Blepharoplasty

What is blepharoplasty?

Blepharoplasty is also called eyelid surgery. The surgical procedure is usually performed for people with excessive eyelid skin or fatty bags around their eyes. It can reduce the signs of ageing and create a more youthful appearance. On some occasions, brow drooping is part of the issue and can be dealt with at the same time as the eyelid.

Modern blepharoplasty techniques minimise fat removal and reshape the eyelid and its folds, as it has been realised that excessive fat removal does not lead to successful long-term results.

The specifics of the blepharoplasty procedure vary and will depend on your exact needs. Some patients only have surgery on their upper or lower eyelids while others have surgery on both.

Who is it for?

Blepharoplasty is generally performed for people with excessive eyelid skin, loss of eyelid shape, or fatty bags around their eyes, often in an effort to reduce ageing signs. It is for those looking to improve their appearance or those having functional problems with their eyelids.

Blepharoplasty does not remove dark pigmentation under the eyes. It doesn’t totally remove lines (like 'crow's feet') around your eyes. If you have lines around your eyes, the surgeon may recommend laser resurfacing during the surgery in order to smooth the wrinkles. Another optional add-on is to use Botox injections.

When assessing your lower lid, the surgeon will also look at your cheek and tear trough, the groove between your lower lid and cheek. Sometimes these areas are the true problem, not the lid itself. If you have dry eyes or severe eye problems you will not be suitable for blepharoplasty.

Eyelid surgery may be suitable for you if:

• You’re relatively healthy.
• You don’t have any serious pre-existing eyelid conditions.
• You’re trying to treat droopy eyelids, puffy bags, loose skin, or dark circles around your eyes.

How is blepharoplasty surgery done?

You will have a general anaesthetic, heavy sedation or local anaesthesia. The blepharoplasty operation takes between one and three hours. There is no pain during the procedure.

Upper eyelid blepharoplasty

An upper eyelid blepharoplasty is usually performed under a local anaesthetic that is injected in your eyelids. It’s an effective treatment to improve your vision and can make you look younger. Your surgeon will make a cut on the natural skin crease just above your eyelid. They will remove any excess skin and fat that is pushing through the muscle.

Lower eyelid blepharoplasty

A lower-eyelid blepharoplasty is performed under a general anaesthetic. You may also have injections of local anaesthetic to help with the pain after the operation. The operation usually takes an hour to 90 minutes. Skin in your lower eyelid can lose its tone, sag and develop wrinkles. It can also appear puffy because of the bulging fat pads. A lower-eyelid blepharoplasty can help to reduce wrinkles and puffiness. Your surgeon will make a cut along the rim of your eyelid below your eyelashes to just beyond the outside edge of your eye. They remove any excess skin, and remove or redistribute any fat that is pushing through the muscle.

If your eyelid problem doesn’t involve excess skin, your surgeon will perform the operation through cuts made inside your eyelids. They either remove the fat pads or reinforce the muscle before closing the incision with stitches.

Incisions made during your eyelid surgery are placed so the scars are concealed naturally once you have recovered. The incisions made on your upper eyelid are placed within the natural crease of the eyelid. Fat deposits can be trimmed or smoothed, tightening of muscles can be done if necessary, and removal of excess skin is undertaken. Sometimes a tarsal fixation, to make a specific eyelid shape, is performed.

Incisions to your lower eyelid are performed just below the eyelash line. Excess skin in your lower eyelid is removed via this incision and the excess fat can be removed or repositioned.

Another way to correct lower eyelid conditions is through a transconjunctival incision (inside the eyelid), which allows for access to the eyelid fat without visible incisions. This technique is ideal for patients who need fat removed or added, but no skin removed.

It can also be combined with laser resurfacing of the eyelid skin, which reduces lines and wrinkles. This process involves no skin removal. Most eyelid incisions are closed with removable or dissolving sutures, surgical tape or skin adhesives

Key facts about blepharoplasty surgery

• Blepharoplasty can correct a number of your eye problems including bags and puffiness under your eyes, sagging of your upper or lower eyelids and excess skin or fat above or below your eyes.
• An eyelift can create a positive improvement in your overall look that still looks like you.
• Scarring is minimal because your cosmetic surgeon will usually make incisions in the natural fold of your eyelid. This approach results in minimal scarring.
  Most blepharoplasty patients are able to return home the same day as their surgery. Some patients choose to stay overnight because their vision is blurry due to ointments.
• After your surgery, it’s normal to experience a period of discomfort due to the inflamed tissues caused by the surgery. You will need to apply ointments and drops for several days or weeks until the inflammation subsides.
• You will have fine scars in your skin creases following the surgery. When they are completely healed, in most cases they’re not noticeable.
  Sometimes a patient may suffer a small loss of skin sensation over their eyelids, but there is no significance to this.
• Once home, you must spend time in bed or a comfortable chair with your head elevated for 2-3 days. To limit swelling and discomfort, you’ll need to rest for a week after the surgery. In the days after the blepharoplasty procedure you should avoid strenuous activity.
• You will experience bruising for seven to fourteen days. It will take 1-3 months for the swelling to completely dissipate. Time off work is recommended following the surgery. Patients are advised to put off important social gatherings until six weeks after their surgery.
• You can resume driving when you feel comfortable, can see well, are able to react and are off your pain medication. For most patients this is 5-7 days after the surgery.
• After the surgery your face should look brighter and younger. If your upper eyelid is interfering with your vision, this should improve.
• Possible complications of blepharoplasty include infection, bleeding, asymmetry, eye discomfort, ectropion (pulling down of the lower lid), eye injury, scar or wound problems. Blindness after blepharoplasty has been reported in medical literature, but is exceedingly rare.
• Blepharoplasty will not completely remove dark pigmentation under the eyes, nor will it completely eliminate lines such as ‘crow’s feet’. If fine wrinkles are present around the eyes, we may recommend laser resurfacing during surgery to smooth these wrinkles, or Botox injections as an adjunct.

What should I do before my eyelid surgery?

In the two weeks before your eyelid surgery avoid taking aspirin or related compounds that interfere with normal blood clotting. Before the surgery, wash your face thoroughly. It’s important not to apply any facial lotions, creams, or makeup before your surgery

Even though eyelid surgery doesn’t require an extensive recovery period, you still need to plan ahead. You will need to take a few days off work. Some people return to work within five to seven days, especially if just the upper lids are done. If you’ve had lower lid blepharoplasty, the recovery can take a bit longer.

What’s the recovery time after blepharoplasty surgery?

You will be given medication to limit any pain and nausea and are usually able to return home on the day of your surgery. Because your vision will be blurry (due to ointments) some patients prefer to stay overnight in hospital.

At home you need to set yourself up in a comfortable chair, on a couch or in bed, with your head elevated. It’s recommended that you keep your head elevated for two or three days following the surgery. This will limit your swelling and discomfort. Strenuous exercise should be avoided but walking is encouraged.

Bruising is usually present for seven to fourteen days. We recommend two weeks off work, and if you have an important social or public event coming up, try to allow six weeks recovery.

Your swelling will take one to three months to fully resolve. At home using ice packs will reduce the swelling and speed up your recover. When you go outside you’ll need to wear sunglasses. It’s helpful to have eye drops on hand in case you get dry eyes after the surgery.

What results can I expect from eyelid surgery?

After eyelid surgery your eyes will be brighter, more open and tighter. The droopy eyelids and excessive skin will be gone. After eyelid surgery, the upper lid that borders you brow can change position. You may have less crow’s feet wrinkles and have a slight change in your natural expression.

To achieve the best result that meets your expectations, it’s important to understand what may happen to the area surrounding your eyelids. During your consultations with the surgeon before eyelid surgery, these areas will be considered. It’s important to note that overdone eyelid surgery can look unnatural and may increase your risks of dry eye and other eye complications.

Are there risks or complications with blepharoplasty surgery?

Any surgical operation brings complications of anaesthesia. Your anaesthetist will be able to discuss with you the possible complications of having an anaesthetic.

General complications of every surgery include:

• Pain. Your healthcare team will give you medication to control the pain. To reduce discomfort and prevent headaches, it’s important that you take the medication.
• Blood clot in your leg (deep-vein thrombosis – DVT). This can cause pain, swelling or redness in your leg, or the veins near the surface of your leg to appear larger than normal. Your healthcare team will assess your risk. They will encourage you to get out of bed soon after the operation and may give you injections, medication, or special stockings to wear. Let the healthcare team know straightaway if you think you might have a DVT.
• Blood clot in your lung (pulmonary embolus). If a blood clot moves through your bloodstream to your lungs. If you become short of breath, feel pain in your chest or upper back, or if you cough up blood, let the healthcare team know straightaway. If you are at home, call an ambulance or go immediately to your nearest Emergency department.

What are the specific risks and complications of eyelid surgery?

• Swelling: it’s normal to have some temporary swelling following the blepharoplasty procedure. The swelling can feel like a “tight” feeling in and around your eyes. It will subside gradually but can take several months to fully resolve.
• Bruising: Most bruising typically resolves within 10–14 days of the eyelid surgery. It can take longer in some cases though.
  Itchiness, watering or dryness of eyes: It’s not uncommon for patients to experience watering or dryness or itchiness of their eyes following surgery. These symptoms may require you to use artificial tears or eye drops for relief. It’s rare for these symptoms to be permanent. It’s important to note that patients who have dry eyes before surgery are at an elevated risk for permanently worse dry eyes after surgery.
• Corneal exposure: On rare occasions, patients can experience difficulties closing their eyelids after their eyelid surgery. This can lead to problems in their cornea due to dryness. If this complication occurs, additional treatments including revision surgery may be necessary.
• Corneal ulceration: Eye shields may be placed into your eye to protect them during surgery. Dissolving sutures (stitches) are used in the surgery. On rare occasions they can rub and cause corneal ulceration. This may cause further discomfort or require further treatment.
• Scarring: You’ll have a scar from the blepharoplasty surgery. Upper lid scars are place in the crease normally formed by opening the eye, and can extend laterally to the eye, depending upon the amount of planned skin removal. Lower lid scars are normally placed immediately below the lashes, and can extend out lateral to the eye in some cases where a longer incision is needed. Scars always fade over time but will not disappear. It is normal for scars to take up to 1-2 years to fully mature by flattening and become more normal in colour. If healing has been poor and scarring is unsightly, a scar revision procedure may be required.
• Asymmetry: Most people have natural differences between their left and right sides of their bodies. Factors such as skin tone, asymmetric fatty deposits, skeletal prominence and muscle tone all contribute to normal asymmetry in body features. There may also be minor differences in the symmetry between the left and right eyelids following the surgery - this is quite common.
  Signs of Ageing: Eyelid surgery won’t stop the process of ageing. It won’t remove “crow’s feet” or other wrinkles, eliminate dark circles from under the eyes, or lift sagging eyebrows.
• Eyelash hair loss: Some patients may experience loss of some eyelashes where the skin was elevated during surgery. The occurrence of this is not predictable, and may be temporary or permanent. It is quite uncommon.
• Loss or sensation of the eyelid skin: Some patients may notice a loss of sensation to the skin at the lashes. This most commonly recovers over a few months if it occurs. This can make makeup application a bit challenging.
• Changes in vision: Some patients may experience some vision changes following a blepharoplasty procedure. This usually resolves quickly. These vision changes are rarely long lasting or permanent.
• Scleral show: During the healing phase of a lower lid procedure, your lower lid may be pulled down slightly leading to more of the white of your eye showing under your iris. This is more common in patients with lax or weak lower eyelid tone. If it occurs revisional surgery may be recommended.
  Ectropion: A displacement of your lower eyelid away from the eyeball is a rare complication. This is a serious complication, causing discomfort, excess tear production, dry eyes and is often unsightly. Further surgery may be required to improve this condition if it occurs.
• Diplopia: Permanent double vision is a rare complication of lower lid surgery. If it occurs it may require further surgery but may not be correctable.
  Lower lid retraction: Tight scarring of the internal layers of your lower lid (middle lamella) can occur after lower lid surgery. It’s uncommon but if it occurs it shortens the lower lid, causing exposure and ectropion. If it occurs it commonly requires further surgery.
• Upper lid closure: In rare cases too much skin can be removed from the upper lid making it difficult to close the eye. This can be exacerbated by swelling and will usually settle. In some cases it may require further surgery.
• Blindness: It’s extremely rare for patients to experience blindness following blepharoplasty surgery. The risk is considered to be approximately 1 eye in every 40,000 procedures. Internal bleeding around the eye during or after surgery can cause blindness but the occurrence isn’t predictable. Smoking, pre-existing eye disease, straining, lifting and coughing add to the risk of blindness after surgery.

Are there any alternatives to a blepharoplasty?

Blepharoplasty surgery is the most effective way to reduce sagging in your eyelids. If you decide not to have blepharoplasty surgery, your surgeon may be able to recommend an alternative. It’s important to note that if an upper eyelid is interfering with your vision, the problem may get worse over time. Over time your lower eyelid will continue to sag because of the effects of gravity.

Alternative forms of management include not treating the skin laxness and bagginess in the eyelids by surgery. Minor skin wrinkling may be improved through chemical skin peels, laser resurfacing, or other skin treatments.

Dermal fillers and Botox injections may have a place in some patients rather than surgery. It’s important to note that risks and potential complications are also associated with alternative surgical forms of treatment.

How do I choose a Blepharoplasty Surgeon?

With any elective surgical procedure, the most important factor in choosing a surgeon is experience. We suggest you look for a board-certified plastic surgeon who performs the procedure frequently and has proven safe results.

Once you’ve got a short list of surgeons, we suggest you have multiple consultations before you select one. Find the best Blepharoplasty Surgeons in Australia here.

Important To Know

Infection, bleeding, asymmetry, eye discomfort, ectropion (the pulling down of the lower lid), eye injury, double vision, scar or wound problems are possible complications of blepharoplasty. There have been reported cases of blindness after blepharoplasty, but it is extremely rare. So that you can make an informed decision, your elected surgeon will discuss the possible risks associated with blepharoplasty. Although the majority of patients do not experience these complications, it's important to understand how they can be managed in the event that they occur.