The operation is usually performed under local anaesthetic as an outpatient procedure.
The skin excess and the areas of fat bulging is estimated and marked before the operation in an upright position.
After injection of the local anesthetic the skin is incised along the upper edge of the eyelid, just below the eyelashes. If there is a lot of excess skin on the sides the incision may need to extend beyond the actual eyelid, but will also follow a natural skin crease making it hardly visible. The pockets containing the orbital fat are exposed underneath the eyelid muscle and any excess removed or repositioned. If the so-called tarsus, which is the thick band of tissue that stabilizes the eyelid, may need to be tightened or even shortened and reinserted at where it attaches to the bony eye socket. Once the skin excess has then been removed, the wound edges are then sutured together leaving a hardly visible scar which usually follows a natural skin crease.
The skin incisions are usually closed with fine non-absorbing sutures, which are removed after 5-7 days.
What to expect after the operation
The skin around the eye is very thin and prone to swelling and discoloration. It is therefore completely normal for the entire eyelid, sometimes also the lower eyelids, to swell up and turn blue. This can be reduced by cooling the area immediately after surgery for 24-48 h and keeping the head slightly elevated.
The final result can usually be appreciated after about 6-8 weeks, once all the postoperative swelling has gone down.
If you are generally prone to swollen eyelids this may only be corrected long-term to a certain degree by surgery, since the swelling is not due to the actual skin excess but the quality of the skin itself.
Keep the head slightly elevated (at least 30 deg) and cool the eyelids (not with ice as it can cause thermal damage) for at least 48 h after surgery
The sutures will be removed 5-7 days after surgery and the dressings can be left intact until then.
Showering and washing your hair is allowed, however rubbing the eyelids should be avoided until the wounds have healed completely.
Makeup can be applied anywhere more than 1cm away from the wounds after 48h.
Everyday activities are usually possible immediately after surgery, however strenuous activities, including exercise should be avoided until the swelling has gone down.
Regular follow-up appointments with your surgeon will be scheduled at 1 week, 6 weeks, 3 months and 1 year after surgery.
As with every surgical procedure lower eyelid blepharoplasty is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
The most common surgical complications after lower eyelid blepharoplasty include:
- postoperative bleeding, hematoma
- insufficient skin excision
- overexcision of excess skin
- ectropion (droopy eyelid)
- unsightly or asymmetrical scars
- irritation of the conjunctiva
- dry eye
- persistent swelling
Rare complications after lower eyelid blepharoplasty include:
- delayed wound healing or wound breakdown
- corneal injury
- permanent incomplete lid closure
- injury of the lacrimal duct
- bleeding into the eye socket, if left untreated subsequent blindness
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special investigations or tests before surgery?
Usually not. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed immediately after surgery. However, your eyelids will be quite swollen and discoloured for at least a week after the procedure, so it is advisable not to schedule your surgery immediately before any public events.
I already had a lower eyelid blepharoplasty some time ago. Can I have one again?
Yes, you can, provided there is actual skin excess. Sometimes other conditions can make the eye look tired even when there is no skin excess. The overall risk of complications is slightly higher for every repeat-procedure.
My eyes are not the same size. Can this be corrected with a blepharoplasty?
Nearly every person’s face is asymmetrical to a greater or lesser degree. This also applies to the eye region. Naturally the aim of surgery is to achieve as much symmetry as possible. There are however many factors that cannot be influenced by surgery that may have an impact on the overall appearance and symmetry of face (e.g. bone structure, muscle activity etc.) so that despite meticulous technique it is never possible to create a 100% symmetrical result.
I often have swollen eyelids, especially in the morning or when I am tired. Will this go away after surgery?
Eyelid swelling is caused by many factors, including the anatomy and function of the lymphatic vessels within the skin and underlying tissue. The tissue’s increased tendency to swelling is something that cannot be corrected surgically, however most patients do notice a significant improvement after the procedure.
I have dark circles under my eyes, will these be corrected with a lower blepharoplasty?
Possibly to a certain degree. As with eyelid swelling there are many reasons for dark circles under the eyes, foremost the fact that the eyelid skin is extremely thin so any changes in blood circulation immediately become visible. Especially when you are tired the blood may contain slightly less oxygen in that area and is therefore darker in colour. Also chronic edema or swelling can lead to deposits of pigments within the skin. All these factors can be influenced somewhat by removing the excess skin and tightening the tissues, however it is unlikely for the dark rings to disappear completely. Sometimes good results can be achieved if additional lipofilling (fat grafting) is performed underneath the eyelid skin.
I would like an upper and lower eyelid blepharoplasty. Can they be done at the same time?
Yes, this is possible. Naturally it will increase the operation time to approximately 2 h and it is recommended that the procedure be done under general anaesthetic or at least with sedation.
What happens if too much skin is removed?
If too much skin is removed, the edge of the eyelid will be pulled downwards and may prevent you from being able to close your eye completely. A gap between the upper and lower eyelid of a few millimeters can be absolutely normal immediately after surgery and in most cases settles completely over a period of 3-4 weeks. If the gap remains significant and causes discomfort such as a dry eye or increased tear production it will be necessary to re-open the surgical wound and correct the defect with a thin skin graft.
Can I wear make-up after the operation?
Once the wounds have healed completely (approximately 1 week after surgery) you can apply make-up freely. Before this time the wound itself should be kept clean and dry. You may apply make-up to the surrounding areas though.
Will I get a sick certificate for the time I am off work?
Only if the procedure is covered by your health insurance. Sick certificates cannot be issued for cosmetic procedures. You will need to take leave for the entire period that you are absent from work.
Will my health insurance cover the costs for the surgery?
In most cases not. If the skin excess is significant with a measurable decrease of the visual field (usually done by an ophthalmologist) the procedure may be covered by your insurance. In such cases written approval must be obtained by your surgeon prior to surgery.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. asymmetry, scarring, under- or overcorrection etc.) are not covered.