Updated: Jan 26
Cosmetic surgery can be costly and it is difficult to know who to go through. Although the NHS is not there to provide purely cosmetic surgery we show what procedures are done and why?
Eyelid surgery on the NHS
Blepharoplasty and ptosis surgery are sometimes done on the NHS although this is not available for everybody and there are strict criteria that apply. These surgical procedures are not done for cosmetic reasons but are done if the droopy eyelid is blocking your vision and affecting your quality of life. They may also be done if the upper eyelid skin is needed to treat other conditions on your face. Lower eyelid blepharoplasty is rarely done on the NHS as eye bags and extra skin on the lower lids does not block the vision.
What are the NHS Criteria for eyelid surgery?
There are strict criteria that apply and the NHS usually requires evidence with the hospital taking photographs and performing visual field tests which are difficult to trick to prove that the surgery is needed. The evidence must show that the vision is being blocked and affecting your quality of life for surgery to be considered.
What other conditions qualify for eyelid surgery?
Some people suffer from a condition called cicatricial ectropion of the lower eyelid. There are a number of causes for this and it is essentially a turning out of the lower eyelid due to the skin shortening. A common procedure used to correct this is to take the excess skin from the droopy upper lid and place it into the lower lid that is lacking in skin. Part of the scar is hidden under the lower lashes. Although this is lower eyelid surgery it differs from a lower eyelid blepharoplasty where skin is sometimes removed and the excess fat is addressed.
Patients with thyroid eye disease may be left disfigured one the disease reaches what is called the burnt out phase. These patients may also qualify for surgical rehabilitation which may include blepharoplasty surgery to try and improve their appearance froth damage caused by the Graves orbitopathy. Other surgical procedures they may undergo include orbital decompression and squint surgery to help improve any double vision.
Other less common indications for these procedures on the NHS is in patients needing eyelid reconstruction following skin cancer. Cancer affecting the upper eyelid or lower eyelid may need reconstruction. An upper lid blepharoplasty may be performed where any excess skin can be used in the reconstruction. This can be done under local anaesthetic but general anaesthesia may be required if the reconstruction is more extensive. The excess tissue the upper blepharoplasty can be used with good effect in a surgical procedure to reconstruct the area around the eye.
The take home message
These procedures may in turn help with the appearance of eye bags or droopy eyelids but I am sure you agree that the main indication here is not cosmetic surgery even though there maybe an eyelid lift as part of the reconstruction. In the NHS these cases are most commonly done by Oculoplastic surgeons and not plastic surgeons or cosmetic surgeons.
What about the risks of eyelid surgery?
With all surgery there are risks. You can help minimise the swelling by using a cold compress, sleeping on a few pillows following the surgery to allow the swelling to drain and following your post operative instructions. You can have a dry eye, watery eyes or blurry vision as the eyelids settle during the healing process. In rare cases there are more serious potential risks such as permanent dry eye, double vision and loss of vision but make sure to discuss these with your surgeon at your initial consultation.