Blepharoplasty (eyelid surgery)

Eyelid surgery, or blepharoplasty, alters the appearance of the upper eyelids, lower eyelids or both. The aim is to improve the look of the area around the eyes and, in some cases, to improve vision that is obscured by drooping eyelids. Blepharoplasty can change:

• loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, which can sometimes affect vision
• extra skin and fine wrinkles of the lower eyelid

It cannot remove dark circles under the eyes, lift sagging eyebrows, or get rid of crow’s feet.

If you are concerned about the way you look, or are thinking about cosmetic treatments to boost your confidence, there are alternatives. These may include lifestyle changes or learning to accept yourself the way you are.

Things to consider before surgery#

• Upper eyelid surgery is often carried out separately from lower eyelid surgery, so be prepared for two separate operations.
• The financial cost. Cosmetic surgery is not usually covered by health insurance. However, some costs may be covered if the surgery is performed for medical reasons, for example if the eyelids drape onto the eyelashes and block your vision. Your doctor can advise whether your situation qualifies, and you should ask your medical practitioner about any out-of-pocket costs.
• Smokers are at increased risk of complications. If you are serious about surgery, try to quit smoking first.

Finding a practitioner#

Ask your doctor to recommend a suitable medical practitioner or hospital where blepharoplasty is performed. At your first consultation, ask about their training and experience. It is best to have the procedure done by a practitioner who is specially trained in blepharoplasty and who performs this type of surgery often.

Before the operation, discuss a range of medical issues with your practitioner, including your:

• Physical health – an examination helps decide if the treatment is appropriate.
• Medical history – some pre-existing conditions and past surgery may influence decisions, including the type of anaesthetic used. In particular, tell your practitioner if you have any eye conditions such as glaucoma, dry eye, wet eye or a detached retina; any thyroid disorder such as Graves’ disease or an underactive or overactive thyroid; any cardiovascular disease, high blood pressure or other circulatory disorder; or whether you have diabetes.
• Eye exam – you may need to be assessed by an ophthalmologist (eye specialist) before surgery.
• Risks and possible complications – make sure you understand these so you can decide whether blepharoplasty is right for you.
• Medication – tell your practitioner about anything you take regularly or have recently taken, including over-the-counter preparations such as fish oils and vitamin supplements.
• Past reactions – tell your practitioner if you have ever had a bad reaction or side effect from any medication.
• Preparation for surgery – your practitioner will give you detailed instructions for preparing at home. For example, you may be advised to take a particular medication or change the dose of one you already take. Follow all instructions carefully.

The operation#

You may have a local anaesthetic with sedation, or a general anaesthetic. Your practitioner will advise which is best for you. The operation varies with the details of the surgery, but generally the practitioner will:

• make an incision in the skin fold across the eyelid to treat sagging of the upper lid
• make an incision either just below the lashes or on the inside of the lower lid (a transconjunctival incision) to treat the lower eyelid
• remove excess skin, and reposition or remove excess fat
• tighten underlying tissue such as muscle with sutures, if required
• attempt to hide all incisions within natural skin folds and creases
• close incisions with stitches, surgical tape or tissue glue

Tissue glue#

Tissue glue, or fibrin sealant, can be used to hold tissue layers together during surgery and to reduce bruising afterwards. It is made from elements of human blood produced from donor blood plasma. The plasma is screened for hepatitis, syphilis and human immunodeficiency virus (HIV) before use, and the blood components are heat-treated to prevent any possible virus transmission. Tissue glue has been used safely for many years as a sealant in cardiovascular (heart) and general surgery.

After the operation#

Immediately afterwards you can expect mild pain or discomfort, numbness, the use of cool compresses, gauze and dressings over the eyes, swelling and bruising around the eyes, possible bruising on the whites of the eyes, a sensation of wet or dry irritated eyes, and extreme sensitivity to light.

Complications#

All surgery carries some degree of risk. Possible complications of blepharoplasty include:

• risks of anaesthesia, including allergic reaction, which may rarely be fatal
• surgical risks such as bleeding or infection
• blood clots that may cause potentially fatal complications such as heart attack, deep vein thrombosis or stroke
• temporary or permanent areas of numbness
• temporarily blurred or impaired vision
• dry or watery eyes
• difficulty closing your eyes; for example, the upper eyelid may stay open while you sleep, which can dry out the eye surface and cause scarring
• lid lag, a pulling down of the lower eyelid (often temporary)
• ectropion, a slack, outward-rolling lower eyelid
• lumps inside the lower eyelid that can irritate the eye surface
• eyelid disorders involving abnormal positioning of the upper eyelids (eyelid ptosis) or loose eyelid skin, which can coexist with sagging forehead and eyebrow structures
• sunken or unnatural-looking eyes if too much fat is removed
• inflamed, itchy scars
• bleeding behind the eye
• vision loss, including complete blindness
• further surgery to treat complications

This is not a complete list. Your medical history or lifestyle may put you at increased risk of other complications, so speak to your practitioner for more information.

Self-care at home#

Be guided by your practitioner. General suggestions include:

• Follow all instructions on caring for your wounds.
• Apply eye ointment as prescribed.
• Expect soreness and swelling around the eye for a few weeks.
• Avoid any trauma to the eyes; for example, do not rub them.
• Use cool compresses to manage short-term irritation, discomfort and dryness.
• Protect your eyes from sunlight until healing is complete. This is very important.
• Report any bleeding, severe pain or unusual symptoms to your practitioner.

Long-term outlook#

Post-surgical swelling reduces over time. Many people find blepharoplasty makes a real difference to their appearance, especially if they had very loose upper-lid skin or large bags under the eyes. Your final results will show within several weeks, but it may take up to a year for incision lines to fully heal. While blepharoplasty can correct certain conditions permanently, you will continue to experience the effects of ageing.

Alternatives#

There are no other medical alternatives that can reposition or reshape the eyelids. Talking to a counsellor or psychologist may help you work through concerns about your appearance, and you may decide that you like yourself the way you are.

Key points#

• Smokers are at increased risk of complications.
• The blood components in tissue glue are heat-treated to prevent any possible virus transmission.
• All surgery carries some degree of risk.
• Your medical history or lifestyle may put you at increased risk of other complications.
• Protect your eyes from sunlight until the healing process is complete; this is very important.

Where to get help#