The eyes and eyelids are arguably the most prominent features of a person’s face.
Eyelids play a crucial role in both visual function and appearance. Operations in this field need to be carried out with the utmost precision and care.
Mr Richard Scawn is a highly experienced Consultant Ophthalmologist and Oculoplastic Eyelid specialist at St John and St Elizabeth Hospital, who is world-renowned not only for his cosmetic procedures but his eyelid reconstruction experience.
Here, he outlines two of the most common oculoplastic procedures, and talks us through his process for maintaining his fastidious approach to eyelid surgery, whilst delivering complex surgical reconstructions for the NHS.
Consultant Ophthalmologist and Oculoplastic Eyelid specialist, Mr Scawn
I decided to specialise in eyelids in as a young eye surgeon
I was working at Chelsea and Westminster Hospital in 2008 when I was inspired by the reconstructive element of eyelid surgery. I was seeing patients who had terrible injuries from trauma, burns and acid, as well as children born with facial and eyelid abnormalities. We worked alongside incredible specialists in the craniofacial team, all with the shared goal of trying to make a difference to their vision and quality of life. This is, of course, also valuable in helping them integrate into society and grow up to be confident human beings.
Oculoplastics encompasses everything except the eyeball
Oculoplastic surgeons start off life as eye surgeons – doing cataracts, glaucoma and retinal work. We then specialise in plastic surgery of the eyelid and the surrounding structures including the eye socket – the bones that surround the eye, from the eyelid down to the cheek – and therefore anything involving the skin, muscle and bone in that area. We also cover the tear drainage system, which means patients who have watery eyes also fall within our area of expertise.
The eyelid procedures I carry out most frequently
My NHS work focuses on cancer work, trauma and reconstruction, repositioning, reforming and creating new eyelids.
My two most frequent private operations are ptosis and blepharoplasty. Ptosis is the term for a droopy eyelid and the operation to correct it involves tightening the internal eyelid muscle that lifts the eyelid.
Blepharoplasty involves removing excess skin and fat to correct puffy or saggy eyelids.
- Ptosis: In ptosis the muscle that lifts the eyelid has slipped off its attachment or weakened with age. To correct this I make a small incision within the crease of the eyelid, so the incision is hidden and can’t be seen when the eyes are open. I find the muscle which lifts the eyelid – which is called the levator palpebrae – advance the muscle forward and suture it internally. The surgery is performed under local anaesthetic with sedation. I can ask the patient to open their eyes towards the end of the operation, check the eyelid height, and fine tune the eyelid position if needed. The beauty of the patient being awake is that you can ensure the adjustment is precise. Then I put some stitches in the skin, and that’s the end of the procedure.
- Blepharoplasty: again, this procedure involves a hidden incision, but in this operation we’re removing extra skin and extra fat because of puffiness and surplus skin. Blepharoplasty can be performed on the upper or lower eyelid. It involves removing skin from either the top or bottom eyelid, and then going down beneath the muscle layer to remove the puffiness which is caused by fat that prolapses forward. The eyeball is surrounded by fat as a natural shock absorber, and as we get older it tends to prolapse forward and give the eyelid a puffy aged look.
Patients generally recover from both of these operations during a period of one to two weeks.
Every operation we do is highly visible
The eyes are truly the shop window to the soul – so everything I do as an oculoplastic surgeon is highly scrutinised and extremely visible. It is fine and delicate surgery. It is also a partnership with the patient with us working together to meet their goals. I need to get inside their head and very much ‘under their skin’ to deliver their goal.
I visualise every operation before I carry it out
Every operation I perform I will prepare in my head the night before. I will visualise the operation and the steps of it in my head – in a similar way that golfers, for example, will talk about seeing the shot before they play it. I look at the notes, look at my photographs and mentally carry out the procedure in a sort of virtual reality. I think that’s very important.
I use a specialised tool to ensure bloodless operations
During my training in California and at the Chelsea and Westminster Hospital, I learned to use monopolar cautery for almost every stage. It is an electrical cutting instrument that closes off the blood vessels as I make incisions. This is an alternative to using a scalpel, and the end result for me seems to be a reduction in bruising, swelling, and very bloodless surgery.
I was featured in the Tatler Beauty and Cosmetic Surgery Guide 2020
I was extremely honoured to be featured in the Tatler Guide for 2020. It’s the gold standard for cosmetic surgeons in the UK and it was brilliant to get the recognition for both my technical skills and patient care.
One of the interesting things about the Tatler guide is that of the four eyelid surgeons included, I’m the only one that does NHS work. That means I’m still dealing with emergency eye conditions, and I’ve got plenty to keep me busy at the sharp end!
The London Eye Unit at St John and St Elizabeth Hospital offers exceptional diagnosis, intervention and aftercare for all eye conditions, all under one roof. For more information call 020 7078 3848 or email [email protected]