Eyelid Surgery (Blepharoplasty)

Blepharoplasty is the term for operations that correct baggy, wrinkly or puffy eyelids. Although most patients are over 35, occasionally patients will seek treatment for puffy eyelids at a younger age, particularly when this is a family trait.

As the eyelids age, the stretched skin produces a "hooded" appearance and the outer corners of the eyelids also move downwards. Patients often remark that others sometimes ask if they are "tired or sad". Women may also have difficulty in applying makeup, particularly to the upper lids.

In most instances the problem is that of excess skin or fat in the eyelids which is addressed by surgery on the eyelids. The outer corners of the eyelids can also be elevated slightly with a manoeuvre named lateral canthopexy, and a movement of as little as 1 to 2 mm upwards is usually enough to produce a striking result. In some patients, the problem lies in the heaviness of the brow which contributes to the "tired" look and a brow lift operation is indicated. This is done using a small surgical telescope (endoscopic brow lift) and through hidden incisions in the hairline.

As the eyes are obviously the part of the face that most people notice a great deal, a well-executed blepharoplasty procedure can dramatically rejuvenate the face and "brighten" someone's appearance.

Types of Surgery

The upper lid blepharoplasty is performed through an incision on the upper lid itself to remove excess skin and some fat and better define the eyelid. A lateral canthopexy can also be added to lift the outer corner of the eyelids, as explained above.

The lower lid blepharoplasty is more complicated and the excess skin and fat are addressed separately. If excess skin is present, this is removed through an incision just below the lash line that heals nicely. Excess fat in the lower lid was traditionally removed (and still is by some surgeons) but this technique has been shown to produce unnaturally hollow lids which is not desirable and quite "aging" in itself. Many patients who have had this procedure in the past now need to have fat re-injected into the lid-cheek area to correct the problem. Instead of removing fat, the fat is redistributed and the orbital septum (the part of the eyelid which stops the fat from bulging out) is repaired and strengthened to create a much more natural and youthful lower lid than was possible with the older techniques. Again the outer corner of the eye may need to be reinforced with the additional techniques of canthopexy or canthoplasty.

What to Expect from Surgery

The operation may be performed under local or general anaesthetic and this will obviously be discussed with you prior to surgery. It is advisable to stop all blood-thinning medication prior to surgery. Smoking is also a cause of poorer tissue healing and should ideally be stopped for 2 weeks around the time of surgery.

After surgery, we suggest that the eyes are rested and cooled for the first 24 hours with ‘cool pads' to minimize bruising and swelling. The sutures are removed at 3-6 days and although the extent of bruising varies between patients, most of this has resolved by 7 to 10 days.

Contact lens wearers can generally use these again after 10 to 14 days. The scars on the lids fade quickly and are as close to ‘invisible scars' as we can produce anywhere on the human body! This is because of the special nature of eyelid skin which is unique and heals beautifully.

Summary

Blepharoplasty is one of the most commonly performed cosmetic procedures and generally produces very pleasing results with a brighter and fresher looking appearance.