Eyelid Surgery (Blepharoplasty)

Cosmetic eyelid surgery or Blepharoplasty is an operation to remove excess skin, fat and muscle from around the eyes to correct droopy eyelids and bagginess under the eyes. It can be performed on the upper lids and lower lids, at the same time or separately.
As well as correcting droopy, baggy eyelids by removing excess skin, fat and muscle, blepharoplasty will remove wrinkles, but only those that are physically cut away. It will not remove "crow’s feet" and can’t change the color of dark shadows under the eyes.

Blepharoplasty is most often performed as a day case, with no need for an overnight stay in hospital. The operation lasts one to two hours, less if just the upper or lower lids are being done.

Blepharoplasty can be carried out under a local anesthetic, in which case the area around the eyes will be numb but the person will be awake. In other cases, a general anesthetic may be given, which means that the person will be asleep throughout the procedure.

Typically, people are required not to eat or drink for about six hours before a general anesthetic. However, some anesthetists allow a few sips of water until two hours beforehand. Some people having a general anesthetic may need to spend one night in hospital.

The operation may be done using either conventional or laser techniques. For surgery on the upper eyelids, cuts are made into the natural lines and creases in the lid, and into the laughter lines at the corner of the eye.

For surgery on the lower eyelids, a cut is usually made just below the eyelashes. This means the scars run along the eye’s natural folds, concealing them as much as possible. Excess fat, muscle and loose skin are removed, and the cut is closed using fine stitches. If only fat is being removed, sometimes the cut is made on the inside of the lower eyelid, leaving no visible scar.

After the operation, the eyes may be covered with pads. Sterile paper tape will be used to support the operation sites and an ointment may be applied to prevent the eye area from drying out.

• Painkillers will be given to help with any discomfort as the anesthetic wears off.
• Following a local anesthetic, people usually feel ready to go home after a short rest in a chair or on a bed.
• If the procedure is performed under a general anesthetic, a longer rest will be needed. A drip may be put in the arm to prevent dehydration until the person starts drinking enough fluid.
• Anyone who has a general anesthetic will need to arrange for a friend or relative to drive them home and stay with them for the next 24 hours.
• A general anesthetic can temporarily affect co-ordination and reasoning skills, so people are advised to avoid driving, drinking alcohol, making any vital decisions or signing legal documents for 24 hours afterwards.
• Before discharge, a nurse will provide advice about caring for the eye area and arrange a follow-up appointment with the surgeon. An eye ointment may be provided to use at home.
• Once home, further painkillers may be taken if needed, as advised by the hospital. Applying a cold compress, such as ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. Ice should never be applied directly to the skin.

There are some important things to remember while recovering from a blepharoplasty:

• Keep the head higher than the body by lying propped up on pillows, and avoid bending over for a few days – both will help reduce swelling and bruising.
• Clean around the eyes and use any ointment provided as instructed.

• Avoid applying eye make-up until a couple of days after the stitches have been removed, or as advised by the nurse or doctor caring for you.

• Avoid wearing contact lenses for two weeks (they may still feel uncomfortable for a while after that).

• Avoid driving until vision has returned to normal and the eyes have stopped watering.

Most people are able to read or watch television within a few days. The stitches will be removed after five to 10 days. People usually feel like returning to work after a week to 10 days. Most people experience no problems following a blepharoplasty. However, the hospital or a GP should be contacted immediately if the eyeball feels painful for more than a few hours after the operation, or if blurred vision lasts longer than three to four days.

Blepharoplasty is a commonly performed and generally safe operation. For most people, the benefits in terms of relief of their symptoms or improved appearance are much greater than any disadvantages. However, in order to give informed consent, anyone deciding whether to have this procedure needs to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but usually mild and temporary effects of a successful procedure. One possible short-lived side-effect is feeling sick after the general anesthetic.

There are also side-effects particular to blepharoplasty.  These may include soreness around the eyes, which can be helped by taking painkillers. Bruising and swelling for up to three weeks after the operation, which might make the eyes feel tight and difficult to close when going to sleep. The eyes may feel sticky, dry and itchy for the first week. The eyes may become watery for a few weeks. Some people have double or blurred vision for a few days. Some people may have sensitivity to light for a few weeks. Tiny whiteheads may appear along the line where the stitches were – the consultant can remove these with a needle. The scars will be pink and noticeable at first, but should become fine and less noticeable after a few weeks.
 

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Source: Published by BUPA's Health Information Team April, 2003

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