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The top 6 mistakes that can happen with blepharoplasty


Having an eyelid lift with a blepharoplasty can be a very effective surgical procedure in the correct hands to treat excess skin and eye bags. It is an increasing popular procedure amongst women and men who are looking for eyelid rejuvenation to give a more youthful appearance or just a fresher look. It is not a simple procedure though and many surgeons from outside the field of oculoplastics do offer this treatment. Although many perform it well here are the top 6 pitfalls that should be avoided:


1. Removing too much fat


As we age the fat around the eyes can become more prominent and give an aged appearance. Removing some fat may sometimes be required but removing too much fat can give a hollowed look later down the line. It is increasingly recognised that fat around the eyes is a youthful look. Just look at a baby and how fatty their eyelids are! Removing just the right amount of fat in the correct parts of the eyelid can help with eyelid rejuvenation. Removing too much will make you look more aged and potentially startled. What you want is a surgeon who has a conservative approach to the fat, appreciates the role fat plays in youth and how the fat compartments of the eyelid can vary with age. Go for a surgeon that aims to give a natural long lasting result.


2. The eyes look different


Most people's biggest fear from surgery is having two eyes that don't match. This is a mistake that can occur from blepharoplasty. It can occur due to the natural changes in the way each eye heals following surgery. Everyone has a degree of facial asymmetry. If you next watch the news on TV and look at the eyes of the presenters you will notice it if you look for it. Having a surgeon who is aware of this challenge and is able to give you realistic expectations is key. Of course there are some cases where this is a degree of asymmetry that may require a further procedure. In the correct cards and with clear information from your surgeon the risk of this can be kept to a minimum.


3. The lower lid is not in the right postion


Lower eyelid blepharoplasty is very delicate and only a few millimetres in a change in position can be noticed. It can make the eyes look like they are different in size or give the appearance of the squint. If this does occur the tissues should be left to heal with massage to keep any scarring soft and supple. Revision surgery can be used to correct this. If an external approach is used for a lower lid blepharoplasty a canthopexy should also be done at the same time to support the eyelid and maintain its position as it heals. Eyelid surgery done with a scarless or transconjunctival approach does not need a canthopexy unless of course it is desired for cosmetic reasons.


4. The scars look different


In upper lid blepharoplasty the scar is placed in the skin crease to make sure they are not noticeable. 2 millimetres of difference between both eyes is noticeable. The incisions need to be made very precisely and they need to follow the curve of your skin crease to look natural. Having an incision placed incorrectly can result in the eyes not looking symmetrical.


5. A lumpy eyelid


Whilst many surgeons use dissolving stitches as they are preferred by patients I like to use permanent stitches that are removed 10-14 days after the surgery. Dissolving stitches can occasionally react with the body causing eyelid cysts or granulomas. The last thing you want after having cosmetic eyelid surgery are these. To reduce this risk, permanent sutures that are far less likely to react with the skin are used and removed later once the wounds have sealed.


6. You cannot close your eyelids


This is the most serious complication of blepharoplasty. If too much skin is removed you may find difficulty closing your eyelids. You cannot add the skin back once it is removed. The eyelid skin is one of the thinnest skins in the body and the skin elsewhere is not the same. The best approach is to have a more conservative approach and not take away the absolute maximum. You can always go back and take more but you cannot put it back.