, or hollow appearance after surgery. Despite meticulous attention to detail, as with any cosmetic procedure, there is a risk of asymmetry. With any eyelid surgery there is a risk of scratching the delicate surface of the eye (the cornea) and a risk of a gritty sensation after surgery.

Ectropion (pulling of the lower eyelid away from the eye) has been seen after lower lid blepharoplasty, this is more likely in patients with poor lower eyelid muscle tone. In most patients this will correct over two or three weeks with regular massage of the lower eyelid (to breakdown any scarring or adhesions) and after the application of tape at night to support the lower eyelid (allowing the muscle tone to recover). In very rare instances this can require a second corrective procedure.

Further information about blepharoplasty:
Patients can find more information on the BAAPS website: www.baaps.org.uk/procedures/eyelid-surgery

To make an appointment
please call 01223 550 881 or email: igrant@uk-consultants.co.uk

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