Eyelid Surgery
Blepharoplasty (Eyelid Lift)
Blepharoplasty, or “eyelid lift” surgery, is a technique for restoring the youthful appearance to the eyelids, or in severe cases to improve a constricted visual field. It can be performed on the upper eyelids (upper lid blepharoplasty) or lower eyelids (lower lid blepharoplasty).
With ageing (or sometimes as a result of medical conditions such as thyroid eye disease), the skin around the eyelids can lose its elasticity and form folds or “hooding” in the upper lids. In addition, weakening of tissues within the upper or lower lids can cause bulging of fat, giving the appearance of “eye bags”, (particularly in the lower lids). The appearance of either lower lid bags or upper lid hooding may be typical in your family.
Blepharoplasty surgery may involve a combination or skin excision, muscle excision, fat excision and in some cases, fat repositioning. The combination of procedures depends on factors, including age and the shape of the eyelids and face.
Incisions are usually well hidden, being placed in the natural eyelid skin creases.
Blepharoplasty surgery is usually performed as a day case so a hospital stay is not normally needed. It is commonly performed under local anaesthetic (with or without sedation), but may be performed under general anaesthetic in selected cases.
Upper eyelid surgery
Patients seeking upper lid blepharoplasty surgery normally complain of a hooded appearance to their eyes, a “heaviness” to their eyelids, and in severe cases, obstruction of the upper part of their vision by their eyelids or lashes. Patients may also complain of loss of the part of the upper eyelid to which eye-shadow is normally applied.
It is important to assess the underlying cause of patients’ “eyelid heaviness”, as a low eyebrow position (brow ptosis) or drooping of the actual eyelids (ptosis) may be contributory. In some cases a different operation (such as ptosis repair or brow lift), may be required instead or in addition to blepharoplasty.
Upper lid blepharoplasty surgery is usually successful and patients are generally satisfied with the outcome.
Lower eyelid surgery
The youthful eyelid has a smooth surface contour below the lid margin. In older people, there is often a sagging of the lower eyelid caused by bulging fat beneath the skin.
Lower lid blepharoplasty surgery often involves removal of the excess bulging within the lower eyelid. In some patients “fat repositioning” (rather than removal), is required to eliminate a “double bulge”. Results of fat repositioning can be slightly less predictable with potential uneven areas or lumpiness.
What to expect before eyelid surgery
You will meet your surgeon and discuss what you are hoping to achieve from surgery. You will have a full consultation including past medical history, and details of all your medications, particularly blood thinners. In selected cases, blood thinners may be stopped before surgery. Your surgeon will examine your eyes and face and take photographs for your medical records. Your surgeon will confirm whether blepharoplasty surgery is the most appropriate operation to achieve your desired outcome and give you a realistic expectation about the likely results.
What to expect after eyelid surgery
Immediately after the surgery, your eyes are usually padded to minimise bruising and swelling. You should not drive home after the operation. It is common to experience bruising and swelling of the eyelids for a couple of weeks. Stitches may be either absorbable (dissolvable) or non-absorbable, and in either case they are usually removed once the wounds have healed (5 – 14 days). Antibiotic cream is often prescribed to apply to the wounds to prevent infection. It is fairly common for the eyes to feel a bit dry and gritty after the surgery, and lubricants (artificial tears) are often used for the first month after surgery. Mild blurring of vision for a few days is also common as a result of using ointment or surface dryness of the eyes. There may be redness around the incision sites but this fades over several months.
Care after eyelid surgery
The incision sites may feel tight and mildly sore, but discomfort is usually manageable with simple analgesics such as paracetamol. Antibiotic ointments are usually applied to the wounds several times a day and lubricant drops or ointments may be used in the eyes. Cold compresses may be applied to the closed eyelids for up to 10 minutes every hour to reduce swelling over the first few days. Keeping the head elevated, such as by using an extra pillow to sleep, may help minimise the swelling. Activities which increase blood flow to the eyes, such as bending, sporting activities and heavy lifting, should be avoided in the first few weeks after surgery. Sunglasses may be useful in the first few weeks following surgery to reduce irritation to the eyes by sun and wind. The surgical wounds should be kept as dry as possible until the sutures have been removed and the wounds are fully healed (anything from 5 to 14 days).
Limitations of surgery
Blepharoplasty surgery can only reduce the fullness of the eyelids due to tissue excess or bulging, such as skin excess or fat prolapse. True swelling of the eyelids, for example due to allergy, or inflammation within the eyelids, will not be improved by surgery. Surgery will also not eliminate all the wrinkles around the eyelids. This may require supplemental treatments such as botulinum toxin (Botox) injections. It is important to have a discussion with your surgeon pre-operatively, to obtain a realistic expectation of the results attainable, which will always be individualised to your situation. For example, your surgeon may be able to reduce hooding, but not completely eliminate it
Risks of surgery
As with any surgery, there are potential risks. Common risks include bleeding, bruising, infection and scarring. Other relatively common risks include dry eye, minor asymmetry between the two eyes, altered eyelid contour and mild residual hooding. Rarely, incomplete eyelid closure may occur. In addition, over many years, the skin and tissue around the eyes is likely to change and further surgery may therefore be required in the future.
Next Step
If you are interested in finding out more and booking a consultation with Helen Garrott to discuss eyelid surgery, please contact her secretary on 0117 906 4247 or use the contact form here, and we will get back to you soon.
Ptosis surgery
Ptosis refers to drooping
of the upper lid. Ptosis is most commonly acquired and associated with age related stretching of the muscle that elevates the eyelid. Less commonly, it may be congenital (present since birth), associated with contact lens wear, previous eye surgery, trauma or related to muscle weakness disorders.
Ptosis can cause multiple concerns for patients: the cosmetic problem of tired
appearing eyes, asymmetry, obstruction of the upper visual field and chronic brow ache from raising the brow to compensate for the ptosis.
Most ptosis surgery is performed via a well-disguised incision in the upper lid skin crease (anterior approach). Less commonly, it is performed via the undersurface of the eyelid (posterior approach). Both approaches involve locating the muscle that elevates the upper lid and reattaching it to the firm part of the eyelid (the tarsus) with sutures. In some congenital cases and muscle weakness disorders, a brow suspension may be required in the form of a pentagonal sling, often with a silicone band, which indirectly attaches the eyelid to the muscles of the forehead. Most ptosis surgery is performed under local anaesthetic, which is important in order to set the appropriate eyelid height.
Ectropion surgery
Ectropion refers to an outward drooping of the lower eyelid. It can be unsightly and also cause discomfort, discharge and watering. It is most commonly related to excessive laxity of the lower lid that occurs with ageing. Surgery is usually performed under local anaesthetic and involves tightening of the lower lid. Patients should expect mild bruising and swelling for up to 2 weeks.
A small minority of patients with severely sun-damaged skin or facial scarring may require skin grafting to the lower lid.
Entropion surgery
Entropion refers to an inward turning of the eyelid, resulting in the eye lashes rubbing on the eye. It may cause significant discomfort, irritation and discharge. It is usually associated with age related stretching of the eyelid tissues and more rarely caused by scarring of the undersurface of the eyelid. Surgery is performed under local anaesthetic and usually involves tightening of the lower lid and sutures to correct the lid position. Patients should expect mild bruising and swelling for up to 2 weeks.
Chalazion incision and curettage
Chalazia (or meibomian cysts) are slowly enlarging nodules within the eyelid caused by blockage of the meibomian glands, the normal glands in the eyelids that produce the oily substance in tears. They are common and usually due to underlying blepharitis (inflammation of the eyelids).
These cysts often resolve spontaneously within a 6-month period, and their resolution is often aided by the application of hot compresses, massage and topical antibiotic and/or steroid ointment.
If a chalazion is recurrent, particularly in an elderly patient, other diagnoses should be considered.
Non-resolving chalazia can be quickly and easily treated with incision and curettage in a treatment room, often on the same day as your clinic appointment. Local anaesthetic is injected into the lid and a small incision is performed on the undersurface of the eyelid, thereby avoiding an external scar.
Eyelid and periocular skin cancers
By far the most common skin cancer that occurs around the eyelids is basal cell carcinoma. Fortunately, this type of cancer does not metastasize (spread to distant areas of the body), but will continue to grow locally and invade adjacent tissues unless it is completely excised. Other skin cancers include squamous cell carcinoma and (very rarely) melanoma.
The gold standard for treatment is complete surgical excision, often followed by delayed repair of the tissue defect days later, once the pathologist has confirmed that the surgical excision is complete. For those unable to tolerate surgery or with limited life expectancy, other options such as cryotherapy or topical treatment exist, but are unable to provide definitive cure.
Book a Consultation in Bristol
To find out more about one of the above procedures, and to book a consultation with Helen Garrott, please contact her secretary on 0117 906 4247 or use the contact form here, and we will get back to you soon.
