Upper blepharoplasty

What is a Blepharoplasty?

A Blepharoplasty is performed to enhance the appearance of the eyes, either by removing excess skin and/or fat from the upper and lower eyelids. This makes the skin of the upper eyelids less hooded or droopy and those of the lower eyelids, less baggy or puffy.

What will a Blepharoplasty achieve?

The procedure essentially rejuvenates the eyelid area. It is a popular procedure as the eyes are a focal point of the face.

Sagging or bagging of the lower eyelids is a relatively common problem. This becomes more apparent in most people with age and is due to the effects of gravity. Often there is a tendency for quantities of fat around the eyelid to prolapse forward over the bony rim of the eye. These appear noticeable as bulges or bags along the lower eyelid. Often this is accompanied by some laxity of the skin and/or wrinkles. The upper eyelid skin also becomes lax with age and in many cases, prolapsing of fat is also apparent, particularly on the inner aspect of the eye, where it appears as a bulge.

Eyelid hooding and bagging is often misinterpreted by other people as apparent tiredness.

Who should have a Blepharoplasty?

Most people request a Blepharoplasty in their middle years. Some people who have inherited problems of laxity of the upper eyelids, may seek treatment earlier.

How is a Blepharoplasty performed

Before the procedure you will be seen by the Surgeon and your eyelids examined. In some instances eyelid surgery will not be the procedure of choice. Sometimes it is preferable to do some other procedure, such as a brow lift.

The Surgeon will examine your range of eye movements and informally examine your vision. If you have impaired vision in one eye, it is important that the Surgeon be made aware of this.

If you are planning to have a lower eyelid procedure, it is important that the lower eyelid has good tone and function. Any laxity or tendency for the eyelid to pull down, or water excessively, will be looked for. This may be a contra-indication for eyelid surgery of the lower lid.

The Surgeon will discuss the advantages and disadvantages of general anaesthetic versus local anaesthetic with sedation. In most instances it is preferable to have the procedure done with intravenous sedation and local anaesthetic, as this permits a more rapid recovery period.

The Blepharoplasty procedure is carried out here at the Skin Institute. In most cases this is done under intravenous sedation. You will be admitted shortly before your surgery and interviewed by our resident Anesthetist.

The Surgeon will then see you and mark out the lines of incision on your eyelids and go through, again, the procedure in detail.

Once anaesthetized, the procedure will take approximately 1 hour for upper or lower lids.

Upper Lids:
An incision is made in the upper eyelid crease where the eyelid folds naturally when you open your eyes. This scar will become almost imperceptible with time. The excess skin is then removed in a crescent shape above this line, along with any excess muscle or fat. The wound is then closed with either interrupted, or a running suture. In some instances this will be a dissolving suture and in other instances, the sutures will need to be removed in approximately one week

Lower Lids:
The incision in the lower lid is made on the inside of the eyelid. Therefore there is no visible scar, once it is healed. Any fat is removed through this incision. This procedure may be done with a laser, which is used to seal off any bleeding blood vessels. The type of incision is decided by your surgeon and his individual assessment of you. The incision will have fine disolvable sutures.

If you have a lot of excess skin once the fat has been removed, the skin may require revising. This will mean a very fine incision line under your lower lashes to the outer corner of your eye. Your surgeon will inform you if this will be part of your procedure prior to surgery.

Your eyeball, itself, will be protected completely during the procedure with a metal shield. Antibiotic ointment is administered during the procedure to avoid any infection.

How will I be cared for on the day of my surgery?

You will be admitted to the Skin Institute approximately 1 hour prior to surgery. Although extensive pre-operative checks will have already been done, this is time for last minute questions with your surgeon and the anaesthetist. You are changed into our gowns and then placed in bed with a pre-med. After the procedure there is a recovery time of 1 hour when you will be given something to eat, dressings will be applied and instructions given ready to go home. It is not typical to need hospital admission but this can be arranged at the patient's request.

What do I do once I'm home?

You will be permitted home within approximately 90 minutes following your procedure with a person of your choice that must stay with you for a minimum of 24 hours. There will be swelling and some bruising. This can be minimised by applying cool packs regularly for 24 - 48 hours and sleeping well propped up. You can shower after 24 hours. Take all prescribed medication as directed. This includes an oral antibiotic, pain relief, eye drops and ointment. Detailed instructions and a prescription will be given to you prior to surgery.

It is important to avoid any over activity, bending over, alcohol consumption and vigorous activity for a week. Most patients are able to return to work after a one to two week period.

How will I look and feel after the surgery?

By the end of the first week your eyes may still be a bit swollen, but improving every day. Dressings will be removed after 24 hours so you can shower. Your sutures will be removed at approximately Day 5. By the end of the second week most of the bruising will have disappeared, sutures will have dissolved and you can start to think about resuming normal activities, including non strenuous work. You can wear make up to conceal any discolouration. By one month you may resume exercise; your new eyes would have started to settle. It can take up to 12 weeks to see your true result.

What do I do once I'm home?

You will need to take a few days off work. Most people are recovered within 7 days. To be on the safe side, it is advisable to take a week or 10 days off work. The eyelids heal very quickly following surgery, in most instances.

Possible Complications:

As with any surgery there are some risks that must be considered-

Haematoma:
This is a collection of blood under the skin. If this occurs, it may be necessary to release the haematoma.

Bleeding:
If any active bleeding occurs after the operation, it may be necessary to re-operate to seal off any blood vessels. Report any bleeding from the eyes.

Tightness:
It is not uncommon for the eyes to feel tight following the procedure. If a lot of skin has been removed, particularly from the upper eyelid, the eyelids may remain partly opened while sleeping. If this happens, it is important that the eye is kept moist with the drops or ointment during the evening while sleeping. In almost all instances this resolves in a few days.

Ectropion:
Excess laxity of the skin may be treated by resurfacing the lower eyelid skin. Resurfacing with the laser removes surface layers of the skin and permits tightening of the lower eyelid skin. This will be done only if you choose and only if there is sufficient laxity of the lower eyelid skin or wrinkles. The resurfaced area remains pink to red for several weeks following the procedure. For the first 2-3 days it is treated with dressings and then ointments. One of the possible complications of resurfacing of the lower eyelids is pulling down of the lower eyelid rim (Ectropion). In most instances this resolves completely and spontaneously.

Excessive fat removal:
If too much fat is removed, the eyes may appear sunken and hollow. It is therefore very important that a conservative approach is maintained. It is better to do a second procedure, than to overdo one procedure.

Vision:
Vision should not be affected by the operation. Blindness is an extremely rare complication following Blepharoplasty and is caused by uncontrolled bleeding. No cases have ever been reported in New Zealand.

Scars:
A thin scar in the upper eyelid area is noticeable for a few weeks following the procedure, but will always soften and fade with time.

Infection:
Infection is avoided by the use of antibiotic tablets and eye ointment. These will be prescribed to you following the procedure.

Taking everything into consideration, eyelid surgery is a very safe procedure with rare complications. The end result is almost invariably, a very satisfying enhancement of the eyelids and one's appearance generally.

Where do I go from here?

Before your surgery you will need a consultation with your surgeon to assess your suitability for the procedure, and to discuss possible undesired effects and contraindications, including bruising, puckering of the skin, and swelling. You will also have a consultation with a cosmetic nurse to prepare you for the surgery and discuss any concerns.

Blepharoplasty before and after photos >>

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