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Upper eyelids

As you age, several things start to occur around the eyes. The forehead and eyebrow can descend over the upper bony rim of the eye socket (see "Browlift") which in turn can cause folds of skin to develop in the upper eyelid. These can become loose and baggy, resting on the lashes or hanging over the eye, sometimes affecting vision. This droopy look, with excess skin, can also occur without significant descent of the eyebrow or forehead, in which case an upper eyelid blepharoplasty can be very effective in correcting these problems and improving the tired appearance. This relatively straightforward procedure can be carried out independent of any other eye surgery although is often performed in conjunction with a facelift.

The surgery

Surgery can be performed under a local anaesthetic as a day case, or with sedation (A technique which avoids a general anaesthetic but which relaxes and alleviates any inter-operative anxiety such that there is often very little if any recollection of the procedure) or under general anaesthetic with an overnight stay and this would be the case if both upper and lower eyelids were being operated on. After making the incisions, any excess skin and muscle will be removed and if appropriate excess fat may also be removed. The wound will be closed with very fine stitches in the natural fold or crease of the skin to minimise the chance of the scar being noticeable.

Lower Eyelids

The effect of gravity and ageing tends to allow the tissues of the face to descend and this can include the pockets of fat which surrounds your eye. This may be obvious as creases and shadows which may develop under the lower eyelid, producing bags. Other noticeable signs of ageing that can benefit from surgery include: loose, floppy eyelids, tear troughs, fluid-filled pouches over the cheek (malar bags) and loss of facial fat revealing the bones of the eye socket.

The surgery

There are now several alternatives and refinements to the traditional procedure of lower lid blepharoplasty. Removal of periorbital fat can be performed through an incision on the inside of the eyelid, avoiding any scar on the skin and this may be appropriate for younger patients where there is prominence of the fat but no skin excess. For some patients, the fat is repositioned rather than removed, thus avoiding the risk of a hollow appearance. Lower lid surgery on its own or in combination with upper lid surgery is performed under a general anaesthetic or local anaesthetic and sedation (see above) with an overnight stay. Eyelid surgery may be complimented by the use of a mild chemical peel which can improve the fine wrinkling of the skin although this can occasionally result in either permanent lightening or darkening of the skin colour where applied.

Aftercare and follow-up

Post-operatively you will have bruising and swelling, this can be minimised by the use of cool packs. It may take 2-3 weeks to resolve. You will be instructed on the frequent (two hourly) use of drops and ointment at night during this period. Our practice nurse will contact you daily after the operation to ensure that you have no problems during your convalescence. Stitches will be removed after 5-7 days.

Risks and complications

Like all operations eyelid surgery carries the risk of complications although these are infrequent if your surgery is carried out by an appropriately trained surgeon routinely operating on facial and peri-orbital structures.

Watering eyes for a few days is not uncommon following surgery and this is due to the effect of swelling and the temporary affects of surgery on the blink mechanism. This short-term swelling can prevent the eye from completely closing and is one of the reasons why drops are routinely given post operatively. Sometimes the conjunctival tissue behind the eyelids can become swollen (chemosis) and while most resolve spontaneously with simple lubricant drops and ointment, this can last for several weeks and occasionally requires further treatment. Dry eyes are an occasional problem and again usually resolve with lubricant drops and ointment for a few weeks. This is more likely to be a problem if you had a tendency to dry eyes before surgery and a detailed history and a test to identify this before your surgery will be undertaken at the initial consultation. Scratches to the surface of the eye are rare and the risks minimised by surface protectors during surgery. However, on the rare occasions when it does occur this manifests in significant pain and irritability and may require treatment with antibiotic and anti-inflammatory drops. Infection of the incisions is again rare but usually effectively treated with antibiotics. Great care is taken during surgery to prevent bleeding. However, sometimes a small haematoma can develop under the skin which may require the release of the stitches or a short return to the operating theatre. Very rarely, a more serious bleed which usually manifests with pain, can occur. This threatens vision in the eye and requires the immediate return to the operating theatre. When the lower eyelid has lost much of its support and is very lax or where excessive postoperative scarring has occurred there can be a tendency for the eyelid to fall away from the eyeball causing watering and irritation. The surgical procedure can be tailored to try and prevent this, but where it occurs, further corrective surgery may be required. Where too much skin has been removed or where further descent of the facial tissues occurs with time, the white of the eye may become noticeable between the coloured iris and the margin of the lower eyelid; this is known as "scleral show" and if troubling can be amenable to further surgery (see "Midface-Lift").

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