Eyelid surgery

This is best decided during a consultation, but generally the ideal candidates for blepharoplasty are women or men in good physical and mental health with reasonable expectations who have started to develop droopy upper eyelids or baggy lower eyelids. This may occur at any age, but usually starts in the early to mid-thirties. However, because the eyelids are one of the first parts of the face to show signs of aging, many have this part of the face operated on early to good effect, because once done, the rest of the face looks younger.

Many people who come to talk about upper eyelid surgery, need a brow lift instead. To the untrained eye, what looks like baggy, loose upper eyelid skin, is actually the result of gravity and skin laxity in the forehead and brow, which pushes the eyelids down. A significant number of patients who consult me about blepharoplasty, will be advised that they would benefit from a brow lift instead.

If you have thyroid disease affecting the eyes; dry eyes; glaucoma or retinal detachment, I will refer you to a specialist ophthalmic surgeon before proceeding any further.

First, I will take a full medical history and examine you completely; then I will focus on your face, and specifically your eyes. I will assess the shape of your upper and lower eyelids, along with your facial asymmetries – everyone has an asymmetrical face, and it is important to realise this before surgery, rather than notice it for the first time after surgery! This is especially important for surgery in the upper eyelid and brow regions where a slight pre-existing asymmetry can be magnified by surgery and become noticeable when it wasn’t so previously. 

Please come to your consultation prepared with some pictures of yourself 10 and 20 years ago, which along with some  photographs I will take during the consultation, will help us plan and discuss your operation. During our consultation, you will learn about the surgery, and we will discuss its limitations and risks. I will ask about your expectations and goals and by the end of it, we will decide whether I can realistically achieve them.

The incision is made along a natural crease/ wrinkle line. I then separate the skin from the underlying fatty tissue and muscle, and depending on your eyes, I may remove a minimal amount of excess fat, before trimming skin and muscle to rejuvenate your upper eyelids.

In the lower eyelids, incisions are made just below the lashes on the skin or hidden just inside the eyelid on the conjunctiva. Lower eyelid surgery is more extensive and challenging, and I usually combine it with re-shaping and re-draping the midfacial skin to rejuvenate the triangle of skin that is bounded by your eye, the nose and the naso-labial fold (which becomes more prominent as you age).

This involves re-shaping fatty tissue, tightening and re-draping the lower eyelid musculature and trimming excess skin. Along with this, in patients who need it, I may perform a lateral canthopexy to tighten the lateral part of eye and make it appear more youthful.

All skin incisions are closed with very fine sutures which will be removed after 3 – 5 days.

Occasionally, all that needs altering is a small fatty bulge in your lower eyelids, and these can be dealt with through incisions hidden just inside the eyelid on the conjunctiva (so-called transconjunctival blepharoplasty) leaving no visible scar in your lower eyelid.

Blepharoplasty can be performed under local or general anaesthesia. I am happy to perform upper lid surgery under local anaesthesia, but the midfacial rejuvenation I include in my lower blepharoplasty requires a general anaesthetic.

Before surgery, you will be assessed by your anaesthetist who will prescribe medications for your comfort and to lessen anxiety if need be. On the evening before, or the morning of your operation I will review what we have discussed and planned previously, and we will both sign your operative consent forms.

The operation lasts 1-2 hours but may be considerably longer if combined with operations on the face or brow.

After surgery, you will awake in a recovery area and soon afterwards you will be returned to your room. Most patients go home the day after surgery on simple pain-relieving medications and a short course of antibiotics.

You are likely to have swelling and bruising for several days after your surgery. Although you will notice a difference in the shape of your eyelids soon after surgery, the final result will become apparent gradually – starting from when the swelling resolves after 2 weeks and maturing over 2 months or so.

You will be given special cold packs to dress your eyes for 2 days after your surgery and for the first few nights after your operation I ask you to sleep with your head and chest propped up several pillows to help decrease the swelling.

Your vision may be somewhat blurred for several days after your surgery – in part because of your surgery and in part, from the ointment you will be given to apply to your eyes to moisten them just after the operation and when you go home. This ointment is necessary whilst post-operative swelling is present because during that period (usually less than a fortnight) your upper and lower eyelids may not close normally – especially when you are asleep.

You can expect to be up and about a day or so after the operation, but you should take life easy for a week or so and avoid strenuous exercise. Initially you may find it uncomfortable to read or watch television, but this will resolve after 2 – 3 days. You should not wear contact lenses for at least two weeks, and even then, wearing them may feel uncomfortable for a while.

Depending on your occupation, and whether your blepharoplasty was combined with other surgery, you should be able to return to work in 7 – 10 days. Bruising and swelling will resolve in 10 – 14 days and will usually be concealable with simple make up within a week.

The scars from your operation are positioned to be hidden within natural skin creases. Initially, during the inflammatory stages of healing they are red and visible, but ultimately, they will fade in colour. New scars benefit from friction-free massage (using Vaseline, for instance).

Beginning to massage the scars very gently 2 – 3 weeks after surgery, will help them mature, soften and flatten faster than if left to heal alone. New scars should be protected from sunlight for 2 years to avoid them pigmenting differently to the surrounding skin and becoming a different colour permanently. Factor 15 sun block should be applied whenever they are exposed – even to a British winter sun.