Blepharoplasty is surgery to the upper or lower eyelid. Upper eyelid surgery involves making a judgment of how much excess skin can be surgically removed with or without a small amount of fat near the medial edge of the cut. The surgery can be done under local anaesthetic as a day case and takes about 30 minutes to perform. The closure of the wound usually involves a non-absorbable stitch that is removed at 5-7 days. Use cooling eye pads over the next 2 days to help with bruising and swelling. Mild painkillers only required. Risks are around bleeding, infection, red scars and managing the patient's expectations.
Lower lid blepharoplasty is a more complicated procedure comprising skin tightening and/or fat redistribution or removal. Skin excision is performed by a cut just under the lower eyelid margin, the excess trimmed and the remaining skin re-draped onto the lid. This excision can be skin only or include the underlying muscle.
The fat is either re-draped to camouflage the tear trough or excised. Occasionally a lid tightening procedure is required to compliment this procedure.
The operation takes about 90mins and the patient stays in hospital overnight, wearing cooling eye pads to help control the bruising and swelling.
Risks include bleeding, infection, and problems with the eyelid position. Blindness has been reported but is very rare.
This is where the consultation with the specialist is so important. The issues to explain to the patient about an upper lid blepharoplasty are that whilst eyelid skin will be removed optimally and safely this will not affect eyebrow position, which also contributes to the patient's appearance. An understanding of the risk benefits here is most important. Lower lid surgery whilst being more complex can for the right patient be a very rewarding procedure. The surgeon should ensure there are no medical problems, which might increase your risk as well as an examination of the tone of the lower eyelid and overall health of the eyeball.
Surgery to the excess skin and fat of the eyelids. Upper eyelid surgery, local anaesthetic, minimal risk. Some bruising for 1 week. Generally very good outcomes. Lower eyelid surgery under general anaesthetic or sedation. Overnight stay. Involves tighter patient selection, incision under the eyelid margin, moderate risk, very good outcomes.