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Everything you need to know
For most people, the skin around the eyes is the first to show signs of ageing. As you get older, the eyelids can droop or ‘bags’ develop under the eyes. Excess skin or fat on the upper eyelid can impair your vision. Some people’s genes can lead to bags under the eyes developing from an early age too. Functional blepharoplasty can help improve your vision by removing obstructions and restoring a more natural eyelid contour.
Eyelids play a crucial role in facial aesthetics. Addressing sagging or asymmetrical eyelids through blepharoplasty can contribute to overall facial harmony and balance. Some individuals may feel self-conscious about the appearance of their eyelids. Blepharoplasty can help improve self-esteem and confidence by addressing these concerns.
There are two types of blepharoplasty: upper eyelid blepharoplasty and lower eyelid blepharoplasty. Both upper and lower blepharoplasty can be performed independently or together, depending on the specific concerns of the patient.
Before
Consultation
Firstly, you will need to book a consultation with one of our oculoplastic surgeons.
During the appointment, they will thoroughly explain the surgical procedure to you. The discussion will cover expected outcomes, potential risks and benefits, as well as the necessary pre- and post-operative care. Photographs will be taken for comparison post-surgery, and it’s beneficial to bring any previous facial photos for surgical planning. A detailed medical history, including information about medications, allergies, past surgeries, and lifestyle habits (such as smoking), will be collected.
The surgeon will also conduct a comprehensive examination of your face and eyelids to assess various factors, such as the condition of your eyes, eyelids, skin, eyelid laxity, and the presence of conditions like blepharitis or dry eyes, which could impact the surgery. Addressing any underlying conditions may be required before proceeding with surgery to ensure optimal results. If you have issues such as a droopy eyelid (ptosis) or droopy eyebrow (brow ptosis), your surgeon will discuss whether you would like to correct these concerns as well.
During the consultation, you will have the chance to ask questions, as well as the possibility of non-surgical treatments, such as tear trough filler, that could help you achieve your desired outcomes and delay surgery.
Pre-Assessment
If you decide to have surgery, you will have a call with our pre-assessment team, where they will check your fitness for surgery and talk you through the procedure. This is a standard check to make sure you are safe to go ahead with surgery.
If you take any blood thinners—for example, warfarin or aspirin, tell your doctor straight away, as you may need to stop taking these or modify your intake from a week before surgery. Your doctor will give you specific instructions if this is the case. You should also tell your doctor if you take nonsteroidal anti-inflammatory drugs (NSAIDs), such as ibuprofen.
You will also need to protect your skin ahead of surgery, so wear SPF50 for two weeks before your procedure.
Surgery day
A blepharoplasty is a day-patient procedure meaning most people can be treated and go home the same day.
If you will be having a general anaesthetic, you should stop eating six hours before surgery. Two hours before, you should stop drinking (including water), chewing gum and sucking boiled sweets. Brush your teeth with toothpaste only on the morning of surgery. If you are just having local anaesthetic, you will not need to fast.
On the morning of surgery, do not wear any facial make-up or contact lenses, wear loose, comfortable clothes and bring a small bag with things you might need during your stay. Items to remember include a toothbrush and toothpaste, your phone and a charger, and any prescription medications. Your doctor will let you know if you can take any medications with a sip of water before surgery or if you should wait until after. As your eyes will be sensitive to light after the procedure, it’s a good idea to bring a pair of dark sunglasses with you as well.
Once you have arrived and are settled in your room, a nurse will monitor your vital signs (such as body temperature and blood pressure) and run through your medical history, medications and emergency contacts.
Your doctor will then once again run you through the procedure and ask you to sign a consent form for surgery.
During
Both upper and lower eyelid blepharoplasty can be conducted using local anaesthesia, intravenous sedation, or general anaesthesia, depending on your preference and safety considerations.
In an upper blepharoplasty, a precise incision is crafted along the natural contour of your eyelids—following the skin creases. Excess skin, fat or muscle is removed and then the incision is closed, with the scar usually hidden within the fold of the eyelid.
In a lower blepharoplasty, an incision is made just beneath the lashes in the lower eyelids, or on the inside of the lower eyelid. Fat is repositioned or removed from the bags under the eyes, and sometimes a little excess skin is also removed before the incision is closed.
In cases where there are bags in the lower eyelids without extra skin, fat removal can be achieved through a small incision on the inside of the lower eyelid (transconjunctival blepharoplasty), eliminating the need for an external scar.
To finish, the surgeon will usually apply thin, sticky strips called suture strips to support the eyelids. These can be removed up to one week later.
Bandages or padding are rarely necessary, and if used will typically be applied briefly immediately after the procedure and removed before you leave hospital.
Eyelid surgery can take between 45 minutes to 2 and a half hours. Most people can go home the same day.
After
Once we’re happy you’re doing well, we will take you to your private room where you can start your recovery.
You should be able to go home within a few hours – however, you will need to have a friend or relative collect you as you will not be able to drive for a few days after surgery. If you had general anaesthetic or sedation, if possible, ask someone to stay with you overnight as anaesthetic and sedation can make you feel very tired for around 24 hours. During this time you should not drink alcohol, cook or make important decisions.
As with any surgery, there will be some after-effects. These include:
- The need for pain relief
- Some postoperative swelling
- Dry eyes
- Sensitivity to sun
- Blurred vision
Most of these symptoms should go away in a few days.
Most patients experience bruising and swelling for the first ten days after surgery. To help reduce swelling, we advise you to use ice packs in the days following eyelid surgery. Frozen peas placed in a small plastic bag and covered in a thin cloth is an effective icepack. This can then be gently placed on your eyes up to 6 times a day. Do not rub or place any pressure on your wounds. Although it won’t take away the bruising, ice packs do help to reduce swelling. You should also gently clean your eyelids using the prescribed creams or eye drops.
During the initial 7 days post-surgery, it’s recommended to sleep in a semi-upright position with multiple pillows supporting your head. This will facilitate the reduction of swelling.
As the wounds from eyelid surgery heal, you may experience some itching. It is crucial to resist the temptation to rub your eyes or eyelids after blepharoplasty.
By two weeks, you should also be able to wear contact lens and make-up again. However, you may want to run this by your doctor in the post-surgery check-up. During this post-procedure appointment, the team will check for any skin resurfacing, any improvement in your visual field and how the incisions are healing. They will prescribe you further medicine if you’re still suffering from dry eyes.
Most people can return to work after two weeks. However, you may need to wait a little longer depending on your job. Your surgeon will be able to advise you on when it’s safe to return to work.
Bruises and redness may take several weeks to fade and scarring may be visible and feel tight for a few months after surgery. Over time, your scars should fade until they are practically invisible.
Complications
Complications can include:
- Blurred or double vision
- Uneven (asymmetrical) eyes
- Reduced or increased sensation in your eyelids
Very rarely, more serious complications can arise. These include:
- An injury to the eye muscles
- The lower eyelid drooping away from the eye and turning outwards (ectropion)
- Bleeding into the eye socket
- Visual impairment
Before you progress with surgery, your surgeon will discuss the risks and benefits in detail so that you can make an informed decision.
Medically reviewed by Dr Nick Koutroumanos - MBBS FRCOphth PgC Clin Ed FHEA on 13/12/2023
Hospital Fee Guaranteed
from £1,695*
The price shown includes all costs associated with your treatment, from admission to discharge. Doesn’t include surgeon or anaesthetist fee. Our hospital fee is guaranteed at the price quoted and valid for one month from the date issued, subject to pre-assessment.
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How to pay for your treatment
If you’re… paying for yourself
Did you know you don’t need private medical insurance to come to St John & St Elizabeth Hospital? As a self-pay patient, you can access safe, outstanding quality health care at times to suit you.
For scans and tests, as well as to see most consultants, you’ll still need to be referred by a medical professional like your GP, but as a self-pay patient, the process is more straightforward. You won’t need authorisation from an insurance provider, and you’ll have greater choice of consultant and appointment times.
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