Eyelid surgery (blepharoplasty) is a procedure to remove excess skin or fatty bulges from the upper or lower eyelids. This may help to improve the tiredness around the eyes. Upper eyelid surgery can also be used to create a crease above the eyelids where such has not formed naturally. This is particularly the case with Asian eyelids. Eyelid surgery may be performed alone or in conjunction with other facial rejuvenative procedures. A common mistake is to request surgery to the upper eyelids for heaviness there when in fact this is due to brow descent. At consultation Dr Scamp will advise you whether or not blepharoplasty or brow lift or both would be of benefit to you. Information on brow lift can be found elsewhere on this web site. It is possible to perform other rejuvenative surgery to the face in conjunction with eyelid surgery. Cosmetic surgery to other parts of the body can also be performed at the same time. Ask Dr Scamp about this at consultation.
Would I benefit from eyelid surgery?
If you are physically (and psychologically) well and have excess fat or skin around your eyes, you may benefit from blepharoplasty. Changes achieved with blepharoplasty are subtle. If a more dramatic transformation is anticipated you may need to undergo other procedures in addition to a blepharoplasty. There are many different forms or treatments for the signs of ageing around the eyes and Dr Scamp will advise you at consultation, which he feels are most beneficial for you. With regards to the upper eyes, the most common mistake is to attribute the heaviness there to the eyelids themselves when it is, in fact, due to brow descent.
As mentioned above brow-lift is the treatment of choice for this condition. You may find more information on this topic elsewhere on the web site. Upper blepharoplasty can create a sharper eyelid crease and remove some of the excess fat and skin to brighten and freshen the upper lids. If crow’s feet are a problem these may be improved by brow lifting but may require Botox (Botulinum Toxin) injections to further soften them. Information on Botox injections can be found elsewhere on this web site. Fatty bulges in the lower lids can be improved by lower blepharoplasty. This is sometimes performed through the inner aspect of the lower eyelids which avoids a skin scar.
In other situations, an incision running along the border of the lower eyelid lashes and out to the side is required. Commonly, a support procedure to the lower eyelid is performed at the same time (lateral canthopexy). This is to prevent or correct sag of the lower lid (ectropion). If there are many fine lines affecting the lower lids then surgery may not be the treatment of choice. These often respond better to laser resurfacing. Dr Scamp would advise you at consultation whether this is the treatment of choice for you.
Most commonly, blepharoplasty surgery is to soften the “bags” around the eyes. Commonly as one ages, the production of tears and oil from the glands around the eyes to keep the eyelid surface moist decreases. Older people are therefore more prone to “dry eye” syndrome. Surgery may make this worse. The condition is usually treated by application of eye drops at frequent intervals during the day and ointment to the eyes at night. These are simply designed to help keep the surface of the eyeball moist.
What are the risks of surgery?
All surgery carries with it some risks. The most common risks are bleeding or infection. Infections are uncommon in the eyelids as the circulation there is very good. In addition, you will be given some antibiotics at the time of surgery to reduce that risk. If laser resurfacing is done to the lower eyelids, there is a risk of cold sores breaking out in the resurfaced skin. This can lead to scarring. For that reason you will be given anti cold sore pills to take at the time of your laser resurfacing. Bleeding may complicate eyelid surgery. This will make the swelling and bruising much worse and the time to recover substantially longer.
Avoid medications that make you bleed for two weeks prior to surgery. These include aspirin, arthritis pills and vitamin E. Red wine and smoking also tend to make you bleed more. Following lower blepharoplasty a complication called ectropion may occur. This refers to the lower lid margin being pulled down. Commonly with lower blepharoplasty, Doctor Scamp also performs a lateral canthopexy, (which is a support procedure to the lower lid) to prevent this. It can however, still occur. Usually this is temporary and related to the heaviness of the lower lids as they are swollen. With the passage of time and resolution of the swelling, the condition usually resolves.
You can hasten this by massaging the eyelids upwards and outwards. Slight asymmetry is common both before and after surgery. Swelling and bruising around the eyelids may last for as long as ten or fourteen days. Blurring of vision in the first few days after surgery is common. When the upper eyelids are swollen and stiff after surgery, they may not close well. This is particularly a problem when you are asleep and may result in the eyes becoming dry. You may need to place ointment in the eyes at night to keep the eyes moist whilst this swelling resolves.
Millions of blepharoplasty operations have been done throughout the world. There have been approximately 60 cases worldwide of people who have lost some vision in one eye. It is felt that this is mostly due to bleeding behind the eyeball. Particular attention is paid at surgery to preventing bleeding.
How do I plan my surgery?
You may contact Dr Scamp’s office to obtain information on the surgery and to discuss it with his staff telephone 07 5539 1000. He may also be contacted on fax number (07) 5539 1177 or email firstname.lastname@example.org. At the initial consultation, Doctor Scamp will take your medical history and examine you. He will advise you not only on eyelid surgery but any other methods to rejuvenate the area around the eyes which may be best for you. Doctor Scamp will need to know what medications you are on and what vitamins you are taking. If you have a history of dry eyes, examination by an optometrist prior to surgery may be useful. Be clear in your goals for this surgery. Remember that blepharoplasty is a subtle procedure and produces subtle changes. Other procedures may be required if a more dramatic transformation is desired. At consultation, Dr Scamp will explain the techniques which he feels will most benefit you. Photographs will be taken of you, these will be used to explain what benefits can be expected. If you live at a distance and two consultations would be difficult, allowances can be made. If you contact the office prior to your consultation information can be sent to you so that you are already well familiar with the procedures upon arrival.
Preparation for surgery
Remember to: Avoid aspirin for two weeks prior to surgery Cease smoking six weeks prior to surgery (this includes nicotine patches as well). Avoid vitamin E pills (high dose) for two weeks prior to surgery. Have your eyes checked by an optometrist if you feel you get dry eyes. Plan to have enough time off to allow the bruising around your eyes to disappear ( 1-2 weeks). Have someone to drive you home after surgery and stay with you for the first night.
Where will my operation be performed?
Eyelid surgery is commonly performed as a day patient in a registered day theatre. If you prefer however, it can be performed as an inpatient with a stay of one or more nights. It is a gentle procedure and there is usually little discomfort after surgery, which makes it suitable for day surgery.
What sort of anaesthetic will I have?
In general, Dr Scamp prefers general anaesthesia for eyelid surgery. The procedure is very delicate and unwanted movement at an inopportune time could compromise the result.
What is done at the surgery?
Blepharoplasty takes between one and two hours depending on whether two or four eyelids are done. The incisions in the upper eyelids are in the crease approximately 8mm above the eyelashes. This means that they are very hard to see. Excess skin and fat is removed and the muscle that lifts the upper lid may be tightened or sutured to the skin to create a more distinct crease there.
With lower blepharoplasty the incision will either run along just beneath the eyelashes and a little out to the side, or the procedure may be performed (where suitable) by an incision on the inside of the lower lids. If the fat is removed by the incision inside the eyelid, it is also possible to resurface the lines of the lower eyelid at the same time with laser.
What happens after surgery?
When you waken your vision will be blurry, as there is usually some antibiotic ointment in your eyes. Discomfort is usually minimal. There will be pills for you to take for any discomfort that you feel. You will have some ointment to place in the eyes at night to keep the eyes moist. Use cold packs to take down the swelling of the eyes. Commonly, in the first few days to weeks after surgery, you may experience excessive tearing, light sensitivity and some blurring or double vision. Sutures are removed a few days after surgery. As the swelling and discoloration around your eyes subsides you will start to look and feel much better.
Getting back to normal
Contact lenses may be uncomfortable for up to two weeks after surgery. You will be able to mix in your usual social circles as soon as your swelling and bruising disappears. This may take up to two weeks after surgery. Before then you will get by very well in some dark glasses. Feel free to use make-up to hide the bruising of your eyelids. Instruction on camouflage make-up can be given by Doctor Scamp’s staff. Avoid vigorous activity for two weeks after the surgery as this will tend to accentuate the swelling there.
This is particularly true with bending, lifting or doing anything head down. The scars of blepharoplasty are subtle, but do not completely fade for up to a year after surgery. However, even in the first few days after surgery they are often difficult to see for the casual observer. Expect the effects of blepharoplasty to last for some years. Where it is of benefit, some people return down the track for repeat surgery. Write down any questions you have and ask Dr Scamp at consultation.