Blephroplasty – Eyelid Surgery
Our eyes are the most important features on our face and their beauty can be greatly reduced by excess skin creases and eyebags. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat-usually along with excess skin and muscle from the upper and lower eyelids. Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a facelift or a browlift.
The normal ageing process involves the stretching of the eyelid skin resulting in excess folds and wrinkles, and sagging of the fat around the eye itself, and appears as bulges in the upper and lower lids. Heredity is often an important factor when young or middle-aged patients exhibit changes that are usually associated with older age. These patients are fed up of comments from their friends that they constantly look tired, despite having had a good night's rest!
Although eyelid surgery can correct drooping upper lids and puffy bags below your eyes, it cannot remove crow's feet lines, or eradicate all eyelid creases. Any attempt to do so would invariably require excessive tensioning of the skin, which would result in a downward pulled or staring appearance of the eyelid. Nor does it improve or lift sagging eyebrows. Procedures such as laser skin resurfacing (for lines and wrinkles) and the Brow lift (for sagging eyebrows) are designed for these purposes. Dark circles under the eyes may improve a bit following blepharoplasty, if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.
A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance. And while it is true that it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Additionally in some patients the procedure might improve vision by removing the excessive skin of the upper eyelids which can hang down and interfere with peripheral vision.
Blephroplasty – Eyelid Surgery FAQs
Am I suitable for eyelid/eyebag surgery?
The best patients are those who are healthy, psychologically stable and well motivated. Most are 35 or older, but if puffy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age. During your consultation Mr. Karidis will ask you about your general medical history to identify any medical conditions that may increase the risk to blepharoplasty surgery such as thyroid disease, high blood or eye pressure, bleeding disorders, or tear production disturbances such as watery or dry eyes.
What does the eyelid/eyebag surgery involve?
On the upper eyelids, the incision is carried out in the natural crease line that occurs approximately 1 cm above the eyelashes. The incisions may extend into the crow's feet or laughter line area at the outer corners of your eyes. Surgery here is designed to correct both the excess skin and the excess fat. After making the incisions, the excess skin and muscle is trimmed from the upper eyelids together with any fat, which is usually present on the area adjacent to the sides of the nose. The incisions are then closed with very fine sutures. It is important to remember that you cannot remove all skin in this region because some skin always need to remain behind after this surgery in order to allow good closure of the eyelids! On the lower eyelids, the technique very much depends on the patient's individual circumstance and requirements. Therefore if the problem is mainly prominent lower bags without excessively loose skin, you may have what is termed as a transconjuctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. Alternatively, when loose skin needs to be trimmed, the incision starts underneath the eyelashes and extends 1 cm or so outwards into the crow's feet area. The skin is then lifted upwards and outwards, gently tensioning the area and overlapping skin removed. Before suturing, any bleeding points are meticulously stopped.
Is upper eyelid surgery alone enough?
Many patients come to the clinic requesting upper eyelid surgery to improve the contour and appearance of hooded skin they see and perceive in the upper eyelid region. The majority of these patients certainly do benefit from upper eyelid surgery. However there are a proportion of patients who experience heavy upper eyelids as a result of drooping eyebrows. As a result of the close proximity of the eyebrows to the upper eyelids, any sagging eyebrow skin can in fact make your upper eyelid skin also look heavier or saggier. If this is the case then this will be pointed out to you at the consultation. In these patients either a brow lift on its own will improve the appearance or a combination of upper eyelid and brow lift surgery will be required.
What type of anaesthetic is used for eyelid/eyebag surgery?
Eyelid surgery is performed using either local or general anaesthesia depending on the extent of surgery. In the former, the skin around your eyes will be numbed using an injection. This is usually accompanied by some intravenous sedation to make you feel relaxed and insensitive to pain. Some people find the prospect of having an operation around the eyes under only local anaesthesia somewhat daunting. In these situations then a light general anaesthetic is probably best. In the case of a general anaesthetic you will be completely asleep. The type of anaesthetic suitable for you will be discussed at the time of the consultation. Whether the decision is for a local or a general anaesthetic, eyelid surgery is most commonly performed as a day case procedure.
How long does eyelid/eyebag surgery take?
Blepharoplasty usually takes between 30 and 60 minutes depending on the extent of surgery and whether the upper or lower eyelids (or both) are performed. The upper eyelids take about 25 minutes to perform while the lower eyelids usually takes slightly longer to perform —about 40 minutes.
What happens after eyelid/eyebag surgery?
Following eyelid surgery you will have cold compresses applied to the eye region and be carefully observed for the first 3 to 4 hours, to ensure that no bleeding occurs which may spoil the final result of your surgery. The upper and lower eyelid sutures consists of a single very fine thread beneath the skin surface running along the wound. There will be small strips of tape over the bridge of the nose and along the outer corners of the eyes to hold down the stitches. In the transconjuctival technique mentioned above, there are no sutures in place. You should expect the application of an antiseptic eye ointment postoperatively. This may blur your vision initially but this soon clears. A large pair of sunglasses helps to hide the effects of surgery. After your discharge please read and follow the postoperative instructions carefully.
What kind of after effects should I expect?
Following eyelid surgery you will experience swelling, tightness and bruising around the eyes to varying degrees. Generally speaking there is usually more swelling and bruising with lower eyelid surgery than with upper eyelid surgery. There is frequently slight leakage of blood from the incisions, and your eyes may be gummy for a week or so, all of which can add up to a disturbing and scary postoperative picture. Furthemore the eyes will probably look uneven and even over pulled in the corners. This is normal as there are internal stitches causing this in an attempt to support he eyelids through the swelling and bruising. Do not be alarmed. This always settles, however may take a few weeks before it is completely resolved. The eyelids should be gently splashed with water and not rubbed in any way. The majority of the swelling usually subsides after the first 10 days postoperatively. Bruising however may persist for a longer period, even up to one month in some cases. Elevation of the head, avoidance of any stooping and the use of cold compresses reduce the swelling and bruising.
What are the scars like?
Scars will form as a result of the eyelid surgery. Overall, blepharoplasty scars heal relatively well. Generally all scars are red somewhat in the first couple of months. These then gradually fade over a period of about 6-9 months. In the upper eyelid, the scars are tucked into the base of natural fold or crease of the upper eye socket and difficult to spot. However variations in the healing process do occur from individual to individual. The scars of the lower eyelids, are along side the lower eyelashes and almost always heal with a near invisible line after several months have passed. Those extending out into the crow's feet area can become a little reddened and lumpy requiring perhaps a little longer to settle completely. Massage of these scars speeds up the maturation process and is recommended in all cases.
Is eyelid/eyebag surgery painful?
Generally speaking, eyelid surgery is not considered a very painful procedure. Of course your eyelids will probably feel tight with some mild stinging as the anaesthetic wears off and it is normal for this to continue for a few days afterwards. Mild painkillers such as paracetamol usually control this. A number of patients may experience a feeling of numbness in the eyelid region. This is to be expected and normal sensation usually returns quite quickly in a matter of weeks. However, rarely, this may be delayed and may take a few months.
How long does a blepharoplasty last?
The effects of blepharoplasty surgery are permanent in that skin that was removed does not return. However the ageing process does not stop with this or any other surgery and therefore you are likely to age and develop laxity around the eyes in the years to come. In general however most people who have had previous blepharoplasty operations do not require similar surgery again for at least 10-12 years.
What could go wrong with blepharoplasty surgery?
All surgery carries some uncertainty and risk. When a blepharoplasty is performed by a qualified Plastic Surgeon, complications are infrequent and usually minor. Still, individuals vary greatly in their anatomy, their physical reactions, and their healing abilities, and the outcome is never completely predictable.Complications that can occur include: Haematoma (a collection of blood under the skin that sometimes must be drained by the surgeon), minor infections, scar lumpiness and distortion (usually temporary).
With lower eyelid surgery, lowering or irregularity of the lower eyelid (depending on the degree, termed scleral show or ectropion) can sometimes occur as a result of the pulling effects of scar tissue in some people. This is unpredictable and sometimes occurs only in one eye. As a result, slight changes of the shape and size of the eye may be noticed. If this is very noticeable, then for some people this can be a little distressing. Massaging, as will be instructed, early on diminishes the chance of this happening. If it does occur however then more intense massaging to the lid, and even application of some taping will help alleviate this problem. You will be instructed accordingly in the follow-up clinic. In these circumstances it may take up to two to three months to correct. Very rarely however, if conservative treatment is unsuccessful then surgical correction is required. Transient watering of the eyes to varying degrees can also occur. Conversely, dryness of the eyes has also been reported. Although this is usually temporary and diminishes with time it can very occasionally be long lasting or very rarely permanent. You will be instructed as to what measures will be needed if this does occur. Although every effort is made to preserve eyelash hair, rarely hair loss may occur in the lower eyelash area adjacent to the incision which is made to elevate the skin. This occurrence is not predictable. Hair loss may be temporary or permanent. Loss of vision, although extremely rare (approximately 1:100,000 incidents) is possible. Mr. Karidis has never encountered this complication. Tiny whiteheads may occasionally appear under the skin at the site of the sutures, after your stitches are taken out. These usually settle on their own, however if they don’t they can be removed easily with a very fine needle in the outpatients department. You can reduce your risks by closely following Mr. Karidis's advice both before and after surgery.
How many blepharoplasties does Mr.Karidis perform?
In accordance with the National Healthcare commission guidelines, according to the last five years of annual audit figures submitted to the Hospital of St. John and St. Elizabeth in London, Mr. Karidis performed on average 350 eyelid operations per year. In the last 10 years he has performed over 3000 eyelid operations.
How long before I’m back to normal?
Prepare to look a little scary in the first 4-5 days, particularly if you have had your upper and your lower eyelids done! Generally speaking the lower eyelid surgery takes longer to recover than upper eyelid surgery. You should however be able to read or watch television reasonably comfortably after 2-3 days. Contact lenses should be avoided for 2-3 weeks, and even then may feel uncomfortable for a while. It is advisable to plan on taking it easy for the first week after surgery. During this time get plenty of rest and allow your body to spend its energy on healing. With upper eyelid surgery, you should be able to go back to work by 5-7 days. As stated above, lower eyelids take more time to settle and therefore you probably would need about 7-10 days off. However, you must understand that everyone is different in their healing responses and therefore some people may need significantly longer which could mean 3 or even 4 weeks off in a minority of cases. Bruising can be masked with light makeup. You may be sensitive to sunlight, wind and other irritants for several weeks, so you should wear sunglasses and a sunblock when you go out. It is especially important to avoid activities that raise your blood pressure, including vigorous sport, bending or lifting.
Blepharoplasty is one of the most popular aesthetic surgery procedures. The chances are excellent that you'll be happy with your surgery, especially if you realise that the results may not be immediately apparent. The positive results of freshening your eyes and reducing a tired appearance will benefit your self-esteem and confidence and should last for years. But always remember the procedure can never halt the ageing process. The clock can be turned back but you cannot stop it ticking.
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