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Cosmetic eyelid surgery (blepharoplasty)

Published by Bupa's health information team, June 2009

This factsheet is for people who are having cosmetic eyelid surgery, or who would like information about it.

Cosmetic eyelid surgery (also called blepharoplasty) involves removing excess skin, fat or muscle from around the eyes to give a more alert and youthful appearance. The procedure can be done on the upper and lower lids, at the same time or separately.

Your care will be adapted to meet your individual needs and may differ from what is described here. So it's important that you follow your surgeon's advice.

About cosmetic eyelid surgery
Getting advice
What are the alternatives to cosmetic eyelid surgery?
Preparing for your operation
About the operation
What to expect afterwards
Recovering from cosmetic eyelid surgery
What are the risks?
Questions and answers
Related topics
Sources

About cosmetic eyelid surgery

As you age, the skin around your eyes loses its elasticity. You may develop loose folds of skin on your upper eyelids and deep creases under your lower lids. Your muscles in this area may also slacken so that fat around your eye bulges forward and makes your lower eyelids appear baggy. Cosmetic eyelid surgery can remove the excess skin, fat, or both, from around your eyes.

Getting advice

It's important not to rush into the decision to have cosmetic surgery. Discuss your options with your GP, who may be able to recommend a reputable surgeon or advise you about choosing which hospital to be treated in.

Before opting for cosmetic eyelid surgery, discuss with your surgeon what you are hoping to gain from the operation and the result you can realistically expect. For example, the surgery won't remove wrinkles at the corners of your eyes (crow's feet) or the dark shadows under your eyes.

If you have eye problems such as glaucoma, dry eyes (eyes that don't produce enough tears) or a detached retina, you're at higher risk of complications. You will need to see a specialist eye doctor before your operation.

What are the alternatives to cosmetic eyelid surgery?

Wrinkles around your eyes can also be reduced using chemical peels or laser treatments, or by a brow lift.

Preparing for your operation

Your surgeon will examine your eyelids, vision, tear film (a layer of tears covering the surface of your eye), front of your eye and your retina. He or she will explain how to prepare for your operation. For example, if you smoke you may be asked to quit, as smoking increases your risk of getting a chest or wound infection which can slow your recovery. The time it takes for your eyelids to heal may also be longer if you smoke.

Your surgeon will discuss the options for anaesthesia with you. Cosmetic eyelid surgery is usually done as a day case under general anaesthesia. This means you will be asleep during the operation. Alternatively your surgeon may be able to carry out the procedure under local anaesthesia. This means the area around your eyes will be numb but you stay awake. You may have a sedative to help you relax.

If you're having a general anaesthetic, you will be asked to follow fasting instructions. Typically you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

At the hospital your nurse may do some tests such as checking your heart rate and blood pressure, and testing your urine. Your surgeon will usually visit you to discuss the operation and ask you to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your surgeon will examine your eyes and may take photographs, so that you can compare the results of surgery with your original appearance.

About the operation

The operation takes between one and three hours, depending on the exact procedure and which eyelids are being done. Your surgeon may use either conventional or laser techniques.

For surgery on the upper eyelids, cuts are made into the natural lines and creases in your eyelids, and in the wrinkles at the corners of your eyes. For surgery on the lower eyelids, cuts are made just below your eyelashes and then out into your 'laughter lines' at the corner of your eyes. This means your scars will run along the natural folds of your eyes, which helps to hide them.

Excess fat, muscle and loose skin are removed, and the cut is closed using fine stitches. If only fat is removed and there is no excess skin, the cut may be made inside the lower eyelids, leaving no visible scar.

Your surgeon will apply ointment to your eye area to stop it from drying out and use small strips of sterile paper tape to support your eyelids and hold the ends of the stitches in place.

What to expect afterwards

You will need to rest until the effects of the general anaesthetic have passed. You may need pain relief to help with any discomfort as the anaesthetic wears off. When you feel ready, you will be able to go home - but you will need to arrange for someone to drive you. Try to have a friend or relative stay with you for the first 24 hours.

General anaesthesia temporarily affects your coordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your doctor/surgeon's advice.

Your nurse will give you some advice about caring for your eyes before you go home. You may be given eye ointment to use at home and a date for a follow-up appointment.

Recovering from cosmetic eyelid surgery

You can take over-the-counter painkillers such as paracetamol or ibuprofen if you need to. Don't take aspirin as it can cause increased bleeding. Always read the patient information leaflet that comes with the medicine.

Dissolvable stitches will disappear on their own in seven to ten days. Non-dissolvable stitches are usually removed three to five days after surgery. You may need to continue wearing strips of paper tape to support your eyelids for one week.

You will have some swelling around your eyes. Applying a cold compress, such as ice wrapped in a towel can help to reduce the swelling and bruising. Don't put ice directly on your skin as it can damage your skin.

There are some important things to remember while recovering from cosmetic eyelid surgery.

Keep your head up for a few days, for example, sleep propped up on pillows and don't bend down. This helps to reduce swelling and bruising.
Clean around your eyes with plain water.
Use any ointment or drops your surgeon has given you.
Don't wear eye make-up until your surgeon tells you it's safe to do so, usually soon after the stitches come out.
Don't wear contact lenses for at least two weeks.
Don't drive until your vision returns to normal.

Most people can read or watch television after a few days and can go back to work after seven to 10 days. It's possible that you may not be completely satisfied with your appearance after the operation.

What are the risks?

Cosmetic eyelid surgery is commonly performed and generally safe. However, in order to make an informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications of this procedure.

Side-effects

These are the unwanted, but mostly temporary effects you may get after having this procedure. Side-effects of cosmetic eyelid surgery include:

soreness, swelling and bruising around your eyes - most of the swelling improves after four or five days but you may still have some after two to three weeks
dry, itchy eyes - this usually clears after a few weeks
watery eyes - this can last for a few weeks
sensitivity to light and wind - this will improve after a few weeks
double or blurred vision - this usually improves after a few days
discolouration of the skin on your eyelid - this usually settles within a few weeks but may take several months
scarring - this should fade over a few months

Sometimes tiny whiteheads appear along the line where the stitches were. Your surgeon can remove these with a needle.

Complications

This is when problems occur during or after the operation. Most people are not affected.

Complications of cosmetic eyelid surgery are uncommon but can include:

bleeding under your skin (haematoma) - you may need another operation to stop the bleeding and drain the area, although it may disappear gradually over two to three weeks
swelling that pulls the lower lid away from your eyes - this usually settles on its own after a couple of days, but sometimes another operation is needed
damage to the surface of the eyeball or the surrounding muscles
tightness of the eyelids that means you can't close your eyes, which usually improves after time
bleeding behind the eye which can press on the optic nerve and cause partial or complete blindness - although this is very rare, don't ignore any severe pain you have as it can be a sign of bleeding behind the eye
uneven appearance - your eyes may not look identical, and occasionally another operation is needed

You're at higher risk of complications if you have high blood pressure, heart disease or thyroid problems. You should tell your surgeon if you have any of these. The exact risks are specific to you and differ for every person, so we have not included statistics here. Ask your surgeon to explain how these risks apply to you.