Blepharoplasty (Precision Eyelid Surgery)

Excess sagging skin is most often due to age-related changes in the connective tissues of the skin and support structures of the eyelids. This condition may be typical for your family or associated with chronic conditions especially skin conditions such as dermatitis (eczema) or allergies. Chronic exposure to sunlight and cigarette smoking can worsen these changes.

Blepharoplasty is a very safe procedure for almost everyone suffering from droopy upper or lower eyelids. Although health insurance only covers conditions which impact your vision it is the most common cosmetic surgical procedure performed internationally. Some medications need to be stopped 1-2 weeks prior to surgery to avoid complications. There are some rare conditions that your surgeon will ask you about that may mean it is not an appropriate surgery for you but these will be reviewed at your preoperative assessment.

Removal of excess upper eyelid skin is carried out as day case surgery, generally under local anaesthesia. Occasionally the surgery is performed under local anaesthetic with sedation. You will lie on a couch in the operating room. Your face will be cleaned with antiseptic iodine solution and sterile drapes will be placed around your face. The surgeon will use a pen to mark out the skin to be removed. The ink will wash off later. Anaesthetic is then injected under the eyelid skin, which feels sharp and stings for about ten seconds. After this, the eyelid will be numb and the surgery will not hurt.

The excess skin and fat are cut away. The skin incisions are then closed with sutures, which will either dissolve or be removed in about 1 weeks time. At the end of the operation, the antiseptic is washed off, the ointment is put on the wounds and eye pads applied to the lids. One or both of the eye pads will be removed after about an hour. Eyelids normally heal very well and the wound is hidden in the natural skin crease of the lid.

After the surgery, the eye pads are left on for an hour or so to help reduce bruising. Do not worry if there is some blood on the eye pad when it is removed. If your eye feels sore when the anaesthetic wears off, we provide simple painkillers which are very effective in managing almost all postoperative pain. Normally, the discomfort will settle within a day or two. If you have severe pain, not relieved by simple painkillers, please ring the clinic for advice (see below).

You should not drive yourself home after the operation due to the medications we provide and possible impact on your vision from the surgery. Before you leave the clinic you will be given an ointment to use for a week or so after the surgery. It is normal for the eyelids to appear swollen and bruised for some time after this operation and there may be a little bleeding from the wounds in the eyelids for a short time.

The eyelids should be cleaned gently with tissues soaked in cooled, boiled water. Avoid rubbing of your eyelids for a period of 3-4 weeks. Most forms of light exercise and a normal work pattern may be resumed within a few days of surgery. Eyelid makeup can be worn from about three weeks after surgery.

• Bruising and swelling of the eyelids are common. This usually settles within 1-2 weeks. The surface of the eyeball may also swell (chemosis). These changes will settle after a few weeks.
• Dry, gritty eyes for a few weeks can be helped with lubricant eye drops and ointment. The vision may be slightly blurred for a few days.
• A postoperative infection may develop in the lids – they would become tender, red and swollen and the wound may break down. If this happens then you should contact the clinic since antibiotic tablets may be needed to help correct this and allow the lids to heal. It might be necessary to restitch the wound once the infection has settled.
• Bleeding after the operation is usually slight and stops within a short time. If bleeding continues you should contact the clinic in case further treatment is required.
• Extremely rarely, severe bleeding around or behind an eye can cause permanent loss of vision.
• Very rarely, too much skin is removed and if this causes problems with lid closure, the skin will need to be replaced.
• Sometimes some loose skin persists, often at the outer end of the eyelid and further surgery may be required if it still causing a visual problem.
• Unsightly scarring, persistent eyelid swelling or other unusual skin changes are extremely rare complications.