BLEPHAROPLASTY

The operation of blepharoplasty is designed to remove baggy skin and fat from around the eyes. Eyelid changes occur in some people due to an inherited tendency and in others as a natural ageing process. The operation is usually performed under general anaesthesia, with a one night stay in hospital, although it is possible to do a simplified, day case procedure under local anaesthetic on the upper eyelids only.

An incision is made in the upper eyelid crease extending into the area of the laughter lines on the outside of the eye. The main part of this scar (in the crease) can only be seen by other people when the eyes are shut.

The lower eyelid scar runs just below the eyelashes and again extends out into the laughter lines. The eyelid skin heals very fast to produce a red scar, which can be concealed by make up, in the time before it fades to an imperceptible white line after a few months.

There is generally considerable bruising and swelling immediately after the operation. This can be helped by sleeping propped up. Applying ice packs can also be helpful.

It is not generally a painful procedure and so simple analgesics (pain killers) are usually sufficient.

The swelling settles over a few days and has usually improved by the time you come back to the hospital (five days later) to have the stitches removed. The bruising can last rather longer than this but can be disguised by makeup.

You will be photographed before the operation as part of your clinical record. These photographs remain confidential and are kept securely.

Your GP will be given full details of your surgery and progress.

The hospital holds a pre-assessment clinic (PAC) which is run by the nursing staff. You will be invited to attend one of these clinics a week or two before the operation. They are intended as a medical screen to identify problems and carry out any necessary tests before the day of your surgery.

Before leaving hospital you will be given an outpatient appointment but if you have any problems, worries or concerns after discharge from hospital please feel free to telephone for advice. I can generally be contacted on 07850 484 672 but if I cannot be reached immediately a message can be left on my office answerphone (0208 463 0019) and I will get back to you as soon as possible.

Continuous, buried running stitches are used which need to be pulled out after approximately five days. The ends of the stitches stick out at each end of the wound and are stuck down with adhesive tape. There are four stitches in all, one for each eyelid.

Blepharoplasty can be combined with facelift surgery.

COMPLICATIONS

Anaesthetic complications exist as for any other operation.

Haematoma (blood clot) can develop under the eyelids due to continued bleeding after the operation. If there is excessive bleeding then another operation will be required as an emergency to stop the bleeding. In most cases however the bleeding stops on its own and merely produces more bruising and sometimes a red staining in the white of the eyeball.

The lower eyelid is sometimes pulled away from the eyeball after surgery and it can take a few weeks to settle down. This is due to swelling.

If too much skin is removed from the lower lids then there will be an abnormal shape to the eye with exposure of more sclera (white) of the eye.

Very rarely blindness can occur after blepharoplasty. Nobody understands exactly why this happens but it must be stressed that it is an extremely rare complication.

Very rarely the skin wound heals with a little bunching, lumpiness or overhang in which case a minor revision procedure is required but this can easily be done under local anaesthesia.

LIMITATIONS

Surgery does not remove all the wrinkles from around the eyes particularly the “crows feet”. Neither will it remove the vertical creases that some people have in their lower eyelids.

The aim is to reduce the bagginess of the skin and reduce some of the wrinkles but because the eyelids have to shut there will naturally be some creases. Contact lens wearers should avoid wearing their lenses for a few days after surgery. Distortion of the eyelid and eyeball may make wearing of lenses uncomfortable in the short term although this generally settles down. You will have to rely on your glasses for the first week or so.

If the lower eyelid skin is darker than surrounding skin before surgery then this will remain the same after surgery.

11/01/05