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Summary

Blepharoplasty (eyelid lift surgery) is a surgical procedure performed to remove excess skin from the eyelids. The surgery may either be done when the extra skin blocks your vision or to improve your cosmetic appearance. The procedure may be done under local general anaesthesia. Blepharoplasty for each eye takes about 30 to 40 minutes to complete. You will be discharged on the same day as the surgery. The scar from this surgery is hidden in the natural eyelid fold and may look slightly pink for about six months. The cosmetic improvement attained after the surgery lasts for many years, and in some cases, even becomes permanent. You may need to revisit the surgeon in one to two weeks to remove sutures from the wound.

  1. What is blepharoplasty?
  2. Why is blepharoplasty recommended?
  3. Who can and cannot get blepharoplasty?
  4. What preparations are needed before blepharoplasty?
  5. How is blepharoplasty done?
  6. How to care for yourself after blepharoplasty?
  7. What are the possible complications/risks of blepharoplasty?
  8. When to follow up with your doctor after a blepharoplasty?

Blepharoplasty or eyelid lift surgery is the surgical removal of extra skin under your eyelids and repair of drooping upper eyelids. Your doctor will ask you to undergo this surgery if the excess skin hanging from your eyelids is blocking your vision. The development of excess skin can be attributed to various factors such as trauma, sun damage, ageing, and underlying diseases like thyroid disease. In some cases, swelling of the eyelid occurs due to allergy or infection. Blepharoplasty is also performed as a cosmetic surgery along with other surgeries such as facelift and brow lift, to improve appearance. However, this surgery does not remove or treat dark circles, wrinkles around the eyes, or lift sagging eyebrows.

This surgery is recommended if you have drooping eyelids that cause difficulty seeing and headaches. In addition to drooping eyelids, the following conditions can be treated by blepharoplasty:

  • Excess skin from the lower eyelids 
  • Puffiness or fatty deposits in the eyelids
  • Bags under the eyes

You are an eligible candidate for the surgery if you:

  • Are 30 years of age or more
  • Are in good health
  • Do not have any other eye problems
  • Are a non-smoker

The surgeon may not perform this surgery if you have any of the following conditions:

This surgery may not be performed if you have undergone multiple revision surgeries in the past.

Before the surgery, a pre-operative evaluation will be carried out, wherein the surgeon will explain the details of the operation and conduct a few medical tests such as blood tests and electrocardiogram to ensure that your overall health is good.

The doctor will perform a neurological and physical examination and a complete examination of your eye. In case of any abnormality, your doctor may order diagnostic tests such as magnetic resonance imaging scan (MRI) or computed tomography (CT) scan

Inform the surgeon if you have any of the following conditions:

If you are currently on any medications, you can expect the following before surgery:

  • The surgeon will ask you to share a list of all the medicines, including prescription and non-prescription medicines, herbs, and homoeopathic medications.
  • You will be asked to temporarily stop taking blood-thinning medicines such as aspirin, warfarin, clopidogrel or rivaroxaban before the surgery.
  • If you are taking diabetes medication, the dose of your medicines may be altered as you may need to fast before the surgery, depending on the type of anaesthesia used.

Fasting requirements may vary, depending on whether the surgeon administers general anaesthesia (medicine that puts you to sleep) or local anaesthesia (numbing medicine). You will need to fast only if the surgery is performed under general anaesthesia. In such a case, the surgeon will ask you to not drink or eat anything for at least six hours from the scheduled time of the surgery. However, you will be allowed to drink water until two hours before the surgery.

You need to sign a consent form that gives your approval before the surgery.

Consider the following before going to the hospital on the day of the surgery:

  • Wear loose, comfortable clothes
  • Ask someone to drive you home post-discharge from the hospital

The surgery usually consists of the following steps:

  • You will be taken to the operating room wherein you will be asked to lie on a couch.
  • The surgeon will administer anaesthesia drops in your eyes.
  • The medical staff will then clean your face with an antiseptic solution and cover your face with sterile drapes (to prevent contact with unsterilised surfaces).
  • He/she will use a medical pen to mark the skin over your eyelid.
  • Anaesthesia will then be injected beneath the eyelid skin to numb the area.
  • Next, the surgeon will make a cut (incision) over the marked area, and remove the excess skin.
  • He/she will close the incision with stitches or sutures. Some surgeons may use dissolvable sutures to close the incision. These may dissolve in four to eight weeks.
  • An ointment will be applied over the incision, and your eye will be covered with eye pads.

It may take about 30 to 40 minutes to perform the surgery in one eye. If both the eyes are operated, eye pad from one eye will be removed after an hour of surgery. You will be allowed to go home on the same day.

You can expect the following after your discharge from the hospital:

  • You may experience slight pain in the eyes for 24 to 48 hours post-surgery. The surgeon may prescribe some medications for the pain.
  • You may have blurred vision, double vision, increased tears, bruising, and sensitivity to light for the initial few weeks after surgery. Ask a responsible adult to accompany and assist you at home for a few days.

You need to keep the following things in mind while at home:

  • Avoid driving or operating any heavy machinery during the first 24 hours post-surgery.
  • Apply ice, wrapped in a towel, over the eyes to help reduce bruising and swelling.
  • You should keep your head in an elevated position most of the time during your recovery. 
  • The surgeon will ask you to avoid wearing contact lenses for a few days.
  • Avoid taking any sedatives (substances that slow down the activity of the brain) or alcohol for at least 24 hours following surgery.
  • The surgeon may prescribe anti-inflammatory and antibiotic eye drops to reduce the risk of infection, inflammation, and redness in the eye.
  • Wash your hands frequently to minimise the risk of infection. Read more: Eye infection symptoms
  • The surgeon may ask you to rest for a few days before resuming work. The resting period may vary depending on your condition after the surgery.
  • You should prevent indulging in any physical or strenuous activities for at least two weeks.

This surgery will help you feel more confident by improving your vision as well as appearance. Your scars will initially appear slightly pink (for about six months) and will gradually fade away and become invisible or hidden in the natural eyelid fold. The improved facial features usually last for years and even become permanent in some individuals.

When to see the doctor?

You should contact the doctor if you experience any of the following in the eyes:

  • Vision gets worse
  • Pain 
  • Excess drainage
  • Increasing redness

As with any other surgery, blepharoplasty is also associated with a few risks. Although the risks are rare, there is always a small chance that they may occur. The risks or complications associated with the surgery include:

  • Dry eyes
  • Bleeding
  • Infection
  • Inability to close the eyes
  • Eyelids fold abnormally
  • Double vision
  • Uneven scarring
  • Loss of vision

You will need to visit the hospital one to two weeks after the surgery to remove the sutures.

Disclaimer: The above information is provided purely from an educational point of view and is in no way a substitute for medical advice by a qualified doctor.

References

  1. Few J, Ellis M. Blepharoplasty. In: Rubin JP, Neligan PC, eds. Plastic Surgery, Volume 2: Aesthetic Surgery. 4th ed. Philadelphia, PA: Elsevier; 2018:chap 9.
  2. Bowling B. Eyelids. In: Bowling B, ed. Kanski's Clinical Ophthalmology. 8th ed. Philadelphia, PA: Elsevier; 2016:chap 1.
  3. Guys' and Thomas' Hospital [internet]: NHS Foundation Trust. National Health Service. U.K.; Blepharoplasty
  4. Harvard Health Publishing. Harvard Medical School [internet]: Harvard University; Drooping Eyelid (Ptosis)
  5. American Society of Plastic Surgeons [Internet]. Illinois. US; Eyelid Surgery
  6. Cleveland Clinic. [Internet]. Cleveland. Ohio. US; Eyelid surgery (blepharoplasty)
  7. Scawn R, Gore S, Joshi N. Blepharoplasty basics for the dermatologist. J Cutan Aesthet Surg. 2016 Apr-Jun;9(2):80–84. PMID: 27398007.
  8. National Health Service [internet]. UK; Anaesthesia
  9. Norfolk and Norwich University Hospitals: NHS Foundation Trust [Internet]. National Health Service. UK; Blepharoplasty patient information leaflet
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