Oculoplastic Surgery

A blepharoplasty is an operation to tighten the skin and soft tissue of your eyelids which becomes less elastic and pulled down by gravity as you age. The consultant surgically removes excess skin and muscle from the eyelids, offering a more youthful appearance to patients while also improving vision quality.

A blepharoplasty can be done under local or general anaesthetic. The surgeon will need to know if you are taking any medicines to reduce your risk of blood clots, such as aspirin, warfarin or apixaban.

Surgery on the upper eyelids generally involves:

 Making a cut (incision) along the eyelid crease in the natural skin fold of the eyelid.

• Removing excess skin, fat or muscle.
• Closing the incision, ensuring the scar is hidden in the natural fold of the eyelid.

Surgery on the lower eyelids generally involves:

 Making an incision either just below the lower eyelashes or on the inside of the lower eyelid.

• Repositioning or removing fat from the bags under the eyes, and sometimes also a small amount of skin.
• Supporting the muscles and tendon of the eyelid if necessary.
• Closing the incision.

The consultant will usually apply thin, sticky strips called suture strips to support the eyelids after surgery. These are usually removed up to one week later.

The surgery should take from 45 minutes to two and a half hours. You can go home the same day but will need someone to drive you and stay with you for 24 hours if you have had a general anaesthetic.

Ptosis can block the top part of your visual field and cause difficulty keeping the lid open, giving you eye strain or brow ache from the increased effort needed to raise your eyelids as well as fatigue when reading. Ptosis repair involves the restoration of the upper eyelid’s edge (of one or both eyes), returning it to its normal, healthy state above the pupil.

In adults, surgery is usually performed using a local anaesthetic (you will be awake but not feel anything) as this allows for good lid positioning during surgery. You may be offered a mild anxiolytic such as diazepam to keep you calm. Skin stitches may be visible on your eyelids, but these will be removed around one to two weeks after surgery. The nurse will explain the detail to you.

After surgery your eye may be padded shut for 24 hours to reduce any swelling. You can remove this eye pad at home the following day. Some surgeons prefer to leave the eye without a dressing, so that any change in the vision caused by internal bleeding inside the eye socket can be picked up quickly, but this is extremely rare. Usually, ointment will be prescribed/provided for use at home; the nursing staff will show you how and when to use it. If you start to bleed, wash your hands and apply gentle pressure with a swab/make-up pad over the wound for 10 minutes.

An appointment is usually made for one week after surgery. Your stitches will be removed or be left to dissolve if they are absorbable. A second appointment will be arranged for four to six weeks after that. By then, the swelling in your lid will have gone down and a more accurate assessment of the surgery results can be made.

• Continue your normal daily routine and moderate exercise.
• One or both of your eyes may be bandaged.
• Please carry on using any other eye drops you were prescribed before your surgery unless the doctor treating you has advised you to stop.
• You can use a cold compress on the area for 10 mins every hour if needed; this will help reduce any swelling and bruising. A pair of non-rubber surgical gloves filled with cold water is an easy method or just a packet of frozen peas covered in something clean to avoid direct skin contact (to avoid frostbite).
• We recommend you sleep with your head raised on a couple of pillows for two nights.
• It is often advisable to keep the operated area relatively dry for between two and ten days. You can shower as normal, but make sure you dry your eyelid with a clean cotton pad after.
• Three days after your operation, the swelling and bruising is usually at its maximum. Mild painkillers may still be required and continue using ice if you find it beneficial.
• If your eye remains red, we advise you avoid swimming, contact lens wear and eye make-up for two weeks or longer.
• You will be given advice on driving post procedure by the ward team depending on what you have had done.