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Cosmetic eyelid surgery

Published by Bupa’s Health Information Team, August 2011.

This factsheet is for people who are having cosmetic eyelid surgery, or who would like information about it.

Cosmetic eyelid surgery (also called blepharoplasty) involves removing excess skin or fat from around the eyes to give a more alert and youthful appearance. Eyelid surgery can also help to reduce swelling (puffiness) around the eyes first thing in the morning. The procedure can be done on the upper and lower lids.

You will meet the surgeon carrying out your procedure to discuss your care. It may differ from what is described here as it will be designed to meet your individual needs.

About cosmetic eyelid surgery

As you get older, the skin around your eyes loses its elasticity and the muscles become looser. Your skin can develop into loose folds on your upper eyelids and deep creases under your lower lids. As the muscles become looser, the fat around your eye may also bulge forward and make your lower eyelids appear baggy. Cosmetic eyelid surgery can remove the excess skin and fat from around your eyes giving you a more youthful appearance.

Getting advice about cosmetic eyelid surgery

Talk to your GP about cosmetic surgery. He or she will know the specialists in your area and may be able to help you choose a surgeon or hospital.

Before deciding whether to have cosmetic eyelid surgery, talk to your surgeon about what you’re hoping to gain from the operation and the result you can realistically expect. For example, this kind of surgery can’t remove wrinkles at the corners of your eyes (crow's feet) or the dark shadows under your eyes.

What are the alternatives?

Wrinkles around your eyes can also be reduced using botulinum A toxin (eg Botox), chemical peels or laser treatments.

If you have cosmetic problems with other parts of your face, for example if your eyebrows are also drooping, a forehead or brow lift may be suggested to you instead.

Preparing for cosmetic eyelid surgery

Your surgeon will ask you about your health and your medical history. If you have thyroid disease, high blood pressure, diabetes or eye problems such as dry eye or glaucoma, your surgeon may ask you to see an ophthalmologist before your operation. An ophthalmologist is a doctor who specialises in eye health, including eye surgery.

Your surgeon will examine your eyelids and eyes, including testing your vision. He or she may also do a test to see how well your eyes produce tears.

Cosmetic eyelid surgery can be done using local or general anaesthesia. A local anaesthetic will completely block pain from your eyelids and you will stay awake during the procedure. If you’re having a general anaesthetic, you will be asleep during the procedure.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during cosmetic eyelid surgery?

The time it takes to carry out your surgery will depend on the technique your surgeon uses and whether you’re having your upper or lower eyelids, or both, operated on.

Your surgeon will make cuts along the natural lines in your eyelids – along the creases in your upper eyelids and below your eyelashes in your lower eyelid. This means your scars will run along the natural folds of your eyes, which helps to hide them.

Excess fat, muscle and loose skin are removed, and the cut is closed using fine stitches. If only fat is removed and there is no excess skin, the cut may be made inside the lower eyelids, leaving no visible scar. Your surgeon may also use a laser to tighten any loose skin and reduce wrinkles. Using a laser this way doesn’t leave a scar, though the skin may be red for a few months afterwards. Excess fat may be made to shrink by application of heat (through cautery).

If you’re having the procedure done using a local anaesthetic, your surgeon may ask you to open and close your eyes at the end of the operation. This is to check that your eyelids are level on both eyes.

Your surgeon may apply ointment to your eye to stop it from drying out or to reduce the risk of infection. Small strips of sterile tape (steri-strips) may also be used to support your eyelids and hold the ends of the stitches in place.

What to expect afterwards

If you have had a local anaesthetic, you will usually be able to go home when you feel ready. If you have had a general anaesthetic, you may need to rest until the affects of the anaesthetic have passed.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your operation.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Your nurse will give you some advice about caring for your eyes before you go home. You may be given eye ointment to use at home and a date for a follow-up appointment.

Recovering from cosmetic eyelid surgery

The length of time it takes to fully recover from cosmetic eyelid surgery varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take paracetamol. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your stitches are usually removed three to five days after your operation. You may need to continue using sterile strips of tape to support your eyelids for about a week.

You will have some swelling around your eyes after the operation. You can help to reduce the swelling by applying a cold compress, such as ice wrapped in a towel. Don't put ice directly on your skin as this can damage your skin.

Your surgeon or nurse may give you other advice about what to do once you’re at home. The main points are listed below.

  • Keep your head up for a few days, for example, sleep propped up on pillows and don't bend down. This helps to reduce swelling and bruising.
  • Clean around your eyes with plain water.
  • Use any ointment or drops your surgeon has given you.
  • Don't wear eye make-up until your surgeon tells you it's safe to do so.

Your eyes may be blurry for a few days after the operation. Don't drive until your vision returns to normal.

What are the risks?

As with every procedure, there are some risks associated with cosmetic eyelid surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having this procedure. Side-effects of cosmetic eyelid surgery include:

  • swelling – this may last for several weeks, though many people find that most of the swelling goes down within a week
  • bruising – this usually gets better between seven to 10 days after the operation
  • dry, itchy eyes
  • watery eyes
  • sensitivity to light and wind – wearing sunglasses may help
  • blurred vision – this usually improves after a few days.  

Complications

Complications are when problems occur during or after the operation. Most people aren’t affected.

Complications of cosmetic eyelid surgery are uncommon. They are listed below.

  • Bleeding under your skin (haematoma). This usually gets better on its own within a few weeks. However, if the haematoma is large, you may need an operation to drain it.
  • Small, white cysts can develop along the line where the stitches were. Your surgeon can remove these with a needle.
  • Bleeding behind your eye. This causes swelling, which can press on the optic nerve and cause partial or complete blindness. This is very rare.
  • Uneven appearance. Your eyes may not look identical or level, or the folds of skin and creases may be uneven. You may need another operation to correct this.
  • Blindness, although this is exceptionally rare.
  • Overcorrection of your drooping upper lid. This can lead to damage to your cornea and will need to be corrected with further surgery, otherwise your sight may be affected.
  • Bacterial infection, a risk with any sort of surgery. A sudden increase in redness, swelling and tenderness may be a sign that you have an infection. Treatment using antibiotics is usually required.

 

For answers to frequently asked questions on this topic, see FAQs.

For sources and links to further information, see Resources.

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  • This information was published by Bupa's Health Information Team and is based on reputable sources of medical evidence. It has been reviewed by appropriate medical or clinical professionals. Photos are only for illustrative purposes and do not reflect every presentation of a condition. The content is intended only for general information and does not replace the need for personal advice from a qualified health professional. For more details on how we produce our content and its sources, visit the about our health information page.

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  • Publication date: August 2011

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