Blepharoplasty (eyelid reduction surgery)

Things to consider before surgery

Some people may present with concerns about their eyelids when the predominant problem is actually that their eyebrows have sagged with ageing resulting in an “apparent” excess of eyelid skin. If the main issue is sagging of the eyebrows, then failing to address this before treating the eyelids may actually make no improvement to their appearance and in some cases, could make matters worse.

In this instance, a patient may want to consider a brow lift, another procedure offered in Perth by Dr Mark Hanikeri. 

​High blood pressure, thyroid problems, diabetes, allergies or conditions like “dry eye” may increase the risks associated with eyelid surgery and should be addressed if possible before surgery is considered.

The eyelid surgery procedure

The procedure may be performed under a local anaesthetic though usually, especially for lower eyelids a general anaesthetic or sedation is necessary.  Most patients prefer sedation as it is associated with less side effects from anaesthesia whilst making the surgical experience more pleasant and less stressful.

Excess skin and fat, if necessary, are removed from the eyelids and occasionally, especially for lower eyelids, some type of tightening and lifting procedure will also be performed.  Occasionally for the upper eyelids, part of the procedure involves re-inserting the muscle that opens the eyelids into the skin, which draws the skin into the eyelid crease when the eyes are opened.  This procedure if required results in a much fresher and “wide eyed” appearance though it is associated with more swelling, a slightly longer recovery and potentially a more “surgical” appearance than the simpler techniques that may be used.

​In some cases, dissolving sutures may be used; however, in most patients some removable sutures will be used which will be visible in the immediate postoperative period.  Light dressings and eye ointment may be applied to the wounds at the end of the procedure.

Depending on the specific type of surgery you are getting, there may be slight differences in how the procedure is performed. 

The upper blepharoplasty procedure

For upper eyelid surgery, the incision is hidden in the natural fold of the upper eyelid and may extend slightly beyond the outer corner into the laugh lines. It is usually well camouflaged when healed. 

The lower blepharoplasty procedure

Lower eyelid surgery follows a very similar procedure to upper eyelid procedures, though with some differences. For lower eyelid surgery, often an incision is hidden just beneath the lower lashes. In some cases, the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but cannot be used to remove excess skin.

What to expect after surgery

Mr Hanikeri recommends taking one to two weeks off work after the operation depending on the physical demands of their job. Light activities, including driving and light exercise. They can usually return to normal activities and exercise within four to six weeks depending on the extent of surgery required.

​Scars are not completely predictable however, most are barely visible in the long term. They may appear pink and slightly thickened for a few weeks to months after the surgery but will usually fade to be pale and soft by around three to six months. Their final appearance may take up to eighteen months to achieve. 

What are your basic blepharoplasty aftercare tips?

The aftercare instructions for blepharoplasty will help your eyes recover from the procedure, manage any pain, discomfort and swelling.

Directly after surgery and for a few days after, you will have bandages places on the incision site. The surgeon can allow the use of a cool compress to ease swelling and bruising and for light activity.

You will also be instructed on complications to look out for, medications to take to aid in recovery or pain management and when you would be able to resume your normal day-to-day routine like work and exercise.

Risks of eyelid surgery

All surgical procedures carry some risks. These are discussed in detail during consultation and a written list of the main things to consider will usually be given to you at the initial consultation.

Potential complications include haematoma (an accumulation of blood under the skin that may require removal), infection and reactions to anaesthesia. Bruising, swelling, blurriness and “tight” sensation around the eyes are common, usually short-lived symptoms following surgery. There can be a feeling of dryness or irritation in the eye that requires treatment.

Occasionally, especially when upper and lower eyelids are corrected at the same procedure, a temporary but moderately severe swelling of the sclera (white part) of the eye can occur (Chemosis).  This can be quite distressing for patients but thankfully usually settles within a few weeks but may require short term treatment with steroid eye drops.

All operations on the eye carry a remote risk of blindness.  This risk is associated with bleeding inside the eye socket caused by surgery and is rare.  For eyelid surgery overall it is estimated to be around 1 in 40000 procedures however in most individuals the risk is even lower than this.  For reasons of safety, patients travelling from remote regions are advised to stay in Perth for at least 24 hours after surgery so that their immediate post-operative course can be monitored, and emergency treatment instituted if required. If you would like to know more about blepharoplasty, or to request an appointment, please contact us today.