Eyelid Surgery (Blepharoplasty)

Upper eyelid surgery takes up to an hour, where excess skin and/or fat is removed. The wound is closed with small interrupted stitches and small tape is applied.

The lower lid procedure can take up to an hour and half. The lower skin is reflected from beneath the eyelash line to expose both the muscle and fat. Contouring and tightening of the soft tissues is achieved and the skin is re-draped before trimming and closure using a continuous stitch under the lash line.

Patients are seen at one week for a wound check and exchange of dressings. Further dressing changes may be required as necessary. An outpatient appointment is made to see Mr Adams at 6 weeks and 6 months; appointments are sent by email.

As with all surgery, complications can occur, including bleeding or infection. Fortunately, these are rare with upper blepharoplasties operations. The main problems relate to wound gaping within the first 24 hours secondary to swelling, but this resolves spontaneously as the swelling settles. Occasionally, some asymmetry may be observed in the scar, which might require surgical correction. This can be more likely if there is asymmetry noted pre-operatively, and this will be discussed with you before the surgery.

The main concern with the lower eyelid surgery relates to the small risk of lower lid distortion (ectropion) during which the eyelid does not sit cleanly against the globe of the eye. This can result from excessive swelling or undesirable scarring and can cause “scleral show”. This complication usually settles spontaneously with resolution of swelling. A secondary procedure may be required if this complication persists.

Some symptoms may be experienced, such as dry eye, a gritty sensation or crusting of the eyes in the morning. This problem is usually temporary, but can be permanent. This is associated with swelling and/or reduced lubrication of the eyeball by tears. Treatment with artificial tears usually corrects the problem. Long-term contact lens users may be more prone to it.

Blindness is a frightful and extremely rare complication which has been reported in the literature, and which, therefore, must be mentioned. This is caused by bleeding behind the eyeball where it can compress the artery to the retina. Prompt and expert management of this complication should lead to complete recovery.

Blepharoplasty cannot always remove fine lines, especially crow’s feet, and patients often misunderstand this. This can lead to dissatisfaction in the presence of an otherwise good result. A chemical peel or laser can be useful to improve any persistent lines on the lower lid skin, and Botox can relieve crow’s feet lines, which is outside the scope of conventional surgery.