What is a blepharoplasty?
This is a surgical procedure to remove some of the excess skin from your eyelids. This surgery can be carried out on the NHS if the excess skin is affecting your vision. It cannot be done on the NHS if it is solely a cosmetic problem.
What causes my condition?
Excess skin is often due to ageing, sun damage, trauma or an underlying medical condition like thyroid problems. The eyelid appearance may be common in your family. Sometimes episodes of swelling of the eyelid might be due to infection or allergy.
What does the surgery involve?
The surgery is carried out as a day case procedure, generally under local anaesthetic. Occasionally, the surgery is performed under general anaesthetic or sedation. The whole treatment may last 90 minutes and, usually, both eyes are treated at the same time.
You will lie on a couch in the operating room and anaesthetic drops will be put in your eyes. Your face will be cleaned with antiseptic solution and sterile cloth will be placed around your face. The surgeon will use a pen to mark out the skin to be removed. Local anaesthetic is then gently injected under the eyelid skin, which causes a sharp, stinging sensation for few seconds.
Once the anaesthetic has started to work, the eyelid will be numb and the surgery will not hurt. The excess skin is cut away and the skin wounds are then closed with sutures (stitches), which may also involve strengthening the natural eyelid crease in the eye. If dissolvable sutures are used, they will fall out in a few weeks, otherwise they have to be removed 7-14 days later. At the end of the surgery, ointment is put on the wounds and eye pads applied to the lids. If you have surgery on both eyes then one of the eye pads will be removed after about an hour.
What are the benefits?
Your doctor has recommended that you have this treatment because this condition has affected your peripheral vision and he/she believes your vision will improve as a result of the surgery.
What are the risks?
Blepharoplasty is a fairly safe and successful surgical procedure but, as with any surgery, there are some risks associated with it. They include:
Bruising and swelling - this is common and may remain for a few weeks after surgery.
Scarring - you will have a scar from the surgery. This can be visible initially but then becomes pale and fine.
Infection - this can occur in the wound.
Dry eye and poor eyelid closure - your eye may feel dry for a few weeks after surgery and you may have to use artificial tear supplements.
Asymmetry of the eyelids - sometimes there is a difference between the appearance of both upper eyelids after surgery.
Bleeding into deep tissue can lead to disturbance of vision and could lead to loss of vision in severe cases. This is extremely rare, and you should report any loss of vision to the hospital immediately.
Are there any alternatives?
Alternatively, you can choose to leave things as they are. You can discuss this in more detail with your doctor.
How can I prepare for the treatment?
You will have a pre-operative assessment with a nurse where more information will be provided. You may need to have more investigations, including an ECG or blood tests, if your surgery involves general anaesthetic or sedation. If you are taking any medicines that thin your blood, such as antiplatelet medicines (for example aspirin or clopidogrel) or anticoagulant medicines (for example warfarin or rivaroxaban), please tell your doctor or the nurse as you may need to stop them temporarily before yoursurgery. Also tell your doctor or nurse if you have diabetes as you may need to alter the dose of your diabetes medicines, as you will need to fast before the procedure. Further information on stopping any medicines will be given to you when you come for pre-assessment. Please ask us if you have any questions. Please let us know if you are taking any regular medicines (including anything you buy yourself over the counter or any herbal or homeopathic medicines) and if you have any allergies to any medicines.
Surgery under local anaesthetic If you are having the surgery under local anaesthetic, you can eat as normal before the treatment but you should only have a light meal. Surgery under general anaesthetic or sedation If your surgery involves general anaesthetic or sedation then you should follow the fasting instructions below which will be explained further in the pre-assessment clinic.
Please do not eat or drink anything (except non-fizzy water) for six hours before your appointment. This means that you cannot suck on sweets or chew gum. You are allowed to drink water up to two hours before your appointment.
Please wear comfortable and loose-fitting clothing on the day of surgery. You may need to organise a responsible adult who can assist you on your way home. They may also need to stay with you for at least one day after the treatment.
Consent - asking for your consent
We want to involve you in decisions about your care and treatment. If you decide to go ahead, you will be asked to sign a consent form. This states that you agree to have the treatment and you understand what it involves.
Will I feel any pain?
Anaesthetic is injected under the eyelid skin, which causes a sharp and stinging sensation for few seconds. Following this, you should not feel any pain, although you might be aware of some pulling sensations. Your eye may be slightly painful for about for 24 – 48 hours after the surgery and you can take paracetamol regularly to help with this.
What do I need to do after I go home?
Your eyelids may be slightly painful for about 24 – 48 hours after the surgery and you will need to rest and take normal painkillers.
You may be given antibiotic and anti-inflammatory eye drops. This is to minimise the risk of infection and reduce the redness and inflammation in the eye. It is important to wash your hands before using these to prevent infection. Skin sutures may be left in place or removed after one to two weeks and you will be given an appointment for the outpatient clinic.
Your vision may be blurred for few days and you may not be able to wear contact lenses. However, if your eye gets more painful, your vision gets worse, your eye becomes more red or you notice excess discharge from your eye, you should go to your nearest Eye casualty department immediately.
You may want to take few days leave from work depending on your circumstances. You should not resume any strenuous activity, including swimming, for two weeks. It is best that someone stays with you to help you for a few days after the treatment.
Will I have a follow-up appointment?
A follow-up appointment for a few days after your surgery will be booked for you before you leave the hospital.