Are you considering eyelid Surgery
Eyelid surgery also called blepharoplasty is a procedure which remove excess eyelid skin, muscle and fat. Eyelid surgery can correct drooping upper eyelids, puffy bags below your eyes and the hollow appearance associated with aging. These features make you look tired and old. In some patients the excess skin may overhang the eye aperture and interfere with the visual field.
The Blepharoplasty procedure may be used to correct congenital features and ethnic variability.
The procedure is done alone or in conjunction with other procedures such as facelift or brow lift. It can be done under local and sedation or under general anaesthesia.
Blepharoplasty can enhance your appearance, improve your self-confidence and give you a fresher looks. Before you have eyelid surgery think carefully about your expectations and discuss them with your surgeon.
The best candidates for blepharoplasty are men or woman who are physically healthy, psychologically stable with realistic expectations. Most patients are older than 35 years but if you have familial baggy eyelids you may elect to have surgery sooner. The Asian population wanting to re-create the absent folds also have surgery late teens or early twenties especially those involved in the entertainment industry.
In patients needing surgery for thyroid eye disease I prefer to do the procedure in conjunction with a neurosurgeon and an ophthalmologist depending on the severity.
There are certain medical conditions which make eyelid surgery more risky. These include hyper- and hypothyroidism, dry eye disease, lack of tearing, high blood pressure, bleeding tendencies and diabetes.
Planning your surgery
The initial consultation with your surgeon is very important. The surgeon will need your complete medical and surgical history and a list of all medications. Thus check your records before so as to provide the information. Be sure to inform your surgeon if you have any allergies, taking any vitamins or herbal formulation, drugs or if you smoke.
You should also provide evidence of your most recent eye examination as well as relevant information from your ophthalmologist. If you wear glasses or contact lenses be sure to bring them along.
You should carefully discuss your goals and expectations with your surgeon and make sure that you have a mutual understanding of the expectations. You will have to decide if all four eyelids (not eyes) will be operated on or just the upper or lower eyelids. A decision about the excision of skin with or without fat excision or addition needs to be made preoperatively. The need for additional procedures will also be discussed e.g. fat fills, facelift, chemical peels, botox etc.
The procedure can be done under local anaesthesia with sedation in the surgeon’s rooms or under general anesthesia in theater. This depends on additional procedures performed and your overall health.
Preparing for Surgery
Your surgeon will give you specific instructions regarding smoking, medications, last meals, time and duration of admission if needed.
Please do not wear any eye makeup on the day of the surgery. Eyelash extensions should also be avoided prior to surgery as the ointment used causes detachment of the lashes.
You would have to arrange for someone to drive you home regardless of whether you are admitted or not. You will look battered and bruised for 3 – 6 weeks after the procedure, please keep in mind prior to events, functions and competitions. And certainly not 2 months before your daughter’s wedding!!
Types of Anaesthesia
A blepharoplasty may be performed under a general anaesthetic or under conscious sedation. Conscious sedation have numerous advantages and disadvantageous. The advantageous are: shorter hospital stay, the procedure is cheaper and a lesser risk of deep vein thrombosis. However as the name suggest you will not be completely unconscious, merely sedated to level where you do not experience any pain. Thus the surgical team still requires some corporation from you, the patient.
Eyelid surgery usually takes 2 to 3 hours depending on additional procedures performed. The procedure will be done as a day case when performed as an isolated procedure.
The incisions will be marked, usually the upper eyelids followed by the lower eyelids. The incisions follows the natural creases of your eyelids, the crease of the upper eyelid and just below the lower lid lashes. The incisions will extend into the crow’s feet or laugh lines. Working through these incisions the surgeon separates the skin from the underlying fatty tissue and muscles, removes the excess fat and often trims sagging skin and muscl e.
A small sliver of skin will be removed from the lower lids which will be released and re-draped in an aesthetically pleasing position. In order to prevent the complication of lower eye lid retraction a suture will be placed at the lower outer area of the eye. Initially the stitch may cause slight irritation but it will be absorbed over time.
Sutures will left behind that will be removed at 7 to 10 days post-surgery. Ice bags will be placed on your eyes to minimize swelling and bruising.
After the surgery
After the surgery you will have to apply an antibiotic ointment to the incisions and eye drops in your eye. Pain, swelling and bruising will persist post operatively and will gradually resolve over the following 2 weeks. You will be given antibiotics and analgesia to take home and use as instructed.
If you experience any severe, or worsening pain, or a disturbance in vision please contact your surgeon immediately.
You will be asked to elevate your head postoperatively and used cold compresses to alleviate swelling and bruising. Please avoid any strenuous activity that may cause and increase in your blood pressure.
Your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light and mild blurred vision.
Your surgeon will follow your progress very carefully for the first week or two. The stitches will be removed 7 to 10 days after the operation and once the sutures have been removed the swelling and discoloration around your eyes will gradually subside and you will look and feel much better.
Blepharoplasty performed by a qualified plastic surgeon is associated with few complications which are usually minor.
Below follows a list of some of the more frequent complications associated with immediate prosthetic reconstruction
Local compilations i.e. around the eyes: bleeding or haematoms formation, blurred vision/double vision for a few days post operatively, swelling and bruising, slight asymmetries between the eyelids, delayed wound healing, wound sepsis and later tiny whiteheads once sutures are removed
Systemic complication…. your body: Fluid and electrolyte abnormalities, deep vein thrombosis and post-operative lung complications. These are seen in general anesthesia in combination procedures
Long term and cosmetic complications… the way it looks: Poor scarring, lower lid lagopthalmos, (Inability of the lid to close completely), dry eye syndrome, over correction / under correction, slight asymmetries, ectropion (turning over of the eyelid due to scar tissue)
Your new look
Healing is a gradual process, and scars may appear pink for up to six months after surgery. Please avoid sunlight (any UV radiation) during this time. Eventually the scars will fade to a thin invisible white line. You will have a more youthful appearance and in many patients may only need the procedure once in lifetime.