Eyelid surgery

The Procedure

Hooded or puffy eyelids are common and often run in families. Eyelid surgery (blepharoplasty) restores the natural contour of the eyelids which in turn gives a more youthful, less tired look.

In the upper eyelid this is mainly caused by loose, droopy skin and in the lower eyelid by small pockets of fat that protrude out as the muscle slings around the eye weaken with age.

This procedure can be performed under either local anaesthetic with sedation or general anaesthetic and I usually undertake it as a day case.

In the upper eyelid, the excess skin is marked out and then removed along with a thin strip of muscle, the resulting scar being placed in the natural crease of the eyelid. The fat pockets in the lower eyelid are removed through a small incision just below the eyelashes and any excess skin that results from this is then trimmed.

Both incisions are closed using a very thin continuous stitch that is dissolvable although 2-3 individual stitches are placed to close the area at the lateral edge of the eye. The stitches are then removed 4-5 days later.

It is very important to make sure that it is the eyelids that are at fault and not a sagging (ptotic) brow which is better dealt with by a brow lift. “Crows feet” tend to respond better to treatment with Botox or laser treatments as the skin in this area is usually fairly active and does not respond well to surgery.

Extreme care must be taken where there is extreme laxity or dryness of the lower eyelid in order to avoid problems.

Post-operative care

• Keeping your head up with cool ice packs around the eyes is imperative. Witch-hazel (cooled in the refrigerator) should also be soaked onto gauze pads in order to reduce swelling.

• I will supply you with chloramphenicol ointment which contains a mild antibiotic to stop bugs and keeps the stitch margin moist.

• Bruising is, again, variable but is minimized using Arnica 24 hours before and after the operation as previously detailed.

• Following surgery, there will be some tightening preventing full eyelid closure and occasional drooping but this gradually resolves 2-3 weeks post surgery. If it persists it can be rectified with a small secondary procedure.

• Stopping bleeding during the operation is a high priority for the surgeon as haematoma (blood clot) formation is of great concern and must be dealt with urgently as this can have an effect on the outcome of the operation and may, in rare cases, affect vision.

• Watering, blurring and grittiness will occur but likely be temporary.

• Don’t wear contact lenses for 2 weeks after the procedure and make sure that you wear sunglasses to protect the eyes plus to hide and bruising.