What Is Eyelid Surgery (Blepharoplasty)?


Cosmetic eyelid surgery to counteract drooping and remove unsightly bags beneath the eyes is also known as blepharoplasty. This extremely popular cosmetic surgery procedure removes fat, excess muscle and skin from the eyelids in order to improve the appearance of wrinkles, bags and droopy lids that make the face appear old and tired. The skin around the eye area is very thin and is one of the first areas on the face to show the signs of ageing, so perking up the peepers with this cosmetic surgery procedure can refresh the appearance of the face and leave you looking years younger.

Only a qualified cosmetic surgeon can determine whether eyelid surgery is right for you, but providing you are fit and healthy and have realistic expectations of what can be achieved then surgery can be a great way of giving you more confidence in the way you look.

Eyelid surgery is popular with both men and women and can be used to correct drooping, hooded or puffy eyelids and under eye bags that are either hereditary or caused by ageing. This can be purely for cosmetic reasons or because the drooping lids are obstructing their vision. It cannot help with dark shadows under the eyes or crow’s feet and fine wrinkles around the eyes.

Most people who have the surgery are over 35, although the surgery is performed on younger people where the droopy or baggy eyelids are hereditary.

Although the procedure is relatively simple, not everyone is an ideal candidate for eyelid surgery. Because the eyes are such a delicate area extra care should be taken when deciding whether not to opt for this procedure. Certain ophthalmic and medical conditions such as insufficient tear production, high blood pressure, diabetes, circulatory disorders, cardiovascular disease, or thyroid disease can make you unsuitable for surgery. Glaucoma and dry eye can also be complicated or aggravated by any form of surgery on the eyelids.

Heavy smokers are also not ideal candidates for any type of surgery as they are at more risk when undergoing general anaesthetic. If you do smoke, you’ll be asked to stop at least two months before the procedure, as smoking can also delay the healing process.

Having a thorough consultation with a qualified surgeon is the only way to discover if the procedure is suitable for you.

Droopy eye lids and under eye bags can make you look tired, sad and older than you are. Whether this is a hereditary condition or has been caused by the natural ageing process, cosmetic eyelid surgery can help. The procedure can open up your eye area, making you look younger and more alert. It can also improve your vision if you have severe drooping of the lids that is affecting your eyesight. Patient satisfaction with this procedure is very high as it has long lasting results and can dramatically change and improve the look of your eye area. Results differ from person to person however, so you need to make sure you have reasonable expectations of what the surgery can do for you.

Eyelid surgery is a minimally invasive and generally very safe procedure, which provides very good long-term results, however although there are many benefits there are also a number of risks and potential complications associated with the procedure, which should be carefully considered before you make the decision whether or not to go ahead.

Most complications of eyelid surgery are temporary such as the formation of whiteheads, or milia, around the eye, difficulty keeping your eyes closed while sleeping, temporary blurred or double vision, dryness and burning of the eyes, which can usually be treated with artificial tear drops and temporary problems with excessive tear production.

Infection, scarring and bruising are common side effects of any surgery however more serious side effects of eyelid surgery can include ectropion, hematoma, and retinal detachment. The risks of these complications occurring can be minimized by carefully picking your surgeon, following the post-surgery recovery instructions and the type of implant you choose.

Ectropion is a drooping effect that causes the lower lid to invert, requiring additional surgery to correct.

Hematoma is a serious complication involving blood accumulation beneath the skin. Hematoma is more likely to occur when eyelid surgery is performed in conjunction with another facial cosmetic procedure such as a face-lift or brow-lift.

Retinal detachment can be caused by holes or tears in the retina, occurs when the retina is separated from the outer layers of the eye. Retinal detachment also requires additional surgery to correct.

Infection can occur with any type of surgery. It usually happens within one to six weeks of surgery. In the majority of cases an infection can just be treated with antibiotics. Symptoms of infection include fever as well as severe tenderness, redness, and swelling. To avoid getting an infection, make sure you keep the area around your eyes clean.

Swelling is very common following eyelid surgery. You are most likely to be swollen around the incision areas. Iced eye pads or cold compresses can be used to help reduce swelling. Any swelling that does occur may result in blurry vision for several days after the procedure. You can help reduce the swelling by keeping your head elevated as much as possible, avoid excessive blinking as well as strenuous activities that increase blood flow to the eyes.

Bruising is fairly common after any surgery although not everyone will experience it. The amount of bruising you get will depend on the skill of the surgeon and the individual patient. While bruising is usually very minimal, if you have any large, firm, painful areas of bruising, contact your surgeon immediately as there is the possibility of developing a hematoma, which is a more serious type of bruise that will need treatment. However normal bruising should subside in one to two weeks.

Scarring will occur with any kind of surgery. The locations of your scars will depend on the technique used by your surgeon. In most cases scars will fade over time and will not be noticeable as they are usually hidden in the natural crease of the eye. More skilled surgeons are able to keep scarring to a minimum, so it’s important you choose a surgeon that has proven experience in performing blepharoplasty.

If you have had your eyelid surgery under general anesthetic, in combination with another procedure such as a face-lift or brow-lift then you also need to consider the risk associated with undergoing general anesthetic. You can experience side effects from anesthesia, such as a sore throat, headache, dizziness, nausea, vomiting, shivering, or muscle pain but these are usually temporary. It is very important that you let your surgeon know if you have experienced any reactions to anesthesia in the past.

The likelihood of serious complications arising from the procedure is typically influenced by the surgeon’s skill as well as the patient’s individual response to eyelid surgery. However, these severe risks can be avoided by following your surgeon’s advice and instructions.

Before making the decision to undergo eyelid surgery, you should find out as much information as possible about the procedure, the surgeon and hospital you are being treated at.

Always discuss the procedure with your clinic or hospital first and then go away and think about it before making your decision. You should also have a consultation of at least an hour with your surgeon before going ahead. Do not be afraid to ask any questions and make sure all of your concerns are addressed before you sign on the dotted line. The most important thing is to make an informed decision that you feel confident about.

During your consultation your surgeon should take a thorough medical history and give you a consent form to sign to make sure you fully understand the possible risks and complications. It is very important that you read this form carefully. It is also important to make sure your surgeon is aware of any medical conditions you may be suffering from such as high blood pressure, heart disease, and bleeding disorders, as these can increase the risks associated with blepharoplasty. It is also important to tell them if you have had laser eye surgery to correct your vision as this may also increase the risk of complications. You should also inform your GP about having the surgery in case there are any problems later on.

After examining you your surgeon will explain your options and recommend what type of procedure(s) you may need to achieve the best result. If you have drooping brows, they may also recommend you undergo a brow-lift.

Before your surgery, your surgeon may require you to be examined by an ophthalmologist (specialist eye surgeon) to test for glaucoma (a disease affecting your eyesight) and to make sure that you have no problems with tear production.

To prepare for your surgery you should:

  • Avoid taking aspirin or anti-inflammatory drugs for a period of 10 days before your surgery because they cause the blood to thin and make surgery more dangerous
  • Give up smoking at least two months before the procedure, as it increases the risks and can delay the healing process
  • Avoid drinking alcohol
  • If you take vitamin E supplements you should stop taking them in the weeks before your surgery. You should also avoid gingko biloba and ginseng, as these are believed to prolong the bleeding after the surgery
  • Continue to take prescription and daily medicines as long as they have been approved by your surgeon

While the directions for preparing for eyelid surgery may differ somewhat from surgeon to surgeon, there are some general guidelines you can follow to help ensure the procedure goes smoothly.

Make sure to shower and shampoo before the procedure and to wash your eyebrows. Cosmetics should not be worn. False eyelashes, contact lenses, jewellery, and any other unnecessary accessories should be left at home. The ideal type of clothing to wear on the day of surgery is a loose-fitting and comfortable outfit. Check with your surgeon about whether any prescription medicines or eye drops you regularly take may be taken the morning of your blepharoplasty.

It will also be helpful to ensure you have the following items at home for use after your surgery:

  • Ice packs
  • Clean washcloths
  • Clean bowl for cold water
  • Sterile gauze pads
  • Paracetamol
  • Bottle of artificial tears

Blepharoplasty is usually performed under a local anesthetic. Eye drops are used to anesthetize the eyes and protective contact lenses may be used to protect your eyes during the surgery. When the anesthetic has taken effect, a mixture of adrenaline and lignocaine (a local anesthetic) is injected into the eyelids before the surgery is performed. In some cases, you may be sedated for the procedure and in rare cases a general anesthetic may be used.

Cosmetic eyelid surgery can be performed using a scalpel or laser on either the upper or lower lid, or on both lids. How the procedure is performed will depend on the type of eyelid surgery you are having. Upper eyelid surgery is used to lift the lid by removing excess skin. Lower eyelid surgery removes excess skin and fatty deposits that cause under eye bags.

The operation usually takes between two and two and a half hours. It does not usually involve an overnight stay in hospital unless you are having it in combination with a face-lift or brow-lift so you will be able to go home the same day.

After your eyelid surgery it is very important to have someone to take you home. Your eyes will be sore, red and swollen for a few days and full recovery can take a number of weeks. If you have not had dissolvable stitches, then your stitches will be taken out after two to seven days.

You should be able to go out in public after a week to 10 days as most of the swelling and bruising will have subsided after this period of time. If you do go out it is advisable to wear dark sunglasses for at least a couple of weeks after surgery to protect your eyes from the elements.

Cold compresses can be used to help reduce the swelling and you should bath the area around the eyes to keep it clean. Eye drops may also be recommended if you experience any dry or itchy eye problems. Your surgeon may also provide you with an ointment to help reduce the dryness and keep the incisions lubricated. Applying a recommended antibiotic ointment can reduce the chance of infection but you may experience a slight blurring of vision as a result of using it.

Most people experience some pain after their surgery however for a lot of people this is only minor discomfort. Your eyelids will most likely feel sore and tight while the anesthesia is wearing off. To help reduce some of the pain, use the medication prescribed by your doctor.

You are advised to keep your head elevated as much as possible during the first few days of recovery to help minimize swelling and bruising. It is also important to get as much rest as possible during the recovery period as you may notice your eyes tire easily for the first few weeks.

You should avoid over exerting yourself for a few weeks after surgery as any increase in blood flow to the eyes should be avoided. You should also avoid straining your eyes by reading or using a computer as it can dry your eyes out. Wearing contact lenses should also be avoided. You should be able to resume normal activities after around 10 days.

To ensure a speedy recovery make sure you follow your surgeon’s instructions closely during this healing period. Contact your surgeon immediately if you notice any signs of infection or if you experience bleeding or a sudden increase in pain.