Blepharoplasty

Eyelid surgery can often be done in the office and is often performed with other surgery, such as a facelift. Most patients can go home the same day.The incisions around the eyes are marked and are hidden in skin creases. Local anesthetic is injected and the excess skin is cut away. Underlying fat is then trimmed as needed. The skin is then closed and a cool compress is applied. Some patients with excess fat of the lower eyelids and no excess skin can have an incision placed on the inside of their eyelid (transconjunctival) which is totally hidden. During the procedure the surgeon will create small incisions in the natural folds of the upper eyelid, and just below the lashes on the lower. Excess skin and tissue can then be removed, and the area will be closed with very fine stitching. The fine stitches aim to minimise scarring, but fine lines will be expected at first, though they will fade significantly with time. Blepharoplasty can be performed under local anaesthetic, though a general anaesthetic can sometimes be more suitable. You will usually stay in hospital overnight, but you should arrange to be off work for a week to allow the area to heal. Strenuous activity or sport should be avoided for at least six weeks. Some tenderness and minor swelling can be expected but will reduce rapidly and can be eased with painkillers.

As with any surgery, there are risks such as infection, bleeding, and scarring. Since the surgery does take place around the eyes, there is also the possibility of developing temporary vision blurring or dry eyes. Possible complications associated with eyelid surgery may include, but are not limited to, the following:

- temporary vision problems - double or blurred vision may occur after undergoing eyelid surgery. This typically lasts for just a few days following the surgery,

- eye closure problems - some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent,

- swelling or asymmetry changes - temporary swelling and a slight imbalance of one eye in relation to the other may occur during the healing or scarring process,

- acne - after the stitches are removed, tiny whiteheads may appear. The surgeon can remove the whiteheads with a very fine needle,

- ectropion - this extremely rare complication is the pulling down of the lower lids. Further surgery may be required in order to correct this symptom.

For the upper eyelids the incision is made in the natural crease line that occurs 1 cm above the eyelashes. The incisions might extend into the crow's feet or laughter lines at the outer corners of your eyes. Working through the incisions your surgeon will separate the skin from the subcutaneous layers and remove excess fat and trim sagging muscle and skin. The incisions will then be closed with very fine sutures. For the lower eyelids the incision starts underneath the eyelashes and extends out 1 cm or so outwards into the crow's feet area, the skin is then lifted upwards and outwards, gently tensioning the area and overlapping skin removed. Again the incisions will then be closed with very fine sutures.

There are several types of anesthesia but the most common forms are general, local and monitored anesthesia care. With a general anesthetic, you will be asleep during your surgery. With a local anesthetic, you will be alert during the surgery and only the incision location will be anesthetized. With monitored anesthesia care or MAC, you will be given medications to relax you and the incision location will be anesthetized. A blepharoplasty, depending on the extent of the surgery, usually takes one hour to complete. During surgery, incisions are made that follow the natural lines of your eyelids. Incisions are made in the crease above your eyelids and just below the eyelashes in the lower lids and are closed with a very fine suture. The incisions enable the surgeon to trim or remove excess fat, skin and muscle as needed. The lower eyelid can also be approached through an incision on the inside of the eyelid in cases when only fat needs to be removed. 

After blepharoplasty surgery, the surgeon will probably lubricate your eyes with ointment and may apply a bandage. Some bruising and swelling will be experienced during the first and second weeks, however the majority of the swelling usually subsides after the first 10 days. Your eyelids may feel dry at first, but eye drops can help with this. Any sutures are usually removed after 5 days. Scars will form as a result of the surgery. Overall these scars heal relatively well, but will differ in each individual patient.You should apply a cold pack for 24 hours after the surgery to reduce swelling and bruising. The amount of bruising varies from person to person but the peak of the bruising will during the first week and generally lasts between one and two weeks. You will be instructed on how to apply medication and clean your eyelids. The sutures will be removed two to seven days after surgery. You will begin to feel and look better 2-4 days after the surgery and especially after the sutures are removed. If the surgery was done through an incision inside the eyelid, no sutures will need to be removed.

Your scars will be pink for about six months but will gradually fade to a nearly invisible white line. Since the scars are located in hidden creases, you will barely notice them even while they are healing. After two or three days, you should be able to watch television or read. You should be able to return to work and feel comfortable out in public in a week to ten days. By this time you should then be able to wear make-up to conceal any remaining bruising. Sunlight, wind, and other irritants may irritate your eyelids so you will be instructed to wear sunglasses. You should avoid strenuous activities for about three weeks.