Blepharoplasty

Introduction

Ageing of the upper and lower eyelids is normally due to a combination of loose skin and protrusion of fat. As this causes the appearance of tiredness and eye bags the operation of eyelid reduction (Blepharoplasty) is one of the commonest procedures for facial rejuvenation. In the upper eyelids ageing causes stretching of the eyelid skin producing a “hooded” appearance. In the lower eyelid the most frequent complaint is of puffiness or eye bags. These problems can be rectified surgically by operating on the eyelid itself and removing or adjusting excess skin and fat (Blepharoplasty).

In some patients, the primary problem may be due to sagging of the eyebrows with age rather than the eyelid in which case a brow lift may be indicated. This can usually be carried using “key hole” techniques leaving no visible scars on the eye or forehead. The need for brow surgery either alone or in addition to eyelid surgery will be discussed with you at your consultation. Mr Grover’s approach to eyelid surgery is to provide a natural appearance often guided by looking at photographs of your face when you were younger so any surgery ensures that you, still look like “you”. He is particularly known for his artistic approach to achieving a natural look and has lectured on the importance of an artistic element to surgical technique and how this can improve outcome at the Louvre in Paris as well as the Royal College of Art in London. He will also be honest in informing you if he feels you are not ready for surgery yet but should wait a few years.

Before and after photos of patient operated on by Rajiv Grover

How do I prepare for surgery?
Where will my surgery be performed?
What type of anaesthetic will be used?
What does the operation involve?
How long will the surgery take?
Is it painful?
What can I expect after the surgery?
What are the scars like?
What are the risks?
Summary

How do I prepare for surgery?
It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin has an adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Brufen and Nurofen). If you are a smoker it is helpful to stop for two weeks before surgery and for a week afterwards so as not to restrict the circulation to the skin. While making preparations, be sure to arrange for someone to drive you home after your surgery and to help you out for a few days at home.

Where will my surgery be performed?
The surgery is usually performed at the King Edward VII Hospital in central London where Mr Grover works as a Consultant in Plastic and Aesthetic Surgery. You will usually be admitted on the day of surgery, and stay overnight.

What type of anaesthetic will be used?
Blepharoplasty is usually performed under a general anaesthetic, so you'll sleep through the entire operation.

What does the operation involve?
On the upper eyelids the incision is carried out in the natural crease line that is located about 8-10 mm above the eyelashes. Surgery here is designed to correct both the excess skin and the excess fat. After making the incisions, the excess skin and muscle is trimmed from the upper eyelids together with any fat. The incisions are then closed with very fine sutures which are passed below the skin therefore leaving no external stitch marks.

On the lower eyelids, the technique very much depends on the patient's individual circumstance and requirements. If the problem is mainly prominent lower bags without loose skin, you may have what is termed as a transconjuctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. Alternatively, when there is also some loose skin the incision is made just underneath the eyelashes where it is very well hidden. The skin is then lifted upwards and outwards, and after removing some underlying fat, the skin is carefully sutured after removing the excess.

How long will the surgery take?
Blepharoplasty usually takes between an hour and an hour and a half, depending on the extent of the surgery.


Before and after photos of patient operated on by Rajiv Grover


Is it painful?
Your eyelids will probably feel a little tight and as the anaesthetic wears off and it is normal for this to continue for a few days afterwards. Mild painkillers such as paracetamol are usually sufficient to provide comfort. A number of patients may experience a feeling of numbness in the eyelid region. This is normal and usually returns in a matter of weeks, although occasionally it may take a little longer.

What can I expect after the surgery?
It is hoped that you will have only mild swelling and bruising following your Blepharoplasty, however this does vary from patient to patient. Whilst in hospital the nurses may apply cool soothing pads to your eyes in order to minimise this swelling further. In addition it is advised to rest for the first few days with your head elevated on 2-3 pillows as this also helps. .Your eyelids may feel dry at first during the night so eye ointment will be advised to make them more comfortable before sleeping.

During the first week you should avoid straining and bending down as this tends to increase the swelling. After about a week your stitches will be removed by Mr Grover and you will be able to wear make-up to hide any residual bruising.

Most patients can return to work after about 14 days although it will probably take at least 3-4 weeks before you would be ready for a major social event. To aid recovery strenuous sport should be avoided for 3-4 weeks. It is better to avoid wearing contact lenses for at least two weeks after Blepharoplasty and in some individuals this is best avoided for about a month.



What are the scars like?
In general, blepharoplasty scars heal well although variations in the healing process do occur from individual to individual. The scars along the lower eyelashes and in the upper lid almost always heal with a near invisible line after several weeks have passed. Those extending out into the crow's feet area can become slightly reddened and may require a little longer to settle completely. Massage of these scars speeds up their recovery and this will be discussed with you by Mr Grover once the stitches are out.

What are the risks?
It is important to stress the possibility of risks although in practice these are rare and blepharoplasty as an operation with a high level of patient satisfaction and a reliable outcome. You can be reassured that Mr Grover will do everything possible to minimize your risk. He has a strong interest in improving safety and is responsible for the UK National Audit of Cosmetic Surgery & Safety for the Royal College of Surgeons.

  • Excessive internal bruising (haematoma) occasionally occurs and may require removing some stitches to wash out the bruising from beneath the skin. This has no effect on the long term outcome of surgery.
  • The eyes may tend to water in cold air or windy weather during the first week or two until the swelling subsides.
  • The lower lid may droop very slightly while the lid is heavy and swollen but this is self-correcting once the swelling has reduced. Very occasionally it may require further surgery.
  • Redness in the scars occurs occasionally during the initial three months and is more common in red haired people. This can be treated by gentle massage and improves spontaneously.
Summary
Procedure time60-90 minutes
General / Local anaestheticGeneral
No. nights in hospital1 night
Time off work2 weeks
Sensitivity period2-4 weeks
Back to normality / sports4-5 weeks

Blepharoplasty is one of the most popular cosmetic surgery procedures for facial rejuvenation. The chances are excellent that you'll be happy with your surgery but you must be aware that the results may not be apparent immediately. The freshening of your eyes and improvement in the tired appearance will benefit self-esteem, confidence and should last for years. Please remember the procedure can never halt the ageing process. The clock can be turned back but no surgeon can stop it ticking.

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