What is a blepharoplasty?
Blepharoplasty is more commonly known as eyelid surgery. The procedure involves the removal or repositioning of tissue (which may include excess fat, muscle or loose skin) from the eyelids, which in turn has the effect of tightening the skin and tissue around the eyes.
The medical term for surgery to the eyelids is 'blepharoplasty', which derives from the Greek word 'blepharon', which means 'eyelid' (in turn from the Greek word 'blepein' – to see).
Blepharoplasty in fact describes two types of surgery – surgery to the upper eyelids ('upper lid blepharoplasty') and surgery to the lower eyelids ('lower lid blepharoplasty').
Why might eyelid surgery be needed?
The ageing process results in the skin losing its elasticity. Although this happens to almost all the skin on the body, it is particularly noticeable on the face and around the eyes. The loss of elasticity is caused by a combination of gravity as well as sun exposure. These effects are most noticeable on the “orbital septum” which contains the fat around the upper and lower eyelid. When this happens the fat layer protrudes and causes what is commonly referred to as eyelid “bags”.
Whereas fat layers in other parts of the body increase or decrease with body weight, the fat layer in the upper eyelid does not (this type of fat is called 'non habital'), which has the effect of making any fat protrusion in the upper eyelids even more noticeable where someone has lost body weight.
Gravity and loss of skin elasticity have a similar effect on the lower eyelids, causing bags under the eyes, which can make some people look older and tired, even when they're not.
Some things can accelerate the formation of sagging eyelids and bags under the eyes, such as:
- Genetic factors (this can run in families).
- Continuing lack of sufficient sleep.
- Allergic reactions.
- Fluid retention (this is particularly noticeable immediately after waking up).
- High salt diet, or simply eating a meal containing a lot of salt, which contributes to fluid retention.
- Thyroid conditions (which can especially accentuate bags under the eyes).
- Sun exposure.
In most cases bags under the eyes are not painful, however you should seek medical advice if any swelling of either upper or lower eyelids is painful or is red or itchy or where the swelling is marked, as it may indicate a severe infection or allergy.
Who should consider eyelid surgery?
Bagging and sagging of the eyelids can reduce range of vision, in particular 'peripheral' vision, particularly your ability to see things above you and to your sides. Where the eyelids restrict range of vision and/or you cannot open your eyes fully, this constitutes a medical reason for having corrective surgery. Excess upper lid skin can also make you strain to keep your eyes open. Patients often describe feeling like they are always straining to keep the eyes open which is another indication for considering blepharoplasty.
Aside from corrective medical reasons to get eyelid surgery, many people also consider it as a cosmetic procedure. Excess skin on the upper or lower eyelids as well as fat also makes people look older than they are. Having a blepharoplasty can greatly improve this – with patients looking more refreshed and having a more youthful appearance after a blepharoplasty.
Is eyelid surgery right for you?
There are a number of factors to consider in deciding whether a blepharoplasty is right for you. Firstly, it's important to understand that eyelid surgery only changes the appearance of the eyelids themselves – the procedure does not alter eyebrows, 'crow's feet' around the eyes or dark circles under the eyes.
In your initial consultation, Dr Robinson will run through all of the issues you should consider, including your medical history, especially relating to any conditions affecting the eyes, such as glaucoma, wet or dry eye, or a detached retina, plus other conditions including thyroid disorders, diabetes and any cardiovascular conditions, including high blood pressure.
He will also run through with you the risks involved in the surgical procedure and potential complications. Your initial consultation would normally also include an assessment of your current level of physical health (including your alcohol intake and whether you smoke) and a review of any medication you are currently taking, including any vitamin supplements, and finally whether you have had any previous adverse reaction to medication or to anaesthetics.
The following examinations are generally also carried out at the initial consultation.
Assessment for ptosis
- Are the lids even to start with?
Assessment for extra fat
- Is it an option to either remove or transpose the extra fat?
Assessment for appropriateness for blepharoplasty
- What are the possible options surgically?
- Photographs of your eyes and eyelids will also be taken to help plan your surgery.
Based on the results of the initial consultation, Dr Robinson will be able to give you an indication of whether a blepharoplasty is the right choice for you.
Blepharoplasty Pre Operative Instructions
Certain medications can increase the likelihood of bleeding during the procedure and should be stopped prior to surgery and Dr Robinson will be able to advise how long before surgery these will need to be stopped. These medications include Warfarin, Aspirin and Apixaban. Some herbal remedies and supplements (particularly vitamin E supplements, St John’s Wort, Garlic, Ginko) can also interfere with anaesthetics and/or cause problems with bleeding, so it is advisable to stop all herbal remedies prior to surgery.
Smoking and alcohol
Continuing to smoke can prolong healing times after surgery, so it is strongly recommended that you stop smoking ideally 6-8 weeks before surgery. You should also avoid any alcohol at least 24 hours before surgery, as alcohol is associated with an increased risk of complications.
The day before surgery
You should wash the night before AND the morning of the procedure, particularly the face and the eyes/eyelids. This will minimise bacteria count, and so minimise any risk of infection. You should not use any facial products at all (for example makeup, moisturiser, deodorant, perfume) or nail polish or shampoo/conditioner. Long hair should be tied back in a pony tail and all jewellery removed before the procedure. Do not wear tight or restrictive clothing or shoes – these should be comfortable and loose fitting. You should remove any fake eyelashes.
In the 6-hour period immediately before surgery you should not eat or drink anything at all. If it is absolutely essential you take any medication during this period please speak to Dr Robinson or his team and you may be able to take it with a very small sip of water.
You should also arrange for someone to drop you at the surgery AND drive you home. You should not drive yourself as you will still be under the influence of the anaesthetic (and nor should you take public transport). You should also have someone stay with you overnight the night of the procedure.
What is involved in eyelid surgery?
Upper eyelid blepharoplasty
The section of skin to be removed from the eyelid is marked while the patient is in a sitting position.
This section is generally elliptical in shape starting from just above the tear duct (the eyelid being closed) and ending at the eyelid outer edge. Prior to making an incision, Dr Robinson will gently pinch the skin of the eyelid while it is closed to determine how much skin needs to be removed.
The excess skin, and if necessary, any fat present are then removed from the upper eyelid. If there has been any stretching to the underlying orbicularis muscle, this may need to be carefully trimmed. Similarly, if there is any so-called 'orbital' fat protruding, a layer called the 'orbital septum' will be opened and these pads of fat will be carefully trimmed.
Afterwards the skin is closed very carefully to ensure scarring is minimised. The incision (around 3cm in length) is made into the skin crease of the eyelid to make sure it is generally hidden from view.
Lower eyelid blepharoplasty
This procedure is normally carried out under a general anaesthetic. It often does not involve the removal of very much (if any) fat, but more a repositioning or redistribution of the fat present. The incision is made to the inside of the lower eyelid, so there is no visible scarring at all. Once this is complete, the incision is carefully closed.
If the lower eyelid continues to sag, another procedure called a 'canthopexy' may be needed, where the supporting tendons and muscles are slightly shortened to tighten the eyelid.
Blepharoplasty Post Operative Instructions
You can generally go home on the same day as surgery, after a brief period of observation.
After the procedure it is perfectly normal to experience some mild pain and numbness in the eyelids. There may also be some swelling and bruising around the eyes (similar to having a 'black eye') and a feeling that the eyes are dry, or wet or simply irritated. Some sensitivity to light and temporary double vision is also common. Lubricating ointment applied during the procedure may result in temporary blurred vision.
In the 12-hour period after surgery it is recommended to apply icepacks to the eyes for 10 minutes every hour, and then for 10 minutes every three hours or so the following day.
- Clean the eyelids gently using the recommended eyedrops and/or ointment and always wash your hands first.
- Avoid rubbing your eyes.
- Do not use contact lenses for at least 14 days after the procedure (normal glasses are fine).
- Do not wear any eye makeup for 14 days.
- When going outside use dark sunglasses – this protects your eyelids from any wind and sunlight.
- When going to bed or lying down raise your head above chest height for 3-5 days.
- It is recommended that you apply 30+ SPF sun protection to the eyelids for at least 6 months after the procedure.
You may need to come back in to have sutures removed within 7-10 days of surgery. 'Absorbable' sutures may not need removal.
To aid recovery generally, avoid vigorous activity (e.g. swimming, running, lifting heavy objects, aerobics etc) for 21 days after surgery and do not smoke. Do not take any blood thinning medication (as listed above) for at least 7 days after surgery.
Return to work from eyelid surgery normally takes around 7 days but can be expedited if necessary. The recovery time for a full return to normal activity including exercise can happen at 3 weeks. Most bruising will have subsided within 14 days. The eyelids should settle into their new 'look' 3-6 weeks after surgery and if there is any scarring this should fade appreciably by month 6.
In the following circumstances you should seek immediate medical attention:
- Chest pain / shortness of breath.
- Abnormal heart rate.
- New (and severe pain) in the eye.
- Vision difficulties.
What are the possible risks of eyelid surgery?
All medical procedures, particularly those that involve anaesthesia, carry some risk.
General risks of all types of surgery include:
- Infection of the surgical site.
- Allergic reaction to anaesthetic.
- Formation of blood clots that may cause potentially fatal complications e.g. heart attack, deep vein thrombosis, stroke.
Risks specific to blepharoplasty include:
- Bleeding (particularly into the eye socket).
- Removal of too much skin.
- Swelling of the conjunctiva.
- Abrasion to the cornea (i.e. a scratch to the surface of the eye).
- Eyelid ptosis (this is where the eyelid permanently droops).
- Difficulty closing eyes (which may lead to dry eye and scarring to surface of the eye).
- Permanent vision loss (very rare).
- Unnatural appearance of the eyes (especially where too much fat has been removed).
Choosing a surgeon to perform a blepharoplasty on the Gold Coast
Make sure that whichever surgeon you choose to perform your procedure is fully trained in the latest techniques in blepharoplasty, since the recommended surgical techniques involved have changed significantly in the past six years. These latest techniques are designed to produce the best possible outcomes for patients undergoing this procedure. Dr Robinson regularly attends the Facial Plastic’s Symposium on Blepharoplasty and currently sits on the Board of the Australasian Association of Facial Plastic Surgeons.
If you are wondering if you are a candidate for a Blepharoplasty, contact us or fill out the Quick Enquiry form.