Why do patients have blepharoplasty surgery?
Patients who come for upper eyelid blepharoplasty are usually bothered by hooded upper eyelids which may cause
- Cosmetically unacceptable appearance making them look tired, unhappy or older than their age
- heavy sensation or headache/ brow ache from raising eyebrows all day
- constant eye irritation from the excess skin touching the eyelashes
- interference in vision either from the lashes centrally or from the hooding peripherally
Patients who come for lower eyelid blepharoplasty are usually bothered by the bulging of the fat pads in the lower eyelids (which may be sometimes associated with excess skin) causing
- tired or sad look or as if they have not slept well or had too much to drink
- watery eyes due to the eyelids not sitting properly against the eyes
Many patients may have a combination of both the above and want a combined upper and lower eyelid blepharoplasty. Occasionally patients come because of the significant asymmetry between both eyelids or simply because they want to look fresher and take a few years off their face!
What are the reasons patients choose you as a surgeon for their blepharoplasty surgery?
There are various reasons patients say they chose to see me:
- As an oculoplastic surgeon I am dually qualified to look after patient’s eyelid problems as well as their eyes. This allows me to keep the well-being of the eyes as my first priority while performing blepharoplasty surgery.
- As a cosmetic eyelid surgery specialist, I only perform cosmetic surgery on the eyelids and not the rest of the face or body. This means I perform a large number of blepharoplasty surgery every year, thus maintaining my expertise and get excellent outcomes.
- As I operate on the eyelids and surrounding structures for non-cosmetic problems such as droopy eyelids, in-turned and out-turned eyelids, watery eyes, skin cancers around eyelids; I have the necessary skills to tackle routine as well as complex cases. I get a number of referrals from my ophthalmology as well as my plastic surgery colleagues.
- Patients may have had cataract surgery with me and after surgery, as their vision is better and they don’t need to wear glasses, they start noticing the saggy appearance of their eyelids which they then want corrected.
What should patients expect at consultation?
The consultation lasts around 30 minutes during which I take a detailed history and make a thorough assessment of patient’s eyelids and eyes. We then discuss the findings with the aid of photographs and drawings and go through the various types of surgery. We also discuss the type of anaesthetic that will be required. Upper eyelid blepharoplasty is usually done under local anaesthesia or local anaesthesia with sedation. Lower eyelid blepharoplasty or combined upper and lower eyelid surgery requires a general anaesthesia.
Once we make a joint decision on which surgery would benefit the patient, I explain the planned surgery in detail including the surgical steps and post-operative care. I also explain the risks and benefits of surgery including the expected outcome. I believe having a frank and clear discussion and realistic expectation is the key to patient satisfaction.
Once the patient is satisfied with the discussion and all his/her queries have been answered, the patient is then listed for surgery on a chosen date. The patient is provided with a blepharoplasty patient information leaflet which helps patient recap some of our discussion. A clinic letter is done to the referring doctor/ GP with a copy sent to the patient. A member of the private patient team then meets the patient or telephones the patient later to explain the total package cost of the surgery and to confirm admission date and other details.
What are the risks of surgery?
As with any surgery the risks include infection, bleeding and scarring. All patients will develop bruising and swelling around the eyelids to varied extent. Patients on blood thinners such as warfarin carry a higher risk of bleeding and the bruising may take longer to settle. There is a theoretical risk to eyesight from bleeding at or after surgery, but as an oculoplastic surgeon I feel I am best placed to manage the bleeding at surgery and take steps to avoid this from occuring. Patients are advised to avoid garlic, ginseng, ginkgo-biloba, and hot curries for a week prior to surgery to reduce the risk of bleeding. Blood thinners such as aspirin are usually stopped 10 days prior to surgery and the warfarin dose is adjusted.
Other uncommon risks include under-correction, over-correction, asymmetry of eyelids, stitch related lumpiness which may occasionally requiring further intervention, although these often improve with time.
What happens on the day of surgery?
Once the patient arrives, he/she is admitted in a private room on the ward a couple of hours prior to surgery. The nursing staff checks on the patient and I meet them to take the surgical consent and also answer any last-minute queries the patient may have.
Once the patient is brought into the operating theatre, after all checks are done, I perform detailed marking on the eyelids and the chosen anaesthetic is then given. Upper eyelid surgery is performed through a small incision in the skin crease of the upper eyelid. Lower eyelid surgery is performed through the inside of the lower eyelid to remove the excess fat. A small incision may be required on the outside of the lower eyelid as well to tighten the eyelid or remove any redundant skin. Surgery is carefully and meticulously completed. Steristrips (small tape) are then applied to the corners of the stitches.
Once the surgery is completed, antibiotic ointment is applied to the wounds and the eyes are padded. The patient is taken to the post-operative recovery unit and then back to their private room. The patient is kept in a semi reclined position and the eye-pads are removed after an hour and the area around the eyelids is gently cleaned. A cool eye mask is then applied over clean wet gauze for 15-30 minutes at a time.
When appropriate, the patient is discharged with instructions on post-operative care and follow up. Patients are advised that they will be in the hospital for around 6 hours as most cases are done as a day case. Some patients choose to stay in the hospital for a night; usually if they are travelling a fair distance.
What is the care required after surgery?
Once the patient goes home, it is important to take as much rest as possible for the first two weeks during which contact lenses, heavy exercises and swimming is to be avoided. A sick note can be given to hand in to work to cover this period. Patients can have a daily shower, but water should be avoided to flow onto the wound by use of watertight swimming goggles or by washing the hair backwards. It is recommended that patients sleep propped up at night for 3 days and they can take simple analgesics such as paracetamol but are advised to avoid ibuprofen if possible. Patients are also advised to drink at least 2 litres of water every day and wear sunglasses if going outdoors. Smoking and excessive alcohol should be avoided to allow good wound healing.
The patient is advised to apply cool eye mask or ice packs (bag of frozen peas will do too!) at least 4 times in the daytime for the first 3 days. This helps reduce bruising as well as swelling.
Antibiotic ointment is also to be applied to the eyelid wound 4 times a day for 2 weeks. This reduces the risk of infection and keeps the wound moist and reduces scarring. If lower lid blepharoplasty is performed additional eye drops and oral antibiotics may be given.
Patient are usually invited to attend the nurse led suture clinic at 5 days post-surgery where the steristrips and long stitches are removed. I see the patient 7-10 days post operatively to remove the finer stitches and to ensure everything is settling well. A final follow up can be arranged in 3- 6 months but in the meantime, patients can contact the nursing team for advice or review if they have any concerns.
Patients are allowed to return to routine activities after 2 weeks. It can take up to 4-6 weeks for all the bruising to completely settle especially in patients requiring lower eyelid blepharoplasty. Arnica gel can be applied to help settled the bruising quicker.
Alhough the patients usually notice an immediate improvement, the true result is masked by the bruising and swelling. By 2 weeks most of the bruising and swelling has improved. It takes up to 3-6 months for the full result of surgery to be obvious as by this time the surrounding and underlying tissues mould to the patient’s natural expressions.
How long does the effect last?
It is expected that the effect would last for at least 5-10 years if not more. Most patients who consult me for revision surgery do so 10-15 years after they have had their first operation. As quoted in Tattler Beauty and Cosmetic Surgery guide ‘If you only have one anti-aging operation, an eyelid lift is the one to choose’.
Where can I get further information on blepharoplasty surgery?
You may wish to visit