Eyelid Surgery (Lower)
Table of Contents
Eyelid surgery, also known as an eyelid reduction or blepharoplasty, is a procedure that aims to remove excess skin, fat, and muscle from the eyelid. The ultimate goal is to improve droopy eyelids or eye bags. This eyelid surgery overview will inform you about the procedure and what it involves.
What can eyelid surgery achieve?
The area around our eyes is one of the first places on your face to show the signs of aging. As a result of this, you may find that the skin here becomes loose, wrinkled and puffy. Consequently, over time this may leave you with a permanent tired appearance. For some, you may find that there is an inherited tendency to develop changes around the eyes, such as eye bags, earlier on in your adult life. If this is something that affects you, then eyelid surgery can help reverse these changes around your eyes. The procedure aims to:
- Reduce the excess skin and fat on your upper or lower eyelids
- Improve your vision if excess skin on your upper eyelid is impeding it
- Give your eyes a more youthful and awake appearance
- Make you less conscious of age-related changes around your eyes
- Boost your self-esteem.
However, eyelid surgery is unable to resolve all problems. It cannot resolve:
- Wrinkles around the eyes
- Dark shadows under the eyes
- Folds of skin extending into the cheek (called festoons).
If you find that you are struggling with any of the above, then a brow lift or a facelift may be a more appropriate option for you.
Who are the best candidates for a eyelid surgery?
Blepharoplasty, commonly known as eyelid surgery, is a popular cosmetic procedure for men and women. The eyes are one of the first places on the face to show the signs of aging. As we age, the skin around the eyes can start to lose its elasticity and the muscles begin to slacken. This slackening of the muscles causes the fat around the eyes to become more prominent, therefore, making the eyes look puffy. This can, therefore, create the appearance of eye bags. Some people find that this bagginess of the eyelids affects their self-esteem and makes them feel unhappy. The purpose of eyelid surgery is to remove this excess skin and fat making the eyes appear more youthful. Individuals suffering from these problems may be suitable eyelid surgery candidates.
As the purpose of eyelid surgery is to remove excess skin and fat from the upper and lower eyelids, suitable eyelid surgery candidates include those who are unhappy with:
- Any loose or baggy skin around the eyelids.
- Their vision due to excess skin drooping over your eyes.
- Eyebags or puffiness around the eyes.
Before going ahead with the procedure, it is important to make sure that you:
- Feel mentally and emotionally ready for surgery.
- Are a healthy individual.
- Do not smoke or use nicotine for at least 6 weeks before surgery.
- Have no serious eye conditions.
Your surgeon will fully assess and examine your face during your consultation. This will allow them to decide which procedure will best meet your desired outcome.
Why have eyelid surgery?
The earliest signs of aging occur around the eyes. These can leave the upper and lower eyelids looking puffy, loose and may create a permanent tired appearance. Hence, eyelid surgery can resolve these issues and can:
- Tighten the skin on the eyelids
- Create a more awake and youthful appearance
- Improve your self-esteem
- Improve the symmetry of your eyes.
What eyelid surgery will not resolve
Although eyelid surgery can improve the appearance of the eyes, there are some problems that it cannot resolve. It is important to remember that this procedure focuses only on the upper and lower eyelids. It is, therefore, unable to correct the following:
- Folds of skin that extend onto the cheeks (which are known as festoons)
- Wrinkles in the corners of the eyes which are known as ‘crow’s feet’
- Dark shadows under the eyes
- Forehead wrinkles
- Low set eyebrows that are drooping over the eyes
- Loose skin anywhere else in the face.
However, although eyelid surgery does not address the above issues, there are surgical procedures that can! Many people combine their eyelid surgery with other procedures. For example, a brow lift can address low set or drooping eyebrows. You can also have a face or neck lift if you are unhappy with wrinkles on your mid to lower part of your face. These can be done at the same time as your eyelid surgery. It is therefore vital that you make it clear to your surgeon what issues you would like to address so they can recommend the most suitable procedure for you.
How is eyelid surgery performed?
An eyelid surgery procedure usually takes between 60 and 120 minutes to complete. It is usually done as a day case, which means you will be able to go home the same day. Your surgeon may perform the surgery using either a general anaesthetic or a local anaesthetic with the use of sedation. Once you have chosen your surgeon, you will have a consultation with them. During this consultation, your surgeon will give you details about the procedure. They will also discuss your expectations from the surgery. Finally, they will give you instructions on what to eat, drink and what medications to take on the day of your surgery.
Either in your pre-operative assessment or on the day of surgery you will need to sign a consent form. In order for you to sign this, you will need to be fully informed about all aspects of the eyelid surgery procedure. Therefore, your surgeon and anaesthetist will discuss the surgery with you and it’s potential risks and complications. It is important that you ask any questions that you may have. Next, your surgeon will examine and draw some lines on the treatment area. You will also discuss your goals for surgery.
On the day of your surgery, you will meet your anaesthetist and be taken to the operating theatre. Your anaesthetist will then deliver your anaesthetic. This may be a general anaesthetic where you go to sleep and wake after the surgery. This may leave you feeling groggy for a couple of hours post-op but will wear off. Alternatively, a local anesthetic which numbs the treatment area with some sedation so you feel relaxed may be used.
Once you are asleep, your surgeon will clean and drape the treatment area. This is to ensure the treatment area is sterile and to reduce the risk of infection.
According to what your desires are, your surgeon will correct the upper or lower eyelids or both. The location of the incision will depend on which part of the eyelid you are unhappy with. Therefore, your surgeon may use two different incisions in this procedure.
This involves making an incision along the natural crease of the upper eyelid. The scar from this technique will be very discreet and lie in the fold of your eyelid.
This technique involves making an incision below the line of the lower eyelashes. This is called a transcutaneous blepharoplasty. Alternatively, your surgeon can also make a small incision on the inside of your lower eyelid. This technique removes fatty deposits only from the lower eyelid and is known as transconjunctival blepharoplasty.
From either of these two incisions, your surgeon is able to:
- Remove or re-position excess fat
- Remove excess skin
- Tighten or remove loose and slacking muscle
The incision site may vary according to your own personal desires and what you wish to achieve from your eyelid surgery procedure.
4. Closing of incisions
Following the procedure, your surgeon will apply steri-strips or sutures to support the eyelid. They may give you eye pads to put on after to help reduce swelling. These will only be kept on for a short amount of time, typically an hour.
5. Return to the ward
Once your surgery is complete, you will return to the ward. You will need to stay there for a few hours or overnight. This is to allow the effects of the anaesthetic to wear off, ensuring you are safe to return home.
What should I expect from my eyelid surgery consultation?
Firstly, you will meet with your surgeon. This initial consultation should last between fifteen minutes to one hour. In this meeting, you will discuss your own expectations, personal goals, and the operation itself. Furthermore, in your eyelid surgery consultation your surgeon will ask you about the following:
- Your current and past medical conditions
- Any medications that you currently take (prescribed, over the counter and herbal remedies)
- If you have any allergies to any drugs
- How much alcohol you drink
- If you smoke or use recreational drugs
- If you suffer from any conditions associated with the eyes
It is important that you share all the above information with your surgeon as it may affect the approach they take. In your consultation, you should also be as honest about your expectations and desires as possible. The more your surgeon knows about your wishes, the more likely they will be to give you the result you want.
After they have taken your medical history, your surgeon will examine your eyes. They will assess how much excess skin and fat you have around your eyelids. They will use the findings from the examination to make a decision on the best surgical approach for you. Your surgeon will also take confidential photos for your medical records with your permission.
What questions should you ask during your eyelid surgery consultation?
It is important to use this initial consultation to ask any questions that you may have about the procedure. Some questions you may like to ask your surgeon include:
- Do you think what I expect to achieve from surgery is realistic?
- What can I do to help with my recovery? How long will it take to recover fully?
- Will I have any scarring? If so, where will the scars be?
- What can I do to achieve the best results?
- Do you have any photos of eyelid surgeries you have performed in the past?
- How long can I expect the results to last?
If you think of any more questions it may be a good idea to write these down and take them with you so you do not forget them. However, do not worry if you think of more questions after your initial meeting. You will have plenty more opportunities to ask any questions you may have.
Risks & complications
What are the main eyelid surgery risks and complications?
All kinds of surgical procedures carry a potential for complications to occur. Therefore, before you decide to go ahead with surgery you should educate yourself on the main eyelid surgery risks. Our surgeons advise that you spend two weeks after your initial consultation considering these risks before you decide to have your treatment. Only once you are aware of the risks can you give your fully informed consent.
Although complications arising from surgery are rare, there is a small chance that they may occur. The potential risks and complications include:
Blurred vision is common after surgery and may occur due to dry, watery eyes or swelling of the eyelids. If this were to occur it, it is often temporary and should resolve in around a month.
This is a rare complication after blepharoplasty. This happens when the muscles that move the eye are injured. Alternatively, it may also happen when the fat surrounding the muscle become scarred. This is often temporary but there is a risk that it may become permanent. If the double vision becomes permanent, you may need to have further surgery to correct it.
Loss of vision
A total loss of vision after eyelid surgery is a very rare complication. It may occur when there is a large amount of bleeding around the eye that creates enough pressure to cut off the blood or nerve supply to the eye. This would present with intense pain, double vision and sudden bulging forward of the eye. If you experience these symptoms it is critical that you seek medical attention as it may require further surgery.
Following surgery, tiny white bumps (known as milia) may form along the incision line. These usually resolve within a couple of weeks. You may also develop small fluid-filled sacs called cysts. These also can resolve by themselves, but if these small cysts bother you, your surgeon can remove them in a quick simple procedure.
There is a risk that your wound may become infected after your procedure. However, infections are often minor and not very serious. If you develop an infection, you may notice the following symptoms:
- A temperature over 38° C
- Increasing redness or swelling around the wound
- Yellow and foul-smelling pus oozing from the wound
- An increase in pain and discomfort, that your painkillers cannot control.
Most infections are mild and will resolve after a short course of antibiotics. It is however, to get infections treated quickly as they can spread and become more serious.
As your surgeon needs to make an incision during your blepharoplasty, the procedure will always leave a scar. The scars, however, tend to be minimal and well-hidden. The extent of the scar will depend on the technique your surgeon uses and the ability of your skin to heal. Some patients experience some more severe forms of scarring such as hypertrophic or keloid scars. It is important to let your surgeon know if you have any of these types of scars in the past.
Bleeding during the procedure may result in bruising around the eye. Rarely, there can be a large amount of bleeding which may affect your vision. This would require immediate medical attention and may need another operation.
Removal of too much skin
Sometimes your surgeon may remove too much skin in the operation. This may result in:
- Lagophthalmos – the inability to close your eyes completely.
- Ectropion – the lower eyelid drooping away from the eye and turning outwards.
- Eyelid retraction – the lower eyelid being pulled down.
There is always a risk that you are unhappy with the final result of surgery and the look of your eyelids. Therefore, we advise that all patients choose their surgeons very carefully. Being honest about all of your expectations and desires from surgery will help you achieve the results you want.
General surgical complications
All the different kinds of surgical procedures carry some common general risks. Everyone involved in your care will do all they can to reduce the risk of any of these occurring. These general risks can include:
- Nausea and vomiting
- Reaction to your anaesthetic
- Blood clots in the legs and lungs
- Post-operative pain.
If you have had an operation in the past and been affected by any of the above it is vital that you tell your surgeon. This way they can take extra measures to prevent them from happening again. Carefully following your surgeon’s aftercare advice will also help reduce the chance of any eyelid surgery risks and complications from occurring.
Preparing for your treatment
How can I prepare for eyelid surgery?
Before you go in for your surgery, there are some things you can prepare at home. Preparing well will make it easier for you to recover once you get home after the procedure. Below are some eyelid surgery preparation tips that our patients have found to be useful.
Some people find it useful to clean the house, take out the bins and do the laundry before coming into hospital. This ensures your recovery time can be relaxing without having housework to do.
To allow yourself to rest after your eyelid surgery, it may be a good idea to do a food shop before your operation. You could even batch cook some food for the freezer so you don’t have to worry about cooking!
Children and pets
To aid in your recovery, you may find it useful to ask family and friends to look after young children and pets for the first few days. This will allow you to get all the rest you need after you have your procedure.
You will be unable to drive after your eyelid surgery. This is due to the anaesthetic agents that they use in the procedure. It is therefore important that you arrange transport to take you home from the hospital. Furthermore, you will be unable to drive until your vision is back to normal so it may be useful to plan your daily activities around this and arrange help as necessary.
Eating and drinking
In order to help your recovery and maintain your results, you should eat a healthy diet. Try to eat foods that are high in protein and low in sodium and fats. This should include lots of fruits and vegetables. Try to drink plenty of water and stay away from drinks with caffeine in them.
Eye wear after surgery
Following surgery, you will be unable to wear contact lenses for a while. Therefore, you should make sure you have a pair of glasses with your prescription if you need them after your procedure.
Furthermore, your surgeon will recommend that you wear sunglasses for a few days after the procedure. This is to protect the eyes from wind, rain, and sun. Wearing sunglasses will also conveniently hide the swelling and bruising that occurs after surgery.
After surgery, some people find it more comfortable to sleep with a few extra pillows than normal. Therefore, it may be useful to get some extra pillows ready for this. It may also help to sleep in a slightly inclined position, on your back. This will reduce the swelling that may occur after the operation and protect your eyes from damage. Your surgeon will advise you specifically on the best way to sleep after your eyelid surgery.
Following these eyelid surgery preparation tips can help you feel more ready for surgery and it will allow you to have the relaxing recovery time that you deserve!
What can I expect after eyelid surgery?
By knowing a bit about your eyelid surgery aftercare, you may feel a bit more at ease before going in for your procedure. During your consultation with your surgeon, they will inform you about the eyelid surgery aftercare process. This will include information about when you can go back to driving, work, and exercise.
Your surgeon often performs the surgery as a day case, which means you will be able to go home the same day. Before you leave the hospital you will be given an appointment for one to two weeks time with your surgeon. In this appointment, your surgeon will check the results of the surgery, remove any stitches and discuss any next steps of care.
How will I feel after surgery?
How you will feel after surgery will depend on the anaesthetic agent used during your surgery. If they use a general anaesthetic, you will wake up slowly and feel a little groggy at first. You may find that the drugs they use in the operation may affect your concentration and memory for the first couple of days. But this will resolve over time.
If you have a local anaesthetic, the treatment area may feel a little numb for few hours. Furthermore, as the medication begins to wear off, you may find you experience some tingling or burning sensations around your eyes. If this is uncomfortable you can ask for some pain medication.
Is there anything I need to do in the first 24 hours?
It is important that you have adult supervision in the first 24 hours after your surgery. You may feel dizzy or have problems with your vision straight after the surgery and it is important that you have support in case of this. We recommend you ask someone to stay with you after your procedure.
Returning to work
After your eyelid surgery, you will need to take about a week off work. Most people return to work in seven to ten days after the surgery. If your occupation involves driving, it is important you do not return before your vision is back to normal.
You will not be able to drive yourself home after the surgery. This is due to your eyes being slightly swollen from the procedure and the medications used may cloud your judgment. You must, therefore, ask a friend or family member to collect you from the hospital. Your surgeon will usually advise that you do not drive until your vision is completely back to normal and the swelling around your eyes subsides.
Returning to exercise
It is important that you do not partake in strenuous exercise in the first week following your surgery. This is because aerobic activity can increase the swelling around the treatment site. You should also avoid swimming for the first week.
Care of the treatment area
You will feel some pain and discomfort around the eyes after your eyelid surgery. You will also have some swelling and bruising in this area. This should all resolve within a few of days. Over the counter painkillers such as paracetamol can help with the pain.
You may also find that your eyes are sensitive, difficult to shut or watery after surgery. This should settle down within a few weeks. To aid your recovery, it is essential that you clean the eye area with clean water. Your surgeon may also recommend some ointments or eye drops to use as well.
What other points should I consider?
You should avoid rubbing your eyes after your procedure as this may disrupt the stitches on your eyelids. It is important to keep in mind that you will not be able to wear contact lenses for a couple of weeks after surgery, so you should get some prescription glasses to wear during this time.
The final results
Although you can see the effects of eyelid surgery immediately, it may take up to 6 weeks to appreciate the full cosmetic result.
As the incisions are made in the natural creases of your eye, the scars are often very faint after blepharoplasty. Once your scars heal, your eyes will have a more youthful and awake appearance.
It is crucial that you follow your surgeon’s eyelid surgery aftercare advice so that you can achieve the best results possible.
What are some common eyelid surgery FAQs?
We have created a list of common eyelid surgery FAQs which may help answer some of your questions. If you have any other questions which are not listed below, you can ask your surgeon during your consultation or contact one of our patient care advisers.
Can I wear makeup after eyelid surgery?
Most surgeons advise that you do not wear any eye make up until your eyelids have fully healed following surgery. Generally, this will be around 6 weeks. Your surgeon will give you specific advice on when you can resume wearing makeup.
Do I need to wear anything over my eyes?
We recommend that you wear dark glasses for the first week following your procedure. This will help protect your eyes from the sun and wind and also prevent you from touching your eyes. Dark glasses are also a good way to keep your procedure discreet if you do not wish to discuss it. They will also hide the bruising and swelling of your eyelids!
Will the NHS pay for my eyelid surgery?
As blepharoplasty is generally considered to be a cosmetic procedure, it does not qualify for NHS funding. However, if the reason that you want the surgery is due to excess skin on your eyelids, which is affecting your vision. You may wish to speak to your GP to see if this could qualify you for NHS funding.
Do I need a GP referral for cosmetic surgery?
All of the surgeons at Avrupamed will see you for an initial consultation without a referral from your GP. If you then plan to continue with the surgery, your surgeon will ask for your permission to contact your GP practice so they can obtain your medical records.
What effect does smoking have on the surgery?
Smoking can greatly increase the risk of complications occurring after surgery. Therefore, most surgeons recommend that you are smoke and nicotine free for at least 6 weeks before and after the procedure. Furthermore, some drugs and herbal remedies can affect the way your body heals. This is why it is important to tell your surgeon the full list of drugs and medications that you take.