Eyelid surgery (blepharoplasty)

It is very important to make your surgeon aware, at your consultation, of any tendency to dryness of your eyes, any history of corneal injury or ulceration and any existing visual impairment or eye surgery.

Bring to hospital a pair of clean well fitting sunglasses. They should not rest on the skin around the eye. While these will help to mask the bruising, they also help prevent the eyes screwing up in response to bright light. Our usual warning to avoid drugs, tablets and medicines containing aspirin, ibuprofen or gingo biloba for two weeks before surgery, is particularly important before eyelid surgery. Nor may you smoke in the six weeks before and the six weeks after surgery.

If your operation is to be under general anaesthesia, you may remain in hospital overnight but will probably go home the same day. Some eyelid surgery can be performed under local anaesthetic as a day case.

For upper eyelid surgery, the incisions and therefore the consequent scar is placed about 9 – 10 mm above the upper lash line so that it will disappear into a natural crease upon eye opening. On the lower lid, the incision is placed just below the lash line where it will be inconspicuous. At the outer corner of the eye these incisions are extended into the natural creases.

Excess skin and over-developed muscle can be trimmed along with any excess bulging orbital fat. In the lower lid particularly, the orbital septum will be sutured with dissolving stitches to help conserve and hold the fat in place. This is a delicate operation and attention to bleeding points, no matter how tiny, is scrupulous.

The skin can now be sutured with a continuous suture. Some interrupted sutures may be placed at the outer corners. On top of this will be some steri-strips or surgical paper tapes. In the first hours after surgery moist pads will soothe the eyes and wick away any ooze to prevent crusting. An ointment may be applied.

In the immediate postoperative period and for the next four days, you will be positioned in as upright a position as possible and this includes night time. You should avoid bending where ever possible. Resting cool packs on the eyes and the use of ointment should help with minor discomfort.

The paper tapes must be kept dry and in position until removed by the BPS team at your follow up appointment in one week. It is common for the eyes to feel gritty in the days following surgery and they may be bathed by splashing gently with cool, previously boiled water or by using the supplied eyedrops. Avoid rubbing or toweling the eyes or disturbing the paper tapes. Should the eyelids stick together, they may be gently eased apart with a moist cotton bud.

Strenuous exercise, which includes jogging, heavy housework and any activity likely to increase blood pressure, should be avoided for 5 weeks. Continue to eliminate bending as much as possible.

After the sutures have been removed and the wounds are well healed at 14 days after the operation, camouflage make up can be used to mask the bruising and swelling. Initially sunglasses should be worn and thereafter sun block should be applied to any red, visible, scars for the next three to twelve months.

Some bruising and swelling is unavoidable but this will be minimised by following the above instructions in the section Preparation for Surgery.

Eyelid scars generally heal extremely well but there may be some lumpiness of the scars at the outer corner of the eye. This will settle in a few weeks. You may also be temporally aware of knots in the dissolving sutures under your skin.

Your eyes may feel more dry after eyelid surgery and contact lenses may be more difficult to wear for a short time. Due to tightening of the eyelids, your glasses prescription can change and you may have to have your eyes checked by your optician after surgery.

Depending upon your occupation, you may consider returning to work in two weeks. You should avoid driving for two weeks as this is a visually demanding activity and while there is swelling and the use of ointments continues, your visual acuity might be said to be compromised.

Hopes and expectations can be very high for eyelid surgery and in the great majority of BPS patients this level of satisfaction is achieved. The application of makeup becomes a pleasure again. Eyeshadow no longer disappears under loose skin. Sympathetic but unwelcome comments, about tired appearance, will hopefully cease.

It is not possible to guarantee symmetry of the lids after removal of skin and fat from both eyes and indeed significant asymmetry, of which you are unaware, may exist prior to the operation. Your surgeon will have the opportunity to assess this at your consultation. Look carefully at your eyes before surgery for they are often a different shape.

It should be remembered that such cosmetic plastic surgery can only partially set back the ticking clock of time and it cannot stop the ageing process. It cannot give you eyes that you did not have before.

Specific complications following an eyelid operation are uncommon or even rare, but you must be made aware of these before considering such surgery.

Infection of the wound is fortunately very uncommon in surgery around the eyes. In a few patients, the scars may become red raised and itchy over a period of 6-8 weeks and in some this may persist for up to 18 months.

Very rarely, the eyes may feel very tight after surgery, perhaps with more white of the eye showing or even with the lower lid turning outwards slightly. This usually resolves as the scars and swelling settle. If it persists then skin may have to be re-introduced into the eyelids.

There is a theoretical and rare risk of blindness with any operation or accident around the eye. The risk is said to be in the region of 1 in 12,000 and most cosmetic plastic surgeons will never encounter a case. The reasons for loss of sight are poorly understood and may be due to either a blood clot behind the eye, or reflex spasm within one of the blood vessels supplying the central nerve of the eye. If this does occur, the loss of vision can be permanent. Because cigarette smoke can cause spasm in a blood vessel, it is imperative to avoid it. When you are in the recovery area after surgery your vision will be checked. If there is a problem you will be returned to the operating theatre and the stitches removed to relieve any possible pressure.

The very existence of these rare risks is the justification for the extremely detailed care and attention you will receive from the Bristol Plastic Surgery surgeons and their team.