Blepharoplasty

This leaflet has been produced to provide information for patients requiring surgery to remove excess eyelid skin.

What is blepharoplasty?

Blepharoplasty is an operation to remove excess tissue from baggy and/or puffy eyelids.

When is blepharoplasty required?

The NHS will only allow removal of excess upper eyelid skin if it impairs vision and this can be confirmed with a visual field test. There are other specific situations where upper lid blepharoplasty may be required, but a special funding application must be submitted and the funding may not necessarily be granted. Surgery for cosmetic reasons, including lower lid blepharoplasty, is not funded by the NHS.

In some patients, eyebrow droop (brow ptosis) may be the main reason for, or worsen the appearance of the overhanging upper eyelid skin. In such cases surgery to lift the brow(s) may be required as a sole procedure or in combination with upper lid blepharoplasty. This will be discussed with you after your examination.

What does the surgery involve?

Upper eyelid blepharoplasty is usually done under local anaesthesia, as a day case. The eye is numbed with local anaesthetic drops and the amount of excess tissue to be removed is carefully marked to ensure that eyelid function and comfort of the eye are not compromised. After injecting a small volume local anaesthetic into the upper eyelid to numb the area, a skin incision is made starting in the natural skin crease and the pre-determined area of skin excess is removed. In some cases eyelid muscle and/or fat may be removed. The eyelid wound is closed with some fine stitches.

Post-operative care

One eye is usually padded overnight to reduce bruising and swelling and the other eye is usually left open to allow you to see. Ice packs also help to reduce swelling and should start in the immediate post-operative period if the eye is not padded. The eyelids will usually appear swollen for a few days after surgery. Remaining upright as much as possible and sleeping with the head elevated on several pillows will help reduce excess eyelid swelling. You will be given lubricant drops and/or ointment to reduce the sensation of grittiness and dryness. The stitches are usually removed when you attend the eye clinic 1 week after your surgery

Blepharoplasty is not a very painful operation, but paracetamol may be required for pain relief. Aspirin and aspirin-containing treatments should be avoided to reduce the risk of post-operative bleeding and bruising. Most forms of light exercise and a normal work pattern may be resumed within a few days of surgery and eyelid make-up worn from about two weeks after surgery.

What are the risks / complications of blepharoplasty surgery?

Possible complications after blepharoplasty surgery include:

• Bruising is common and often unpredictable but usually resolves within 2 weeks.
• Eyelid swelling, which usually subsides within a few days.
• Swelling on the surface of the eye (chemosis) is typically associated with lower eyelid blepharoplasty and could last for several weeks or months.
• Slight blurring of vision is common immediately after surgery because of slight drying of the surface of the eye and the use of antibiotic ointment. However, this is usually transient and often clears with blinking. Your surgeon should be alerted if your vision remains severely impaired more than 24-48 hrs after your surgery and does not clear with blinking.
• Dry, gritty eyes especially if there was pre-existing dry eyes. This usually improves with lubricant eye drops.
• Infection rarely happens.
• Severe bleeding into the eyelids or behind the eye happens rarely during or after surgery, but may cause loss of vision if not managed rapidly or appropriately by the operating team. Loss of vision is extremely rare.
• Excessive skin removal may cause poor blink and inability to completely close the eye, resulting in a dry and uncomfortable eye. The risk is greater if the eyes are already dry before surgery.
• Hollowing of the eyelids results from excessive fat removal.

Medication

Please bring a list of all of your medicines or a current repeat prescription from your GP. You will be given some antibiotic ointment with advice on how to apply it to the operated eye(s) and wound(s) for 2 weeks after the operation. You may need to use paracetamol for a few days after the operation if the eye or wound is uncomfortable.

Contacts / Further information

If you have any queries regarding your appointment for surgery, please contact the theatre bookings team in the Eye Department on: 01223 274863

For urgent post-operative concerns please contact the Emergency Eye Service on: 01223 217778.