Eyelid Surgery

Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat, usually along with excess skin and muscle from the upper and lower eyelids.
Eyelid surgery can correct drooping upper lids and puffy bags below your eyes - features that make you look tired and older than you feel, and may even interfere with your vision. However, it won't remove crow’s feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows.

Blepharoplasty can be done alone, or in conjunction with other facial surgery procedures such as a facelift or brow lift. If you’re considering eyelid surgery, this information will give you a basic understanding of the procedure and what results you can expect. It can’t answer all of your questions, so ask us about anything you need to know.
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The best candidates for eyelid surgery

Blepharoplasty can enhance your appearance and your self-confidence, but it won’t necessarily change your looks to match your ideal, or cause other people to treat you differently. Before you decide to have surgery, you will need to think carefully about your expectations and discuss them with us.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and with realistic expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

The best candidates for eyelid surgery

As people age, the eyelid skin stretches, muscles weaken, and fat accumulates around the eyes, causing “bags” above and below.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves’ disease, dry eyes or lack of sufficient tears. A detached retina or glaucoma is also reason for caution; in such cases you may require an ophthalmic opinion before surgery.
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All surgery carries some uncertainty and risk

When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. There is always a possibility of complications, but you can reduce your risks by closely following your surgeon’s instructions both before and after surgery.

The minor complications that occasionally follow blepharoplasty include blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny white heads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle.

Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another infrequent complication is ectropion, a pulling down of the lower lids. This is usually temporary but further surgery may occasionally be required. Blindness has occurred on exceedingly rare occasions following blepharoplasty.
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Planning your surgery

The initial consultation is very important. I will need your complete medical history, so check your records and be ready to provide this information. Be sure to inform me if you have any allergies; if you’re taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke.

You should also provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses or contact lenses, bring them along. You should carefully consider your goals and expectations for this surgery. We’ll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate.

I will explain the techniques and anaesthesia I will use, the type of facility where the surgery will be performed, and the risks involved. (Note that most insurance policies don’t cover eyelid surgery, unless you can prove that drooping upper lids interfere with your vision.)

Please ask any questions you may have, especially those regarding your expectations and concerns about the results.
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Preparing for your surgery

You will be given specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. These will help your surgery go more smoothly.

While you’re making preparations, be sure to arrange for someone to drive you home after your surgery, and to help you out for a few days if needed.
Eyelid surgery will be performed in hospital either on an outpatient or inpatient basis.

Eyelid surgery is often performed under local anaesthesia – which numbs the area around your eyes – along with oral or intravenous sedatives. You’ll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Some patients prefer general anaesthesia, in which case you’ll sleep through the operation.
Clinical photographs will be taken before your operation.
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The surgery

Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you’re having all four eyelids done, I will probably work on the upper lids first, then the lower ones.

The surgery

Before surgery, I will mark the incision sites, following the natural lines and creases of the upper and lower eyelids.

In a typical procedure, incisions are made following the natural lines of your eyelids: in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow’s feet or laugh lines at the outer corners of your eyes. Working through these incisions, the skin is separated from underlying fatty tissue and muscle, excess fat removed, and sagging skin and muscle trimmed. The incisions are then closed with very fine sutures.

Underlying fat, along with excess skin and muscle, can be removed during the operation. If you have a pocket of fat beneath your lower eyelids but don’t need to have any skin removed, I may recommend a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin, and requires a general anaesthetic. It may be accompanied by laser treatment to the skin to reduce wrinkles.

In a transconjunctival blepharoplasty, a tiny incision is made inside the lower eyelid and fat is removed with fine forceps. No skin is removed, and the incision is closed with dissolving sutures.
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After your surgery

After surgery, your eyes will be lubricated with ointment. Your eyelids may feel tight and sore as the anaesthesia wears off, but you can control any discomfort with the pain medication prescribed.

You will be instructed to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak at 48 hours, and generally lasts about two weeks.) A five-day course of Arnica tablets before surgery may be helpful. You’ll be shown how to clean your eyes, which may be sticky for a week or so. Many doctors recommend eyedrops, since your eyelids may feel dry at first and your eyes may be irritated. For the first few weeks you may also experience excessive tearing, sensitivity to light and temporary changes in your eyesight, such as blurring.

After your surgery

The stitches will be removed four days after surgery. Once they’re out, the swelling and discoloration around your eyes will gradually subside, and you’ll start to look and feel much better.
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Getting back to normal

You should be able to read or watch television after a couple of days. However, you won’t be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.
Most people feel ready to go out in public (and back to work) in about 10 days. By then, you’ll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

You will be advised to keep your activities to a minimum for five days, and to avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including vigorous sports. You may also be told to avoid alcohol, since it causes fluid retention.
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Your new look

Healing is a gradual process, and your scars may remain slightly pink for several weeks or more after surgery. In most people they fade to a thin, white line.

After surgery, the upper eyelids no longer droop and the skin under the eyes is smooth and firm.

Eyelid surgery gives you a more alert and youthful look, and these effects are long lasting.
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