Blepharoplasty (Eyelid Surgery)

Our eyes are the most important features on our face and their beauty can be greatly reduced by excess skin creases and eyebags. Eyelid surgery (technically called blepharoplasty) is a procedure to remove fat-usually along with excess skin and muscle from the upper and lower eyelids. Blepharoplasty can be done alone or in conjunction with other facial surgery procedures such as a facelift or a browlift.

The normal ageing process involves the stretching of the eyelid skin resulting in excess folds and wrinkles, and sagging of the fat around the eye itself, and appears as bulges in the upper and lower lids. Heredity is often an important factor when young or middle-aged patients exhibit changes that are usually associated with older age. These patients are fed up of comments from their friends that they constantly look tired, despite having had a good night's rest!

Although eyelid surgery can correct drooping upper lids and puffy bags below your eyes, it cannot remove crow's feet lines, or eradicate all eyelid creases. Any attempt to do so would invariably require excessive tensioning of the skin, which would result in a downward pulled or staring appearance of the eyelid. Nor does it improve or lift sagging eyebrows. Procedures such as laser skin resurfacing (for lines and wrinkles) and the Brow lift (for sagging eyebrows) are designed for these purposes. Dark circles under the eyes may improve a bit following blepharoplasty, if this is related to large bags, but most often the dark appearance of the lower eyelid skin remains.

A properly performed blepharoplasty procedure will brighten the face and restore a more youthful appearance.  And while it is true that it can add an upper eyelid crease to Asian eyes, it will not erase evidence of your ethnic or racial heritage. Additionally in some patients the procedure might improve vision by removing the excessive skin of the upper eyelids which can hang down and interfere with peripheral vision.

The surgery

On the upper eyelids, the incision is carried out in the natural crease line that occurs approximately 1 cm above the eyelashes. The incisions may extend into the crow's feet or laughter line area at the outer corners of your eyes. 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, which is usually present on the area adjacent to the sides of the nose. The incisions are then closed with very fine sutures. It is important to remember that you cannot remove all skin in this region because some skin always need to remain behind after this surgery in order to allow good closure of the eyelids!

On the lower eyelids, the technique very much depends on the patient's individual circumstance and requirements. Therefore if the problem is mainly prominent lower bags without excessively 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 loose skin needs to be trimmed, the incision starts underneath the eyelashes and extends 1 cm or so outwards into the crow's feet area. The skin is then lifted upwards and outwards, gently tensioning the area and overlapping skin removed. Before suturing, any bleeding points are meticulously stopped.

Risks

Complications that can occur include:

Haematoma (a collection of blood under the skin that sometimes must be drained by the surgeon), minor infections, scar lumpiness and distortion (usually temporary).

With lower eyelid surgery, lowering or irregularity of the lower eyelid (depending on the degree, termed scleral show or ectropion) can sometimes occur as a result of the pulling effects of scar tissue in some people. This is unpredictable and sometimes occurs only in one eye. As a result, slight changes of the shape and size of the eye may be noticed. If this is very noticeable, then for some people this can be a little distressing. Massaging, as will be instructed, early on diminishes the chance of this happening. If it does occur however then more intense massaging to the lid and even application of some taping will help alleviate this problem. You will be instructed accordingly in the follow-up clinic. In these circumstances it may take up to two to three months to correct. Very rarely however, if conservative treatment is unsuccessful then surgical correction is required.

Transient watering of the eyes to varying degrees can also occur. Conversely, dryness of the eyes has also been reported. Although this is usually temporary and diminishes with time it can very occasionally be long lasting or very rarely permanent. You will be instructed as to what measures will be needed if this does occur.

Although every effort is made to preserve eyelash hair, rarely hair loss may occur in the lower eyelash area adjacent to the incision which is made to elevate the skin. This occurrence is not predictable. Hair loss may be temporary or permanent.

Loss of vision, although extremely rare (approximately 1:100,000 incidence) is possible

Tiny whiteheads may occasionally appear under the skin at the site of the sutures, after your stitches are taken out. These usually settle on their own, however if they don’t they can be removed easily with a very fine needle in the outpatients department.

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