Eyelid Correction (Blepharoplasty)
Who would benefit from this procedure?
Blepharoplasty (eyelid correction) can be performed on the upper or lower eyelids to remove excess skin or fat and address the effects of ageing. The upper eyelids can develop loose skin which rests on the eyelashes giving a heavy feel to the eyelids and can even interfere with vision. The lower eyelids can develop 'bags' which combined with loose, wrinkled skin can give a tired appearance. Surgery to correct these changes can make a significant difference and Mr Dheansa always ensures that the final result is as natural as possible.
This procedure is suitable for local anaesthetic in certain cases and can be combined with other surgery in many situations.
This operation is not as effective if the eyebrows have significantly drooped (brow ptosis). If this is present it may be useful to consider browlift surgery too.
How is it done?
Mr Dheansa tailors his approach to each patient and this often means there will be a slight variation according to the patient's needs.
The upper eyelids often require excision of skin and a small amount of the muscle underneath. In certain cases a small amount of fatty tissue may also need to be removed. The scar is placed just above the eyelashes and extends to the side of the eye to ensure that all the loose skin is removed. A running stitch Is usually used to close the skin and is removed after a week.
If only the upper eyelids are treated then the procedure can be performed under local anaesthetic (just the eyelids are made numb).
The lower eyelids often require an incision just underneath the eyelashes which goes out just past the eye. The skin is then lifted and the muscle separated to expose the fatty layer below the eye.
This tissue is then either removed or repositioned to remove the 'bag'. After this the lower eyelid is often tightened before the skin is re-draped and trimmed. The skin is sutured with a combination of running stitches and 'normal' stitches which are removed after a week.
Lower eyelid blepharoplasty often requires a general anaesthetic (you are asleep).
Upper eyelid blepharoplasty on its own can be performed as a day case procedure but lower blepharoplasty requires an overnight stay.
What happens before surgery?
You should have had a full discussion about the procedure, its suitability, outcomes, complications and long-term effects with Mr Dheansa. You should be clear about the incisions to be used, the area(s) to be treated, length of stay and the costs of the procedure. Knowledge of your general health will allow assessment of fitness for an anaesthetic. If you are unclear about any aspect of your care or the procedure itself you must contact Mr Dheansa (contact details below) to clarify the situation before committing to surgery.
After the Surgery
What happens after the surgery?
If you are planned to be a day case Mr Dheansa will review you once you have recovered from the operation. If all is well you will be able to go home. If you are planned to stay overnight then Mr Dheansa will review you in the evening and again the following morning. The only dressing you will need are the paper strips holding the sutures in place.
Mr Dheansa will normally see you a week after your operation. He will check your eyelids and make sure everything is healing well before removing the sutures. He will normally see you two to three times after that to ensure that all is progressing well. Lower eyelid procedures often need longer follow-up as the settling down period is often longer.
What should I expect post-op?
Massaging and moisturising should continue for at least 6 weeks. Mr Dheansa will be able to advise on any other requirements.
What can I do and not do at home?
Try to sleep as upright as possible for the first few days. This will help reduce swelling and discomfort. If possible use cold compresses as these will also help.
Washing your face or having a shower is possible but it is important to make sure the paper strips are not rubbed off.
It is best to take things easy in the first two weeks and only consider increasing activity after this time. You may need to avoid keep fit or sport for four eeks but it is best to discuss this with Mr Dheansa. Most people can return to work within a few days providing there is no strenuous activity. Swelling around the eyes may sometimes cause watering of the eyes or even blurred vision. If this is the case then it is best to avoid driving. If you have dry eyes then eye drops will be useful.
You can wash your face as often as you normally would. However it is best to avoid rubbing around your eyes for the first couple of weeks. Once you are fully healed it is best to gently moisturise the scar behind on your eyelids 2-3 times a day to help them mature. A simple moisturiser like E45 is ideal.
Will my scars change?
All scars go through a maturing process and go through a series of changes before settling down. This process varies from person to person as well as from site to site on the same person. Generally once a wound has healed the scar will be a thin pale line. Over the ensuing 6-12 weeks the scar may become raised, pink and wider. It often becomes itchy too. It then stabilises before slowly becoming flatter, paler and less itchy. This can take up to a further 12 months. Even after this time scars continue to improve but at a much slower rate.
Avoid sunlight on the scar for the first year to avoid it getting burnt and then subsequently dark. It is very hard to make it pale again. Mr Dheansa will advise you of any further precautions or actions if required.
Things to Consider
It is important to be prepared before and after your surgery. Here are a few things to consider about this operation.
Ectropion
The lower eyelids may become pulled down with the swelling. This can mean that the eye may water or be difficult to fully close. You may need to use eye drops while the eyelids settle. Rarely the eyelid may not return to its normal position and in this case a further procedure to re-position it may be required.
Corneal Exposure
If the eyelids cannot fully close, the cornea (the clear surface of the eye) can become exposed and cause problems with vision. Eye drops can help prevent this.
Abnormal Scars
Sometimes even if all heals well a patient may develop abnormal scars (pink, wide, raised and itchy). Patients may already have noticed such a tendency from previous scars. Such scars take a very long time to settle (up to 18 months) and may be difficult to treat. Scars may become thick and red. This is uncommon but often they settle down. On occasion there may be excessive scarring internally which can pull the eyelids down. This may need a release procedure to fully correct.
Asymmetry
People are rarely exactly symmetrical and the intention of any surgery is to get both sides as equal as possible. However, the healing process is not always predictable and may result in minor differences from one side to the other. Often eyelids are asymmetric (not even) before the operation and sometimes this might be the case afterwards. Mr Dheansa always makes sure that the eyelids are as even as possible.
Bruising/Swelling
Some patients may experience some bruising. This often results in increased swelling and some tenderness. The skin may become discoloured and take a few weeks to settle down. Bruising and swelling is often limited and usually resolves within a couple of weeks on the upper eyelids but is more often prolonged on the lower eyelids. It can take 6 weeks or so for the lower lids to settle. This swelling can occur on the inner lining of the eye (conjunctiva) as well as on the skin.
Numbness
The treated area will lose sensation (feeling) after the operation and it will take several weeks for it to return. Some areas may remain numb.
Pain
Usually controlled with painkillers and again often resolves within a week or so.
DVT/PE/Chest Infection
Clots in the leg (DVT) or lung (PE) or chest infection are uncommon with this operation.
What are the potential risks?
There are potential risks and complications with any operation and it is important to be aware of them before committing to any surgery. You may also have particular circumstances that affect the final outcome and these will be discussed with you at your consultation.
Anaesthetic
You will be assessed for fitness for anaesthetic and providing this is appropriate the risks from general anaesthetic are low. Anaesthetic can sometimes cause a reaction though this is very rare.
Bleeding
Rarely there may be significant bleeding under the skin that does not settle. Should this occur you may have to return to theatre to control the bleeding. This should not have any long term effect should it occur. There may be some bleeding under the skin which might need to be released. Again this is uncommon. Very rarely bleeding can go back around the eye and this can affect the vision (potentially permanently) if it is not promptly treated. Although very rare blindness has been reported as a complication.
Dog Ears/Change in Contour
Some wounds can result in a slight dip in the middle if the tissues are not elastic enough. Dips tend to improve over time. Conversely the ends of a wound may have slight bumps (dog ears) which again usually settle but may require a minor procedure to correct.
Wound Infection
Wounds can very occasionally get infected. If you notice increasing redness, pain or an offensive odour from the wound, contact Mr Dheansa as soon as possible. If this should occur you will need to have antibiotics and frequent dressings. The wound may take longer to heal and the resulting scar may be less than perfect.
Delayed Wound Healing
Sometimes if there is a lot of swelling or bruising or infection the wound may open up. In such circumstances you may need to have dressings for a few weeks and the resulting scar may be less than perfect. Although the eyelids generally heal very well, very rarely wounds open up after suture removal. This may require dressings for a little while.
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Frequently Asked Questions
How long is the operation?
About 60 minutes for upper eyelids.
90 minutes for lower eyelids.
When can I shower?
SEE 'What can I do and not do at home?' section above.
How long should I keep taking pain killers?
You will often need pain killers for at least a week but everyone is different you may need to take them for longer.
When can I go to the gym?
You should avoid the gym for about 4 weeks after the operation but check with Mr Dheansa first.
How long until the final result?
It takes about 6-8 weeks for your eyelids to settle.
When can I fly?
Generally it is ok to fly 2-3 weeks after the surgery but this depends on length of flight and your recovery. Check with Mr Dheansa before flying
