Eyelid Reduction (Blepharoplasty)

Eyelid Reduction (Blepharoplasty)

Our skin loses elasticity and our muscles slacken as we get older. This can result in folds of loose skin around our eyes. Our eyeball is cushioned within the socket by fat.  As the muscles weaken, sometimes this supporting fat can protrude forward, causing bagginess in the upper and lower eyelids.  The formation of bags due to protruding fat can occasionally run in families. This means that sometimes even young people can develop eye bags before any significant ageing of the skin.

The appearance of the eyes is often worse in the mornings.  This is usually due to an accumulation of fluid around the loose skin of the eyes during the night.  This fluid gradually disperses while the person is up and about.

A blepharoplasty may involve removing excess skin and protruding fat.  At times it is necessary to remove both skin and fat, sometimes only skin and sometimes only fat.  In the case of bags under the lower lids, the surgeon will sometimes redistribute the fat to give a smoother, even appearance, rather than remove it.

People with inherited tendency to develop bags under their eyes may decide to have surgery in their twenties. Others will be older, maybe mid thirties or more, as the ageing process is often more apparent in the skin surrounding the eyes than elsewhere.

Limitations

The skin near to the incision will appear temporarily smoother.  However, fine lines can reappear quite soon around the eye area.  Also, folds of skin which extend onto the cheek will remain, as will crow’s feet at the outer corners of the eyes.

Although the skin around the eyes will be tighter, the surgeon must leave a slight surplus around the upper eyelid to allow for adequate closure of the eye.

People who have a tendency to develop bags under the lower lids will often need the procedure repeated at some stage as more fat eventually protrudes from the eye socket.

Procedure

Blepharoplasty can be carried out under local or general anaesthesia. The surgeon makes incisions following the natural lines of the eyelids—in the creases of the upper lids for an upper blepharoplasty and just below the lashes for lower blepharoplasty.

Excess fat and sagging skin are removed through the incisions. If you do not need excess skin removed but have a pocket of fat beneath the eyes, this may be removed through an ncision inside the lower eyelid (transconjunctival blepharoplasty).  

Post Surgical Care

Keeping your head elevated in the early days can help to reduce swelling. Your surgeon may also advise cold compresses.

Steri-strips are applied around the incision lines to support the eyelids after surgery. The surgeon may also advise eye drops or ointment.Sutures are removed at 5 days and steri-strips will sometimes be continued for a week or so after this to support the lower eyelids.

You should expect to stay one night in hospital.

What to expect following surgery

Closing your eyes will feel quite tight at first due to the removal of skin and some initial swelling.  The use of eye ointment at night is often advised and is particularly helpful if closure is not complete.

The eyes will be watery but this will improve in a few weeks. There will be some bruising for the first week or  so. The scars will appear pink for a few months but will eventually become barely visible.

Risks

Although complications are not common, all surgery carries an element of risk. It is important that you inform your surgeon of any medical conditions such as thyroid disease, high blood pressure, diabetes and any eye disorders such as glaucoma.

You should also follow any instructions your surgeon gives you following surgery, in order to minimise any risks (you will be given a discharge sheet before you leave the hospital to remind you of any special instructions, along with details of your outpatients appointment).

A pool of blood can occasionally collect under the skin after surgery. This is called a haematoma. A haematoma may disperse spontaneously but may need to be drained if it is large. Avoid aspirin for a week before surgery to reduce the risk of bleeding.

It is not uncommon for the margin of the lower lid to be pulled away from the eye for a day or two after surgery.  This usually settles as the swelling subsides, but may occasionally require another operation.

You may experience a degree of visual disturbance in the first few days following surgery.

The information contained in this website is not exhaustive.  A full consultation with a suitably qualified surgeon is essential to ensure that your individual risks are assessed and to ensure that this type of surgery is suitable for you.

Sources/Further Information:

· British Association of Aesthetic Plastic  Surgeons (BAAPS)

· Department of Health Cosmetic Surgery: Information for Patients (August 2006)