The skin around the eyelids is the thinnest in the body and with age can stretch quite easily. As the skin ages, the underlying orbicularis oculi muscle and orbital septum also loses tone and becomes loose. Fat from the eye socket can herniate forward. A number of factors such as smoking, sun exposure and hereditary factors exacerbate this. Usually eyelid surgery is undertaken from the late 30s or older when the signs of ageing have manifested.
The medical term for excess skin around the upper is ‘dermatochalasis.’ This can be noticeable if it impedes vision, in particular the superior field of vision. The field of vision is important for driving as a minimum of 20 degrees of vision around fixation is required for a class 1 driving licence. Lesser degrees of dermatochalasis may be undesirable cosmetically. Patients often report that they have difficulty applying mascara or that their eyes feel heavy. Lower lids can also give the appearance of being puffy or have the effect of making the patient look tired or for asymmetry.
Blepharoplasty is one of the most common surgical procedures and is generally safe and effective. It usually results in an improvement in function and/or appearance. Upper eyelid blepharoplasty involves the area between the eyebrows and the eyelashes whereas lower lid blepharoplasty involves the area between the lower lid eyelashes and the cheek. Various proportions of skin, orbicularis muscle and underlying fat is removed or repositioned to give the desired result.
Upper eyelid blepharoplasty involves first marking and measuring out the skin. Various degrees of skin, fat and muscle are taken and dissolvable stitches are used to close the skin. This is usually safe and predictable.
Lower eyelid blepharoplasty is a more complex procedure, requiring an incision under the lower lid running out into the area of the ‘crow feet.’ The skin is then folded down to reveal underlying structures and various amounts of each are excised or repositioned. If in a younger patient, the main problem is the bulging fat, a transconjunctival ‘scarless’ approach from under the eyelid is used. Closure of skin is usually with dissolvable sutures.
For both upper and lower eyelid blepharoplasties, the surgeries can be performed with local or general anaesthetic. If under local anaesthetic, a mild sedation can be used if preferred.
Prior to surgery, if having general anaesthetic, patients will be required to starve for 6 hours prior to surgery. Makeup or skin creams must be avoided on the day of surgery. Patients should arrange a friend or family member to accompany them home. A bandage may be kept over the eyes to help settle swelling and if bilateral surgery is performed then both eyes will be padded.
Blood thinning medications such as aspirin etc should be stopped prior to surgery and this will be discussed with you in the clinic in advance of surgery.
The surgery itself is not usually painful aside from the anaesthetic injection, which stings somewhat. Postoperatively there is not much pain and simple painkillers are usually all that is required. Work can be resumed in 7-10 days and at this stage, there will be minimal signs of surgery. For lower lids, the bruising and swelling takes a little longer at around 10-14 days. Working from home will usually be possible from around 2 days postoperatively.
Postoperative instructions for blepharoplasty surgery
Day 1-2 – keep the eyes dry. It will be possible to bathe or shower whilst keeping the eyes from getting wet. A small amount of splashing is unlikely to cause a problem
Day 2-4 – review will be arranged at this stage
Day 3-7 – The eyes can be gently washed with soap and water. It is important to dab but not to rub the eyes. The crusts will come away when ready.
Day 7-10 – Review will usually be arranged at around this stage and sutures may be removed if necessary.
Day 14 – Makeup can be used again