What is a Blepharoplasty?
A blepharoplasty is an operation performed to achieve a rejuvinated, more wide awake look around the eyes. It can be performed on upper and/or lower eyelids.
As we get older, our skin loses some of its shape and tone. This loss of elasticity allows the skin around the eyes to sag and fat around the eye appears to bulge out. In the lower eyelid this causes bags and in the upper eyelid it manifests as a saggy, tired appearance.
What does the surgery involve?
In upper eyelid surgery, small incisions are made within the natural crease of your eyelids. Through the incisions, skin and sometimes fat is removed.The surgeon then closes the incision with fine stitches, hiding the scar in the natural fold of your eyelids.
In lower eyelid surgery, the incision is placed just underneath the eyelashes. The excess skin is excised and the fat can be removed or repositioned as necessary.
The surgery takes between one to three hours depending on whether it is upper or lower eyelids, or both.
Eyelid surgery can be performed either with a general anaesthetic (when you are fully unconscious) or with a local anaesthetic and sedation (you are awake but drowsy). The choice depends on how much surgery is being performed and your personal preference.
When you wake up there can be a slight throbbing or tenderness around the eyes. However, blepharoplasty is a fairly comfortable procedure and most people require minimal pain relief.
Eyelid surgery can sometimes be performed as a day case procedure. However, if both upper and lower eyelids are being corrected, an overnight stay is usually recommended.
You should arrange for an adult to take you home and stay with you for the first night if you have had a general anaesthetic.
What are the risks and side effects of surgery?
Having cosmetic surgery should be a very positive experience. Complications are infrequent and usually minor. However, no surgery is without risk and it is important that you are aware of these potential problems.
There will be bruising and swelling. Swelling usually settles by five to six days but bruising may take two to threeweeks to disappear. You may have blurred vision for a few hours or overnight.
Your eyes may be watery for the first two days and then dry and gritty for two to three weeks following surgery If this happens, you will be prescribed artificial tears to use during the day and some ointment to apply at night.
Sometimes, tiny, white cysts appear along the stitch line. However, if this does happen, they can easily be removed with a fine needle by your surgeon.
The risk of infection is rare as the eye area has good circulation. Post-operative bleeding is also rare.
There are general risks associated with all operations. Very occasionally a blood clot can form in the leg (deep vein thrombosis or DVT) which would require medical treatment. Part of these clots can also break off and move up to the lungs, causing acute shortness of breath and pain in the chest. This is known as a pulmonary embolus (P.E). This is very rare but can be life threatening. Developing a chest infection is uncommon but more likely to happen to people who smoke.
All risks will be discussed in detail at the consultation. However, if you have further questions or concerns, do not hesitate to discuss these further with your surgeon. Decisions about cosmetic surgery should never be rushed.
How do I prepare for surgery?
If you smoke, you should consider giving up six weeks before your operation. The longer you give up beforehand, the better. Smoking reduces the amount of oxygen in the blood and can increase the risk of breathing and healing problems after your operation. If you can’t stop completely, cutting down will help.
Following your first consultation, if you decide to proceed with surgery, a range of dates will be offered to you. Prior to your admission, you may be invited to attend the hospital for a pre-operative assessment with a nurse. Depending on your age and general health, routine blood tests and a heart tracing (ECG) may be taken. You will be given the opportunity to ask any questions you may have or raise any concerns.
If a general anaesthetic or local anaesthetic with sedation is given, you will be asked not to eat anything 6 hours prior to surgery. Black tea/coffee or non-fizzy drinks (nothing containing milk) can be taken up to two hours before surgery. Chewing gum should also be avoided six hours before your operation.
It is important to inform your surgeon, anaesthetist and nurse of any medicines (self or GP prescribed) or recreational drugs you take. Medicines containing aspirin should be avoided for two weeks before the operation since they increase the risk of bleeding during surgery. If there are any other medications that may affect surgery then this will be discussed with you at your first appointment.
After a general anaesthetic or sedation, you must not drive or operate any machinery for 24 hours. Even with a local anaesthetic, there may be some temporary blurring of vision due to the swelling.
What happens after the operation?
After the operation, you will stay at the hospital for a few hours or overnight to recover from the anaesthetic.
You will have bruising and swelling around the eyes and they may also feel watery. Your surgeon will recommend that you keep your head elevated for a few days to help reduce the swelling. You may wish to bring a pair of dark glasses with you to wear on the journey home.
It may feel tight when closing your eyes. Do not be alarmed by this. This feeling will disappear within a week or two.
The surgeon may prescribe some eye drops or ointment for you to apply.
Before you leave the hospital, you will be given a follow up appointment to see either the surgeon and/or nurse so that your stitches can be removed.
What is the estimated time for recovery, absence from work and return to usual activities?
Recovery times vary from one person to another so use the times given as a guide only. If you have any concerns during this period, do contact the hospital team for advice.
The fine stitches in the eye area are usually removed after three to seven days. Avoid applying eye make-up on the day you have your stitches removed.
Blepharoplasty post surgery time line
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1 to 3 days
Bruising and swelling get worse the next day or two after surgery – you will have black eyes.
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3 to 7 days
Fine stitches are removed. Bruising and swelling on the decline. You can wear your make up from about day 5.
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7 – 14 days
Bruising turning yellowish now.
No contact lenses for two weeks.
Back to work from 10 days onwards.
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6 months
Final result can be seen.