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This leaflet provides some information about having a blepharoplasty. The treatment described here may be adapted to meet your individual needs, so it’s important to follow your surgeon’s advice.
Please raise any concerns or questions with your surgeon or nurse. It is natural to feel anxious before hospital treatment but knowing what to expect can help.
What is blepharoplasty?
Blepharoplasty is an operation to correct bagginess of the upper eyelids and under the eyes. It involves removing excess skin, fat and muscle from around the eyes. Blepharoplasty can be carried out on both upper and lower lids, separately or at the same time. It will not remove ‘crows feet’ and can’t change the colour of dark shadows under the eyes.
Blepharoplasty may be performed as a day case but an overnight stay in hospital is sometimes required.
The operation can be done under general anaesthesia which means you will be asleep during the procedure and will feel no pain. Alternatively it can be performed under local anaesthesia in which case the area around your eyes will be numb but you will be awake. One can also choose to have them under local anaesthesia with sedation. Your surgeon will advise which type of anaesthesia is most suitable for you.
Your surgeon will explain how you can expect your eyes to look after having a blepharoplasty, sometimes with the aid of certain pre and post operative photographs and will discuss the associated risks and alternatives to the procedure.
Preparing for your operation
You will receive an appointment from the hospital for pre operative assessment. A blood test and ECG is usually performed at this visit especially if you are having a general anaesthetic. If you normally take medication (eg tablets for blood pressure), continue to take this as usual unless your surgeon specifically tells you not to. If you are unsure about taking your medication please contact the hospital.
Before you come into hospital you will be asked to follow some instructions.
· Have a bath or shower at home on the day of your admission.
· Remove any make-up, nail varnish and jewellery. Rings and earrings that you would prefer not to remove can usually be covered with adhesive tape.
· Follow the fasting instructions given at your pre operative assessment. Typically you must not eat or drink for about six hours before a general anaesthetic and four hours prior to local anaesthetic with sedation. However some anaesthetists allow a few sips of water until two hours beforehand.
When you arrive at the hospital a nurse will explain how you will be cared for during your stay. He or she will do some simple tests such as checking your heart rate and blood pressure and testing your urine. Your surgeon and anaesthetist will usually visit you before the operation. This is a good time to ask any unanswered questions.
If you are happy to proceed with the operation you will be asked to sign a consent form. This confirms that you have given permission for the procedure to go ahead. You need to know about the possible side effects and complications of this operation in order to give your consent. Please see the back on this leaflet for more information about these.
About the operation
For surgery on the upper eyelids your surgeon will make cuts into the natural lines and creases in the lid and into the laughter lines at the corner of your eye.
For surgery on the lower eyelids your surgeon will usually make a cut just below your eyelashes. This means the scars run along the eye’s natural folds concealing them as much as possible. Excess fat, muscle and loose skin are removed and the cut is closed using fine stitches. If the surgeon only needs to remove fat but there is no excess skin the cut may be made inside the lower eyelid leaving no visible scar.
The operation lasts about one to two hours, or less if you are having just the upper or lower eyelid done.
After your operation
If you have had general anaesthesia you will be taken from the operating theatre to the recovery room where you will come round from the anaesthesia under close supervision.
After this you will be taken back to your room where a nurse will monitor your heart rate and blood pressure at regular intervals.
Your eyes may be covered with pads and paper tape will be used to support the operation sites. Ointment may be applied to prevent the eye area drying out and ice packs are sometimes used to reduce any swelling.
Back on the ward
You will need to rest until the effects of your anaesthesia have passed. You will be given painkillers to help with any discomfort as the anaesthetic wears off. Please discuss any discomfort you have with the doctors or nurses.
Your surgeon will visit you to assess your progress and answer any questions you have about the operation.
When you feel ready you can begin to drink and eat starting with clear fluids.
If your operation has been planned as a day case you will be able to go home once you have made a full recovery from the anaesthesia. However you will need to arrange for someone to drive you home. You should try to arrange for someone to stay with you for the first 24 hours.
Before you are discharged you will be given advice about caring for your eyes. You may be given eye ointment to use at home and your anaesthetist may prescribe painkillers for the first few days.
The nurse will give you a contact telephone number for the hospital and a date for a follow up appointment with your surgeon. The stitches may be removed about 5 to 10 days later at the out-patient clinic depending on whether absorbable or non absorbable sutures were used.
After you return home
If you need them, continue taking painkillers as advised by the hospital. General anaesthesia can temporally affect your co-ordination and reasoning skills so you should not drive, drink alcohol, operate machinery or sign legal documents for 48 hours afterwards. You should keep your head higher than your body to reduce swelling and bruising. Lie propped up on pillows and avoid bending over for a few days. Applying a cold compress to the area such as a bag of frozen peas wrapped in a towel should also help. Never apply ice directly to your skin.
The wounds may bleed a little. This can be stopped by applying pressure for at least 10 minutes with a clean handkerchief or swab.
You should clean the area around your eyes as instructed by your nurse or surgeon. Avoid applying eye make-up until a couple of days after the stitches have been removed, or as advised.
You can normally read or watch television within a few days. You won’t be able to wear contact lenses for at least two weeks and they may feel uncomfortable for a while after that.
You must follow your surgeon’s advice about driving and returning to work. Most people go back to work after a two weeks or so. You must not try to drive until you can see normally again. Please contact the hospital if you develop any of the following symptoms:
· Increasing pain
· Bleeding that does not stop within 10 to 15 minutes
· Blurred vision that lasts more than three to four days
What are the risks?
Blepharoplasty is a commonly performed and generally safe operation. However all surgery carries an element of risk. This can be divided into the risk of side-effects and the risk of complications.
These are the unwanted but mostly temporary effects of a successful treatment. An example of a side-effect is feeling sick as a result of the anaesthetic or painkillers.
Specific side-effects of blepharoplasty include soreness around your eyes that can be helped by taking painkillers.
You should expect to have bruising and swelling for up to three weeks after the operation. This might make your eyes feel tight and difficult to close when you go to sleep. Your eyes may also feel sticky, dry and itchy for the first week. For some people they become watery for a few weeks. Other side-effects include double or blurred vision for a few days and sensitivity to light for a few weeks.
Sometimes tiny whiteheads appear along the line where the stitches were, which your surgeon can remove with a needle. The scars will be pink and noticeable at first, but should fade becoming less noticeable over a few weeks. Slight asymmetry between the two eyes with unequal skin folds of the upper eyelid or along the inner contour of the eye is possible though infrequent.
This is when problems occur during or after the operation. Most people are not affected. The possible complications of any operation include an unexpected reaction to the anaesthetic, excessive bleeding during or soon after the operation and infection.
In addition complications specific to a blepharoplasty include a pool of blood collecting under the skin around your eye (haematoma), this may need to be drained if it is large or doesn’t disappear on its own.
In rare cases problems closing your eyes when you sleep can be permanent. Also there is a possibility that swelling will cause your lower lid to be pulled away from your eye. While this usually settles on its own after a couple of days some people need another operation.
Complications that result in loss of vision are extremely rare.
The chance of complications depends on the exact type of operation you are having and other factors such as your general health. Ask your surgeon to explain how these risks apply to you.