Mrs Dalia V Nield FRCS(Ed)   FRCS(Eng)

PROCEDURES: Blepharoplasty

Eyelid Reduction (Blepharoplasty)

A Blepharoplasty is an operation to reduce excess skin and fat (“bags”) in the eyelids that develop with age. It is a very delicate and beautiful operation that gives a fresh look, a “not tired” look.
When we age, the skin looses elasticity and “overhangs” the eyelid, giving an appearance of hooding; sometimes a fold of skin can touch the eyelashes and even obscure lateral vision. In the lower eyelid the skin excess appears as wrinkles and fat herniates underneath to give the appearance of “bags”.
Patients complain that they appear tired when they are not and in some cases, at work, they can be considered as “not coping”. Some people get baggy eyelids very early in life, as a familial condition, others as they age.

What to do?

Discuss it with your GP who can help you to find a Consultant Plastic Surgeon, or look in the internet for the British Association of Aesthetic Plastic Surgeons (BAAPS), that gives lists of Plastic Surgeons in your area. Check that the Surgeon of your choice is registered with the GMC (General Medical Council) and as a Specialist in Plastic Surgery.
Make an appointment to see your surgeon for a full Consultation, so you can make an informed decision to undergo surgery.

Before Surgery

Full Consultation to discuss your general health, allergies, treatments, etc. Your eyelids are examined carefully and the possible operation planned. Pre and Post operative photos are taken. In my practice I develop all my own photographs for confidentiality.
In my practice, the week before surgery we take swabs (samples with a cotton bud) from your nose and throat, to culture. Looking for infection and germs like MRSA. If we find MRSA, the operation is cancelled, the infection treated, you are tested again and when clean we go ahead with surgery. This diminishes the incidence of infection after surgery.
Blood tests are also arranged as necessary.
        
The operation

It is an operation that can be carried out either under General Anaesthesia (you are put to sleep) or under Local anaesthesia. In either case you can be treated as a Day Case, so you can go home the same day.
The operation takes about 1 hour and at the end you will have steri-strips (tape) on the wounds and holding the sutures (stitches). I do not bandage the eyes, so you can read and see. Witch hazel iced packs are applied to the eyelids for 48 hours and eye drops used for around 10 days at home.
The resulting scars are hidden in the fold of the upper eyelid, so it can not be seen when the eye is open and just under the eyelashes in the lower eyelid. The scars are in what we call crease-lines so they are naturally camouflaged. They will be pink initially and then pale.
There are, of course, other ways of doing this operation, various techniques that may be more suitable for your particular case. The technique described here is the most conventional one. Which technique to use is discussed and decided during your initial consultation.

After Surgery

There will be swelling and bruising. If you bruise easily it is better to plan not to have public appointments for 3 weeks, although the sutures are removed 5 or 7 days after surgery and you can wear make-up after that.
I recommend Arnica from the day of surgery and for 2 weeks after, this helps with bruising. With Hazel iced packs helps the swelling.
You will need sun glasses to protect your eyes from strong light, wind and dust. Sometimes your eyes will feel tired at the end of the day for up to 3 months; this is normal and is due to residual swelling. Everyone is different in their reaction to surgery, but it is better to plan for a non-stressful post-operatory period.
There will be various follow-up consultations as required.

Complications

Ectropion: when the lower eyelid is pulled down away from the eyeball. This can be caused by initial swelling and settles within 3 or 4 weeks. Or, it can be the result of removing too much skin from the lower eyelid and may need corrective surgery later on.
Blindness has been described and every surgeon has a way of protecting the eye during surgery.
Bleeding is common with any surgery, more so if the patient is taking anticoagulant therapy or aspirin.
Little cysts along the scar in the upper eyelid are common and this resolves itself in few weeks.
Bad scars are rare as the skin of the eyelids is very delicate and tends to heal well, but it is possible and can be revised.
Change of the shape of the eye can occur.
If you have a complication or an unsatisfactory result, remember I will be there with you to correct it. You will not be alone. If you need corrective surgery you do not need to pay again.

Overall

Blepharoplasty is one of the most beautiful and rewarding operations in Plastic Surgery. It offers a delicate fresh result and it can be repeated when you are older.