Blepharoplasty

Introduction and indications
Blepharoplasty (Eyelid tuck) is an operation designed on a bespoke and individual level to remove excess skin and wrinkles from the upper eyelids and/or lower eyelids, remove or recontour eyelid bags, harmonise the eyelid and cheeks, to minimize shadow, and refresh and rejuvenate the lids/face.
Blepharoplasty for both upper and lower eyelids encompasses a wide range of surgical procedures, ranging from simple excision of excess skin, to more complex re-draping and re-tensioning of the eyelids and removal of intra-orbital fat with or without removal of eyelid muscle. Canthopexy surgery may be incorporated to elevate the outside margin of the eyelids to produce a pleasing up-curve, and support the eyelids. Blepharoplasty can be combined effectively with brow lift surgery, which influences the position of the eyebrow, and maybe a required combination procedure to achieve the desired effect. Similarly blepharoplasty can be combined with variety of face – lifting procedures as required.

The Operation
Blepharoplasty techniques can be performed under both local and general anaesthesia, depending upon the extent of the individual surgical plan. Skin incisions are made in hidden creases, and maybe combined with an incision on the inside of the eyelid through the lining tissue (conjunctiva). Such combination approaches are determined by the specific desired effect. Eyelid incisions heal beautifully, and are amongst the most forgiving incisions used in any form of cosmetic surgery. The surgical time varies from one to two hours. After the surgery the patient awakes with white steristrip tapes applied across the nose and in the crow’s feet area, to secure sutures comfortably away from the eye. An eye pad is applied on both sides, which is comfortably compressed against the upper lid to prevent the eyelid opening beneath. The eye pad provides both comfort and protection from swelling. Occasionally a suture (Frost suture) is placed in the lower eyelid to suspend it to the upper lid. This helps minimise the effect of swelling which can displace the lids from their desired position. The eye pads and Frost stitch are removed at 24-48 hours, but may be left a week in particular situations. Regular checks of vision are made post operatively, and a cold compress is applied to reduce swelling and provide comfort. A semi – sitting position is preferred, with minimal neck movements for 24 hours. Mobility out of bed is encouraged, maintaining straight neck and back.

Recovery period
Blepharoplasty surgery provides relatively easy recovery, and an overnight stay is the longest that is usually required. Swelling and bruising can be persistent and apparent to the casual observer at a week. To more intimate friends, swelling will have disappeared by four weeks, and will be invisible by six months. Gentle cleaning with saline and cotton buds will remove crusting, and is performed initially under instruction. Bending at the neck and waist must be avoided for a week to reduce bleeding risk. Bending at the knees is preferred. An eye ointment for use at night and eyedrops (artificial tears, and/or a light anti-inflammatory steroid) are used to prevent early postoperative dry eye or discomfort from inflammation. Pain and nausea are uncommon. Removal of sutures occurs at any time from 3 -5 days, and is painless. Paper steristrip tapes may be replaced and are worn for a week. These should be kept dry, although hair may be washed backwards in the style of a salon. Gentle massage of the lids to reduce swelling is appropriate after suture removal. Physical exercise should be avoided for 2 weeks, and makeup can be applied after this time. Return to work is usually at 2 weeks. Return to driving reflects recovery of unblurred vision (often from eyedrops!), and is usually 10-14 days.

Possible Complications
Blepharoplasty is a low complication procedure, with a high satisfaction rate. Thee relative risks and benefits for the individual often differ, and are discussed by your surgeon at the time of consultation.

Postoperative Review
You will be seen each day in hospital by the surgeon or member of the team, who are on 24 hour call if the hospital ward staff require support. First outpatient review is at 1-2 weeks, and subsequently at 4-6 weeks and 6 months.