What is a Blepharoplasty? 

Blepharoplasty means reshaping of the eyelid. This applies to the upper and lower eyelid. There is not a single operation which is done for all patients, but the surgery is tailored to individual needs and can involve many different elements such as skin excision, eye bag correction, tightening of the lower eyelid, lifting of the upper eyelid etc. Blepharoplasty does not correct the eyebrows or a lowered eyelid margin. For these conditions either an eyebrow lift or ptosis surgery are required 

What anaesthetic is used? 

An anaesthetic is a way of taking the pain away from the surgery. This can be done with a local injection of a numbing agent with the patient awake or by putting the patient to sleep.  

For the upper eyelids a local anaesthetic can be used if tolerated. For anxious patients, a general anaesthetic might be a better choice. 

What does the surgery involve? 

An upper eyelid blepharoplasty often involves the removal of an ellipse of skin and orbicularis muscle. In some mild cases the lid can be lifted. 

How long does the operation take? 

Upper eyelids take about 2 hours as a rough guideline (approx. 1hr per eye). 

How long is the hospital stay? 

Most general anaesthetic operations can be done as a day case and patients can go home about 3-4 hours after surgery if they are feeling well. 

Local anaesthetic patients can go home shortly after the operation unless there is a problem. 

Where are the scars? 

For upper eyelid surgery, the scars are usually in the eyelid crease extending roughly along the length of the eyelid, but can be longer or shorter, depending on individual needs. 

In most patients, the scars heal well and are not very obvious. However, some patients can develop thicker and more visible scars and it is not possible to predict who is getting this problem. 

What are the benefits? 

Blepharoplasty can be done for functional (=improved visual field if skin overhang obstructs the vision) or cosmetic reasons. Cosmetic surgery improves the appearance but is not medically necessary. 

What are the risks? 

Complications are uncommon but can happen and it is impossible to accurately predict or prevent them entirely. These include bleeding, bruising, swelling, infection, wound dehiscence (=gaping), sensory problems, pigment changes, overcorrection leading to difficulties with eye closure (lagophthalmos), scleral show or ectropion (outwards pull of the lower eyelid), double vision, dry eyes, unfavourable cosmetic outcomes and under correction with the potential to need further surgery. The most serious complication is bleeding in the eye-socket which can ultimately lead to blindness if not recognised and treated in time. The risk of this happening is 0.004% (about 1 in 30,000 operations). It is important to contact the surgeon / A&E department / GP if anything is not right. Fortunately, most complications are minor and can be treated without major intervention. 

What is the recovery? 

For the first 2-3 days, there can be a significant amount of bruising and swelling which tends to settle towards the end of the first week. After 2 weeks, most of the swelling and bruising have usually settled and can often be covered with make-up. Although most of the healing occurs in the first few weeks following surgery, some subtle changes are expected up to 3-6months or longer in some cases following surgery. This includes fading of red scars. Unless there are obvious problems, it is best to wait for about 6 months before considering revisional surgery. 

What can be done to optimise the outcome? 

Before surgery: 

A healthy lifestyle such as a mixed diet including protein and vitamin C as well as drinking plenty of fluids and getting enough fresh air can help the healing process. Smoking, alcohol, excessive caffeine and other unhealthy habits should be avoided. Smoking in particular is known to significantly increase the complication rate and can cause wound gaping, infection and unfavourable scars. Medical conditions such as diabetes, high blood pressure, blood-thinning medication or medications causing immunosuppression should be optimised by the GP or specialist beforehand to minimise the risks. This includes conditions leading to increased coughing or straining, because this can increase the risk of bleeding. 

During surgery: 

If a local anaesthetic is used, it is important to relax and to avoid sudden movements because sharp instruments are used near the eye. If there is pain or discomfort, the surgeon should be notified, and it is usually no problem to inject more local anaesthetic. Unless advised otherwise, the eyes should be closed to avoid injury. 

After surgery: 

Driving a car can be a problem in cases where there is increase swelling after the surgery and it is advisable to have a driver. Ice packs with a protective layer, such as a towel or cloth can reduce the amount of bruising, swelling and pain. Although this surgery is not excessively painful, regular painkillers for the first 48 hours can help. For the first few days following surgery, it is important to relax and to avoid strenuous activities or a dirty or dusty environment. The wounds should be left alone until the wound review. After about one week, the wounds can be gently rinsed with clear water and after 2 weeks, soap, ointment, make-up manual interventions are usually safe. Gentle massage along (but not across) the scar line twice daily for up to 1 year, using any kind of moisturiser will optimise the scarring process. 

*Please Note: This is for general information about this procedure only. It is not intended to be used as medical advice or to replace advice that your relevant healthcare professional would give you. If you have a particular medical problem, please consult a healthcare professional.