Blepharoplasty is an operation to rejuvenate either the upper or lower eyelid tissue which can impart an aged or weary look and in extreme ageing situations may impair vision. When assessing for a blepharoplasty, there are a number of important factors of which to be aware. Frequently, other surgical procedures around the eye are required to gain the full list aesthetic benefits such as a browlift. It is also important to review photographs of potential candidates in their youth to establish what those youthful features were, rather than trying to obtain some aesthetic and not personalised ideal.
Assessment of the clinical state of the eye is of utmost importance. Various eye conditions must be excluded such as dry eyes, the effects of hormonal diseases and ptosis (sagging) of the forehead rather than the skin above the eyelid. This latter feature is one of the earliest detectable changes with ageing and although an upper eyelid appears baggy, it may be the forehead that has descended making the eyelids appear to be the problem and can only be corrected by brow elevation and not surgery to the eyelid. The full, rounded appearance of the eyebrow and upper eyelid of youth can also lessen with ageing. In a similar fashion, the bone of the lower half of the eye socket can become more prominent in the lower eyelid and simply removing fat from the lower eyelid will give a more skeletonized appearance.
Immediately preoperatively, the amount of skin and tissue to be excised is assessed and marked with a marking pen. If the decision has been made to undertake a browlift, this is performed before the blepharoplasty. Surgery can be undertaken under local anaesthetic, with oral or intravenous sedation or under general anaesthetic.
The excessive tissue of the upper eyelid is then removed and this includes skin, possibly muscle and the removal of some fat from the eye socket if indicated. The greatest of care is undertaken to ensure that the eye itself is not injured. Incisions are undertaken in the skin crease of the upper eyelid to disguise the scar.
It is important to note that various skin treatments are most frequently more effective than removal of skin from the lower eyelid. Another important feature to be aware of is that bags under the eyes are also frequently best treated by repositioning fat over the bone of the eye socket surgically or by fat transfer methods. An incision may be undertaken just below eyelashes of the lower eyelid or through the inner surface of the eyelid (transconjunctival route) for surgery to the lower lid.
At the completion of surgery, non-dissolving sutures are used to close the skin and these require removal at 5-8 days following surgery. Immediately after surgery, cooling is applied to ensure that bleeding under the skin and therefore postoperative bruising is kept to a minimum. It is advisable to remain as inactive as possible 24-36 hours following surgery. Smoking will inhibit normal healing.
Well performed eyelid surgery rarely has significant complications and due to the excellent blood supply around the eyes, scarring is uncommon. Wound healing is certainly worsened by smoking. Bleeding into the eye socket (more common with lower blepharoplasty) is an extremely rare event and is not to be confused with normal post-operative bruising.
If you have any questions about this procedure please contact us.