Eyelid Surgery – Blepharoplasty

The ageing process causes the skin around the eyes to lose elasticity and the muscles in the area to slacken: this combined effect allows any fat present to bulge forward and cause bagginess.

Loose folds develop on the upper eyelids, and creases deepen on the lower lids. An eyelid reduction or tightening removes excess skin and fat from around the eyes to create a more wide-awake, younger look. This surgery can be carried out on the upper, lower, or both eyelids.

It is advisable that you first discuss this procedure with your General Practioner (GP), who may then refer you to the Consultant Plastic Surgeon of your choice. Sharing your expectations with your GP. and surgeon is the best way to increase the possibility of achieving your desired outcomes.

Only the wrinkles on the area within the margins of your eye sockets can be removed by an eyelid reduction. It can address the areas as depicted in Figure 1. Please note that Blepharoplasty will not help reduce the effect or appearance of crow’s feet or laughter lines: you may wish to consider other aesthetic enhancement options to address these concerns.

Additional Information

Eyelid surgery is generally appropriate for women and men who are in good health. If you are considering eyelid surgery to reduce the volume and appearance of heavy and loose skin over your eyelids or under your eyes, it may be a good idea to meet with a Consultant Plastic Surgeon to discuss your options and expectations.

Eyelid Surgery - Blepharoplasty

During the consultation, your surgeon will evaluate your health and medical history, discuss your goals, and explain what can be achieved with the procedure. At this point, your surgeon will describe exactly what happens during surgery, explaining the benefits and also the potential complications and possible risks.

Before eyelid surgery, your surgeon may ask you to see an ophthalmologist (specialist eye surgeon) to test for glaucoma, a disease affecting your eyesight, and problems with tear production.

Your surgeon may take photographs both before and after surgery to help in planning the procedure and to allow you to compare the results after surgery. Your surgeon may also wish to advise your G.P. of the planned procedure.

Your eyelid surgery should ideally be performed in a major hospital.

Medications are administered for your comfort during the surgical procedure. Frequently, local anaesthesia and intravenous sedation are used for patients undergoing eye lid surgery, although general anaesthesia may be desirable in some instances. For your safety during the operation, the attending anaesthetist will use various monitors to check your heart, blood pressure, pulse and the amount of oxygen circulating in your blood.

Upper and lower eyelid surgery may be carried out under local anaesthesia, with sedation; however, your surgeon in combination with the attending Anaesthetist may decide to use a general Anaesthetic. This may be the case if you are undergoing surgery for your upper and lower eyelids at the same time. It can take up to two hours for surgery on the upper and lower eyelids of both eyes.

Upper eyelid surgery
During upper eyelid surgery, your surgeon will make an incision in the natural skin fold of your eyelid. Next, unwanted skin, fat, and muscle are removed to give the eye more shape. Once the incision is closed, the scar will be hidden inside the natural fold of your upper eyelid.

Eyelid Surgery

Lower eyelid surgery
During lower eyelid surgery, the surgeon moves or removes fat from under-eye ‘bags’ either through a direct incision just below the lower lashes or through an incision made inside the lower eyelid. A small amount of skin may also be removed, but the muscle that closes the eyelid is not touched.

A more recent surgical technique is to remove less fat than the traditional method. Part of the fat is instead redistributed to correct the tear-trough deformity (the grooved area under the lower eyelid’s ‘fat bag’). This avoids the sunken appearance of eyes that have had too much fat removed.

If you have stitches that need to be removed, you will generally return to the Aesthetic Surgery Ireland Clinic to have this completed between three and five days after surgery.

Fat is removed from under-eye bags

You can go home on either the same day as your eyelid surgery or the next morning. It takes between seven and 14 days to recover fully from the operation, and the results can last for approximately 15 years for most patients.

Eyelid surgery is not generally painful or uncomfortable, but it is quite normal to experience some bruising. This bruising usually subsides reasonably quickly. You may also experience discomfort and swelling of the eye area. The discomfort usually goes away after a few days, but the swelling may last for up to two weeks. Contact your Consultant Plastic Surgeon immediately if you notice any signs of infection or experience bleeding or a sudden increase in pain.

To speed your recovery and help prevent any complications, it is important to follow your surgeon’s post-op care instructions carefully. These instructions may include the following recommendations:

  • Apply cold compresses to the eyes to help reduce swelling.
  • Bathe the area around the eye to keep it clean
  • Apply eye drops and antibiotic ointment as directed to help with dry or itchy eyes and to reduce the risk of infection in the treated area.
  • Avoid exercise and strenuous activities for as long as your surgeon recommends.

There are risks associated with any type of operation, and eyelid surgery is no exception. These risks are higher for those with glaucoma and dry eyes. Before deciding to undergo any surgery, your surgeon should explain the risks posed. These include the following:

  • Reactions to the anaesthetic
  • Possible bleeding behind the eye, which can lead to blindness
  • Bruising
  • Swelling
  • Nerve damage
  • Haematoma (mass of clotted blood)
  • Infection occurring as a result of the procedure.

Risks or complications following upper and lower eyelid surgery include some temporary difficulties. These include the following:

  • Blurred vision
  • Dry eyes
  • Excessive tear production
  • Difficulty closing the eyelids completely
  • Lower eyelid sagging
  • Asymmetry (uneven appearance of the eyes during healing).

If you experience any of these temporary side effects, contact your Consultant Plastic Surgeon immediately. Your surgeon or the Clinic staff may be able to address your concerns, particularly if the healing process is not complete and your body still needs time to adjust.

Please note: that with all procedures there is a possibility of patient dissatisfaction with the outcome.

Allergic reaction to anaesthetic
In very rare cases anaesthetics can cause allergic reactions. The best current estimate is that a life-threatening allergic reaction (also known as anaphylaxis) happens during one in 10,000 to one in 20,000 anaesthetics. Your anaesthetist will choose the drugs for your anaesthetic by taking into account many different factors, in particular, the type of operation, your physical condition, and whether you are allergic to anything.

Most people make a full recovery from anaphylaxis. It isn’t known how many anaphylactic reactions during anaesthesia lead to death or permanent disability. One review article suggests that one in 20 serious reactions can lead to death. This in effect implies that the chance of dying as a result of an anaphylactic reaction during anaesthesia is between one in 200,000 and one in 400,000 anaesthetic procedures.

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.

Upper and lower eyelid surgery can make a dramatic difference in your appearance, especially if you have large bags underneath your eyes. The results of lower eyelid surgery through an external incision are likely to be more noticeable than the results of surgery performed through an incision on the inside of the eyelid. This is because the external incision allows the surgeon to tighten the skin and reduce some wrinkling as well. Generally the results of eyelid surgery last for many years.

For additional information regarding this procedure please consult with your Consultant Plastic Surgeon.