Who is a candidate for blepharoplasty?

The best candidates are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, although you may require surgery earlier if you have a strong family history of baggy eyelids.

A few medical conditions make blepharoplasty more risky. These include thyroid problems such as hypothyroidism and Grave’s disease, dry eyes or lack of sufficient tears, high blood pressure (uncontrolled) or other circulatory disorders, cardiovascular disease and diabetes. A detached retina or glaucoma are also reasons for caution.

The consultation

At the first consultation, I like you to tell me in your own words what it is that worries you about your eyelids and to define the problems as you see them. It is important to be honest and forthright as surgery is tailored around your concerns.

Since the function of the eyelids is to protect the globe(eyeball), it is important to establish that your visual function is normal. I need to know if your vision is normal or if you use lenses or have had correction (glasses, contact lenses, refractive or laser surgery). I also want to know if you suffer from dry eyes, excess tearing or any other vision related problems. Your motivation, goals and expectations with regard to the surgery will also be discussed.

Your eyes and lids will be carefully examined to assess the quantity of excess skin and fat, the quality of the muscle and the bony relations to the eyeball. Your suitability and fitness for surgery will be evaluated.

Following assessment, we will discuss all available options and formulate an operative plan, including type of surgery and anaesthesia to be used. In consultation, we will decide whether all four lids require surgery or just upper or lower. Other facial procedures may in addition be advisable for a harmonious result. Risks and complications, and recovery after surgery will also be discussed.

It is important that prior to surgery you are clear as to what surgery will entail. Please ask questions about any aspect of our discussions - a well informed patient will cope better with surgery.

Peri-operative care

I always perform blepharoplasties in an operating theatre. I usually do the procedure as a day case in the morning, allowing you home later that afternoon. Sometimes you will need to stay overnight, especially if you have had additional surgery to other areas.

Preparing for surgery

Very little preparation is necessary for surgery. If you are well informed and know what to expect, if you are fit and healthy, if your reasons for surgery are good and your expectations realistic, you will be more likely to be happy with the outcome. Smoking is generally unhealthy, but in particular interferes with normal blood flow and wound healing. I would therefore recommend that for any surgery, blepharoplasty in particular, you stop smoking 6 weeks beforehand and you refrain from smoking for three weeks afterwards. Although nicotine replacement products such as the spray, patch or gum are of great assistance, these products also adversely affect wound healing and should be avoided for the same period.

You should arrange for someone to bring and collect you from the hospital and there should be a responsible adult to look after you on the night of surgery. Hospital admission can be arranged if you feel this is necessary. Do not apply make-up on the day of surgery. On the day of surgery, you should be healthy and not suffering from flu or any other illness. All cosmetic surgery is elective and it is better to delay surgery than to tempt problems. You should arrive at the hospital on the morning of surgery having fasted and being nil by mouth for six hours. Your eyelids will be bruised and swollen after surgery and you might find that your eyes are sensitive to light.

It is a good idea, therefore to bring a pair of good quality sunglasses to wear afterwards.

Anaesthesia

I usually perform upper eyelid blepharoplasty under local anaesthesia, but general anaesthesia is fine too. It is advisable to have lower eyelid blepharoplasty under general anaesthetic.

What does the surgery entail?

One pair of lids (upper or lower) usually take me about one hour. All four lids take usually about two hours, depending on the extent of the surgery. If I do all four lids, I usually do the uppers followed by the lowers. I will place marks on your eyelids, and take pre-operative photographs. You will then be escorted to the operating theatre.

After infiltration of the local anaesthetic, once the tissues are numb, the incision is made. This follows the natural lines of your eyelids – in the crease of your upper lids and just below the lashes in the lower lids. The incisions usually extend into the crow’s feet or laugh lines at the outer corners of your eyes. The skin is then separated from the underlying fatty tissue and muscle and excess fat is removed or repositioned, depending on requirements. The skin is then re-draped over the lid and any excess removed prior to closure. Closure is done using a fine suture, which is removed on about day 5 after surgery.

Adjuvant procedures may be performed especially in relation to the lower lid. These include lower lid horizontal tightening if the lid has a tendency to fall away from the eyeball and malar fat suspension if you suffer from dark rings below the eye. Some patients have very little lower lid skin excess and their problem is predominantly an excess of fat. In these cases a transconjunctival blepharoplasty may be performed in which the incision is made on the back of the eyelid, leaving no visible scar. Other procedures such as facelift/necklift can accompany eyelid rejuvenation.

What can one expect after surgery?

Your surgery is usually a day case operation if only eyelids were done. When you leave the hospital let someone drive you home. You will be given eye ointment to use regularly at home.

You will be bruised and swollen after your operation. The bruising takes 2-3 weeks to subside. The swelling is mostly resolved by 6 weeks. Have a pair of fashionable dark glasses handy, so that you can wear them when in public. There should be very little pain. You may need paracetamol for the first few days. There may be temporary visual disturbance too - this is because the eye is close to the site of surgery, so there is swelling around the eye also. This usually resolves over a week. Take regular showers and go for gentle walks in the first week after your surgery. You shouldn’t drive until your vision has returned to normal. Please take it easy - don’t go running or do any strenuous exercises for at least 4 weeks. Most patients take about two weeks off work. You should be back to normal activity by 3-4 weeks.

Mr Soldin will arrange to meet you a week after your surgery to review the wounds and remove the sutures. He is of course immediately available should you have any concerns after surgery - please do not hesitate to get in touch. There are usually 3 follow up consultations included in the fee - one week, 6 weeks and 6 months.

How long does it take to get back to normal?

You should be able to read or watch television comfortably after two or three days. However, you will not be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while. Most people feel ready to go out in public (and back to work) in a week to ten days. By then, depending on your rate of healing, you will probably be able to wear make-up to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a sunblock when you go out. Try to keep your activities to a minimum for three to five days and avoid more strenuous activities for about three weeks. Your body needs to heal. It is especially important to avoid activities that raise your blood pressure, including bending, lifting and rigorous sports. Try and avoid alcohol since it causes fluid retention.

What are the risks of eyelid surgery?

When eyelid surgery is performed by a qualified plastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always the possibility of complications, or a reaction to the anaesthesia.  Discomfort, swelling and bruising can commonly occur. Double or blurred vision for a few days, and a slight asymmetry in healing or scarring are uncommon. Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they will fade to a thin, nearly invisible white line. Abnormal scarring in eyelid surgery is rare. Following surgery, some patients may have difficulty in closing their eyes when asleep – this usually improves over the next week. In rare cases this condition may be permanent. A rare complication is ectropion (a pulling down of the lower lids away from the eye). In this case, further surgery may be required. Permanent vision problems or blindness are very rare.

Are the results permanent?

The expected improvement with eyelid surgery can be dramatic – It is said that the eye is the window to the soul – improved appearance of the peri-orbital region can make you look less tired, less sad, and younger. Surgery however cannot stop the ageing process – with a balanced diet, healthy lifestyle, and sun protection the results should last over 10 years.

If you are worried post-operatively

Telephone the ward of the hospital from which you have been discharged.

Telephone my secretary Angie Harrison during office hours – 07961221874

In an emergency (and you have failed to contact me by the above two methods) then please telephone St George’s Hospital (020 8672 1255) and ask them to either bleep me or the Resident Plastic Surgery doctor on call (Bleep 7050).