Ageing of the upper and lower eyelids causes the appearance of tiredness and eye bags. This is normally due to a combination of loose skin and protrusion of fat. The operation of eyelid reduction (Blepharoplasty) improves appearance and helps alleviate the look of tiredness which accompanies heaviness of the eyelids. In the upper eyelids ageing produces a “hooded” appearance however, in the lower eyelid the most frequent complaint is of puffiness or eye bags. These issues can be improved 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 rather than the eyelid itself in which case a brow lift may be helpful. This can usually be carried out using “keyhole” techniques leaving no visible scars on the eyelid, forehead, or temple. The need for brow lifting either alone or in addition to eyelid surgery will be discussed with you at your consultation. Rajiv’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 that you still look like “you”. He will also be honest in informing you if he feels you are not ready for surgery yet but should wait a few years.

Rajiv will provide a friendly and honest opinion regarding your suitability for eyelid surgery. The consultation begins by carefully listening to your concerns, what you hope to achieve and understanding the reasons behind seeking his help. After checking your medical history and examining your eyes along with studying photographs of you when you were younger, he will discuss what can be achieved, explaining the likely outcome and possible risks. Together you will be able to map out a plan but Rajiv always insists you to take time and think carefully before you make any decisions.

It is important to avoid taking any Aspirin or products containing Aspirin for 2 weeks either side of the operation since Aspirin thins the blood and has an adverse effect on bruising. The same is true for non-steroidal anti-inflammatory drugs (such as Voltarol, Brufen and Nurofen) as well as vitamins, fish oils and supplements. If you are a smoker, it is imperative to stop for two months before surgery and two months afterwards so as not to restrict the circulation to the skin which is vital for healing.

The surgery is usually performed at The London Clinic or the King Edward VII Hospital in central London where Mr Grover works as a Consultant Plastic Surgeon. Both are premier private hospitals with equivalent facilities to a teaching hospital. Both are renowned for providing medical services to the Royal Family and have specialist centres for Plastic Surgery. You will usually be admitted on the day of surgery and stay overnight.

Blepharoplasty is usually performed under a light form of anaesthesia called TIVA (Total Intravenous Anaesthesia). TIVA is halfway between Local anaesthetic with sedation and full General Anaesthetic. It combines the benefits of a quick recovery after the procedure and very low rates of feeling sick with the added safety of being able to safeguard your breathing during the procedure. TIVA allows precise control of blood pressure and carbon dioxide during the operation, much more than local anaesthetic with sedation. This means less bleeding and bruising which is a huge advantage in eyelid surgery not only for surgical precision but also for recovery. With TIVA you will sleep through the entire operation. Mr Grover works with a regular Consultant Anaesthetist with whom he has operated weekly for over 20 years (Dr Raman Verma). Dr Verma is a consultant at University College London specialising in anaesthesia for facial plastic surgery and has been a tutor for the Royal College of Anaesthetists.

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 fat. After making the incisions, the excess skin and muscle is trimmed from the upper eyelids together with any fat. Blood vesels are carefully sealed and the incisions are 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 anatomy and requirements. If the problem is mainly prominent lower bags without loose skin, you may have what is termed a transconjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible external scar. Alternatively, when there is some loose skin (which is the majority of patients) an 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 back after removing the excess.

Blepharoplasty usually takes between 60-90 minutes, depending on the extent of the surgery.

Your eyelids will feel a gentle tightness as the anaesthetic wears off which is normal and continues for a few days afterwards. It is genuinely not painful. Patients are sent home with only mild analgesics like paracetamol and this is usually all that is required to maintain comfort. It is normal to feel some numbness just at the margin of the eyelid and you might notice this most when applying makeup once the eyelids have healed. This usually returns to normal over 3-6 months.

Most patients have little more than mild swelling and minimal bruising following their Blepharoplasty although this can vary. Whilst in hospital the nurses will apply soothing cool pads to your eyes in order to minimise the swelling further. Once at home, you are advised to rest for the first few days with your head elevated on 2-3 pillows when sleeping as this keeps swelling to a minimum. Occasionally eyes may feel a little dry during the night, so eye drops are occasionally advised to keep them more comfortable before sleeping. This is rarely needed for more than 2-3 weeks if at all.

During the first two weeks after surgery you should avoid straining, heavy lifting (no more than 5kg total) and bending down as these actions promote swelling. After approximately a week you will be seen by Mr Grover in his clinic, and he will remove your stitches. After that you will be able to wear some light make-up around the eyes but please avoid make up on the actual scar itself for 2-3 weeks in order to prevent the risk of implanting infection in the newly healed incision.

Most patients can return to work after about 12-14 days although it will probably take about 3 weeks before you would be ready for a major social event. To aid recovery strenuous sport should be avoided for the first 3-4 weeks. It is better to avoid wearing contact lenses for at least two weeks after Blepharoplasty and in some individuals after lower Blepharoplasty, this is best avoided for about a month.

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 by 3 months. Those extending out into the crow’s feet area can become slightly reddened and may require a little longer to settle completely.

All surgical procedures carry risk and Mr Grover will do everything possible to minimise this. The process starts at the consultation with selection of the best procedure for each individual patient, advice on pre-operative preparation, meticulous surgical technique, and personal post-operative care delivered Mr Grover himself which he does not delegate. Rajiv has a strong interest in improving safety and is responsible for the UK National Audit of Cosmetic Surgery & Safety at the Royal College of Surgeons. He has submitted audited figures of procedures and complications each year to The British Association of Aesthetic Plastic Surgeons (BAAPS) for two decades since this database began. His complication rates for Blepharoplasty are in the lowest 1% of all surgeons in the United Kingdom. Rajiv’s personal complication rates audited through The BAAPS over the past two decades are quoted below. This list is indicative of the more common complications but is not meant to be exhaustive.

• Bleeding beneath the skin from small capillaries can cause excessive bruising to collect (haematoma) which may require surgical treatment. The most common time for it to arise is within the first twelve hours after surgery when you will be in hospital. It normally does not influence the ultimate outcome of the surgery. In his figures audited for The BAAPS, Rajiv did not have a single patient requiring surgical treatment for hematoma following Blepharoplasty in over 500 consecutive cases. Of course, this complication can still happen, but with care it can certainly be minimised.

• Infection is uncommon after Blepharoplasty surgery. Prophylactic antibiotics are routinely given during the operation and for 5 days after to reduce the risk. In his figures audited for The BAAPS, Rajiv did not have a single patient requiring hospital admission and intravenous antibiotic treatment for infection following Blepharoplasty in over 500 consecutive cases.

• The lower eyelid 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 if it does not resolve. In his 18 year figures audited for The BAAPS Rajiv did not have a single patient requiring surgical treatment for lower eyelid droop following Blepharoplasty, but of course there is still a small chance that this can happen.

• Wound Dehiscence (0.4%). The stitches for Blepharoplasty are removed at 5-6 days to promote a fine scar. The healed incision at this stage is delicate and if one inadvertently rubs the eye at night part of it can separate. This can usually be treated with Steristrips (paper stitches) but occasionally may need to be stitched again. Rajiv had 2 patients requiring re-suture in the figures audited for The BAAPS (over 500 consecutive Blepharoplasties). One of these ladies wanted to attend the Cheltenham Gold Cup so decided to remove her stitches herself at home at only 3 days. Remarkably most of the wounds remained healed but the outer 7mm on one side needed stitches to help it heal with a better scar. Removing your own stitches at home is best avoided – please!

• The eyes may tend to water in cold air or windy weather and possibly feel dry during the few weeks after surgery. This naturally stops as the fine swelling in the lids subsides but may require lubricant drops till it resolves.

• Redness in the scars sometimes occurs during the initial three months and is more common in red haired or dark-skinned people. This can be treated by gentle massage (but never in the first month following surgery) and usually improves spontaneously.

• Revision Rate (0.6%). However carefully surgery is performed the healing process and each patient’s biology can influence the outcome. As a consequence, patients can occasionally require further surgery to improve a scar or improve the result of a Blepharoplasty where a conservative amount of skin was removed for safety reasons and therefore the eyelids are under corrected. In his audited for The BAAPS Rajiv had 3 patients requiring revision surgery for either scar related issues or under correction of the eyelids out of over 500 consecutive cases during that period (revision rate 0.6%)

Blepharoplasty is one of the most common Plastic Surgery procedures for facial rejuvenation. It can make a significant improvement to the eyes giving a fresh look to the upper third of the face which are characteristics of youth and beauty. In addition to the physical effects of freshening your eyes, blepharoplasty improves the appearance of tiredness and produces a result that 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.