Blepharoplasty Surgery in London
Eyebag and droopy eyelid surgery with or without canthopexy
Blepharoplasty is a type of surgical procedure that repairs droopy skin of the eyelids that develops with time. It is eyelid surgery that may involve a reduction excess skin, muscle and sometimes some of the underlying excess fat. As you age, your eyelids stretch and the muscles supporting them weaken. This results in the underlying normal fat to gather above and below your eyelids, causing the eyebrows to develop a sagging appearance , a drooping and aged appearance of the upper eyelids and the appearance of bags under your eyes. This is what some people consider to be an eyelid lift.
This combinations gives an appearance that makes you look older. The effect of the sagging skin around your eyes and block your side and upper vision (peripheral vision). Blepharoplasty can reduce these visual problems by a reduction of the skin and commonly eliminates them entirely.It can also give a more youthful appearance and make you look more alert.
As an oculoplastic surgeon I specialise in the blepharoplasty procedure and cosmetic eyelid surgery. I deal with plastic surgery around the eyes as well as other cosmetic procedures, cosmetic surgery and reconstructive surgery in this area. A plastic surgeon may offer similar procedures but an oculoplastic surgeon specialises in this area alone.
Is blepharoplasty is right for you? To find out what you can expect realistically from blepharoplasty surgery and explore the benefits and risks of blepharoplasty please read on.
What are the different types of blepharoplasty (scar or no scar)?
There are different approaches to the procedure:
The traditional approach that also address the extra skin with upper eyelid surgery and lower eyelid blepharoplasty is the transcutaneous approach that is discussed on this page. Eyelid surgery to the upper eyelids is known as upper blepharoplasty while the lower eyelid surgery is known as lower blepharoplasty.
Another approach to blepharoplasty is the transconjunctival approach that leaves no scar on the eyelid skin and is performed on the lower eyelid.
The skin pinch blepharoplasty is a useful technique to address any excess skin to the lower eyelid with less surgery than the traditional approach and a quicker recovery.
In addition to blepharoplasty a canthopexy may be required to tighten the lower eyelid and to lift the lower eyelid slightly to give a more almond shape to the eye.
A browpexy is commonly done in combination to an upper eyelid blepharoplasty to stabilise and slightly elevate the outer brow to give a more pleasing look. It is the minimal brow lift done at the same time. An internal browpexy means that there is no additional scar with this procedure.
How does the eyelid change with time?
With the aging process, skin loses its elasticity, creating an excess of skin that starts to sag. The underlying muscle, known as the orbiculares oculi loses its tone causing it to loosen which can create further sagging with the excess lax muscle underlying the skin. Under the muscle is a layer known as the orbital septum. This folds back pockets of fat the surround the eye. With age the septum can also loosen allowing the fat to come forward giving the appearance of eye bags in the eyelids. This process occurs not only in the eyelids but the loosening of the tissues occurs in many parts of the body including the face. The cheeks can also start to descend in the face giving a more tired appearance with dark circles and prominent lines that run down from the eyes to the cheek which are also known as tear trough lines. Another aspect of ageing that occurs with time is the loss of fat in general. When we are younger the area around the eye is full of fat volume giving a young appearance and as we age there is a loss of fat and volume in general which is an ageing hallmark. Interestingly, the fat in the upper eyelid nearer the nose tends to lose less volume than the fat on the outer aspect of the upper eyelid and this can also give an appearance of upper lid eyebags near the nose. It is important not to just get rid of this fat during surgery but to move it to the outer part of the upper eyelid to try and restore some of the fat volume lost during ageing and give a more youthful looking result.
Why is blepharoplasty done?
You may consider having a blepharoplasty if you suffer from drooping or sagging of the eyelid skin that prevents your eyes from completely opening or notice a pull down effect on the lower eyelids. If you suffer from eyeballs alone with no extra skin a conjunctival blepharoplasty may be more suitable. A reduction of the skin and removal of the excess skin from the eyelids can help improve the vision. Blepharoplasty of the upper and lower eyelids can also give the eyes a younger and more alert appearance.
Blepharoplasty is an option if you have:
Excess skin of the upper eyelids that interferes with your peripheral vision
Baggy or droopy skin of the eyelids
Excess skin of the lower eyelids
A large bag appearance under the eyes
Insurance coverage for blepharoplasty surgery may depend on your policy and if the surgery is to help improve the blocked vision caused by the excess skin. If the surgery is only to improve the cosmetic appearance to give a younger and brighter look the most likely won't be covered by your insurance policy. Lower lid blepharoplasty is almost always done for cosmetic reasons as the lower eyelid bag appearance does not affect the peripheral vision and cannot be used to improve vision.
What are the risks?
Possible risks of blepharoplasty surgery include:
Bleeding from the eyelids
Dryness and irritation of the eyes
Difficulty closing the eyes
Scarring (although this is usually put into the eyelid skin crease to hide it as much as possible)
A need for follow up surgery
Temporary blurring of the vision
Rarely, loss of vision
Risks associated with surgery more general including anaesthetic reactions and blood clots
To know which risks most apply to you talk to your doctor to understand more about blepharoplasty as well as the benefits and if they apply to you. At the initial consultation you will be assessed and given an indication at what can be achieved with realistic expectations as well as learn more about the healing process and recovery process. You will be told when you will be able to resume normal activities following the procedure. This way you can decide with your doctor if blepharoplasty is a good option.
How you prepare for blepharoplasty surgery?
Before having a blepharoplasty you will meet your Oculoplastic surgeon who specialises in blepharoplasty to discuss:
Your medical history including any previous surgery and current eye conditions.
Your expectations with an honest discussion about what can be realistically achieved.
A vision examination to check the eyes prior to surgery.
A physical examination of the eyelids to ensure that this is the correct procedure.
Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.
It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during blepharoplasty surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your blepharoplasty and will tell you how long before the operation.
Stoping smoking several weeks before surgery can help improve the healing after blepharoplasty.
You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.
What can you expect before the procedure?
Blepharoplasty is usually done as a day case with Mr Ahmad Aziz in Central London where you can go home the same day. Your surgeon will inject local anesthesia into your eyelids to numb the area and you can also have medication through a drip to help you relax. General anesthesia can be used but it less common.
What can expect during the procedure?
Your surgeon will make an incision along the fold of the eyelid, removing some excess skin, possibly some underlying muscle and possibly fat, and closes the incision to give a natural appearance and hiding the scar within the eyelids natural creases to hide the scar as best as possible.
What can you expect after the procedure?
After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the healing at home.
After surgery you may temporarily experience:
Blurred vision from the lubricating ointment applied to your eyes at the time of blepharoplasty
Watering of the eyes
Sensitivity to light
Puffy, numb eyelids from the anaesthetic and blepharoplasty surgery
Swelling and bruising similar to having black eyes which will settle within a week
Pain or discomfort
Your doctor will likely suggest you take the following steps after surgery:
Use ice packs or cold compresses on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling
Gently clean your eyelids and use prescribed medication on the small incisions.
Avoid straining, heavy lifting and swimming for a week after blepharoplasty.
Avoid strenuous activities, such as aerobics and jogging, for a week.
Avoid rubbing your eyes.
Not to use contact lenses for about two weeks after surgery.
Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.
Sleep with your head raised higher than your chest for 3 days after the surgery.
After a few days, return to the surgeon to have stitches removed, if needed.
Seek medical attention immediately if you experience any of the following:
Shortness of breath
An unusual heart rate
Severe new eye pain
What are the results of surgery?
Many patients are satisfied with the results of blepharoplasty and benefit from a more youthful appearance, better vision if the peripheral field was being obstructed and more self confidence with the reduction of the excess skin. The results of the surgery can last a lifetime but for others the drooping may recur with time. The surgery is not an outpatient procedure but you do go home the same day.
The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. Dark circles from skin pigmentation and crows feet from aging may still persist after the surgery.
Scars from the surgery can take months to fully fade but should be within the skin crease and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.