Blepharoplasty is the medical name for surgery of the eyelids. It involves the removal of baggy skin from the upper and lower lids, along with any excess fat and muscle. It can be performed on either the upper lids or the lower or both together. The eyes are the focal point of the face and they give away ones expression and mood often better than speaking, which is why so many of us put so much effort into keeping them wide open, fresh and young.

The skin around the eyes can be quite thin and delicate. Often the first signs of ageing begin in this area such as skin stretching, muscle weakening and extra fat accumulating under the eyes and on the browbone. This may lead to sagging eyebrows, drooping upper lids and under eye bags. Blepharoplasty can revitalise the eyes and in doing so create a more youthful expression.

Blepharoplasty can be performed under local anaesthetic.

Upper Eyelid Blepharoplasty technique

The ellipse of extra skin to be removed from the upper eyelid is marked out after the patient is lying down, thus allowing for the scalp to pull back and exert any lifting effect.

The bottom edge of the ellipse follows the line of the natural eyelid crease and extends from the area just above the tear duct medially to the outer edge of the eyelid opening, where it then angles slightly up and outward into an existing laugh line.

The skin above the incision is gently pinched while the eyes are closed to determine the maximum amount of skin that can safely be removed without pulling up on the upper eyelid margin or down on the brow. To avoid a stark outcome, the actual amount of skin that is removed is always a little less.

Upper eyelid skin is removed using a scalpel and fine scissors and forceps (the laser is not used, as the final scar may be compromised). Only if the underlying orbicularis muscle is overdeveloped or stretched are its fibers trimmed conservatively. If orbital fat is clearly bulging, a structural layer known as the orbital septum is opened. One or both fat pads are thinned conservatively to avoid hollowing. The upper eyelid's opening muscle (levator muscle complex) located below the fat is identified and avoided during surgery.

Bleeding is meticulously controlled. The skin incision is closed using a continuous stitch that runs just under the skin. If fat is not bulging, the orbital septum is left intact and no fat is removed from the middle pocket. In our practice, such "tissue-sparing blepharoplasty" has become the rule rather than the exception.

Incisions are carefully placed so that within several months they will hardly be visible. On the upper lids the incision is about an inch long and lies in the fold of the eyelid. On the lower eyelids the incision is made just under the lashes in the natural crease. The excess skin and muscle fibres are then removed along with the puffy, fatty tissue. The incisions are closed using very fine suture material.

Risks & Complications of Cosmetic Eyelid Surgery

Blurred vision

• Blurred vision can be caused by irritation, swelling, or damage to any of the muscles that surround the eyeball and coordinate its movement. It is important to remember though that often times these symptoms are temporary. Fortunately, this is a rare problem.

Dry eye syndrome
A variety of circumstances could cause dry eye syndrome, but is most often related to lack of lower eyelid support following eyelid surgery, leading to a lower eyelid which is lower than optimal. This can often be circumvented by a special suture that supports the lower eyelid through the healing process, also known as a canthopexy.

Inability to close your eyes
At times, the removal of too much upper eyelid skin can lead to the inability to close your eyes. In severe cases, skin grafting may be necessary to correct this problem.

Corneal abrasion
A corneal abrasion can occur during ANY operation, whether it be on the eyes or any part of the body, because the eyes may sometimes open during surgery, rendering them susceptible to being scratched by a member of the operating team. Treatment involves taping the eye shut for 2-3 days while it heals.

Hollow (sunken) eyes:
If you are uncertain as to what hollow or sunken eyes look like, look at Mary Tyler Moore. She appears to have had too much fat removed from her eyelids, leaving her with a sunken hollow appearance. This can usually be prevented through conservative removal of fat at the time of surgery.

How to reduce swelling and bruising.

If you have left the operating theatre without an eye pad, begin icepack treatment as soon as possible when you get home.

If you leave the operating theatre with an eye pad, leave it intact until instructed to remove it by a Doctor.

Once the eye pad has been removed, start ice pack treatment as soon as possible.

Sit upright as much as possible during the day and sleep with your head on 2 - 3 pillows for the first few days after surgery. This improves circulation and reduces swelling and aids lymphatic drainage.

Ice pack treatment

Specially designed masks are available from chemists - you would need to purchase several so that there is always one cooled.

Alternatively, a small bag of frozen peas or similar wrapped in a clean cotton cloth will make a good icepack. If ice cubes are used they need to be in a non-leaking clean clear plastic bag.

Sitting up-right, put some clean gauze over the eyelids then apply the icepack. This can be cold and you need to hold a cloth in your hand or wrapped around your head in order to secure the icepack.

Try icepack application for 45 minutes every hour during waking hours if possible, but if you cannot manage this, anything longer than 15 minutes every hour is satisfactory.

Continue icepack applications for 3 days after surgery whenever possible.

Warm compresses

On the 4th day after surgery switch to warm flannel applications for 15 minutes an hour as often as possible until swelling and bruising has settled. Use boiled water, cooled to comfortable hand temperature, applied on a clean flannel or sterile gauze swabs.

Continue for 4 days or until bruising has subsided.

Eyelid cleaning

Wash your hands first!

The first eyelid clean is done when the eye pad is removed (first dressing) or approximately 12 hours after the surgery.

Use sterile gauze squares and saline solution. Either purchase sachets of saline or make up a simple solution with one teaspoon salt in a half pint water which has been boiled. Leave to cool before use and make up new before each use.

Soak the gauze swabs in the saline and place on the eyelids to remove superficial debris.

Dab the eyelids, moving the gauze horizontally across the eyelid and avoiding the eye. Go from the nose end (medial) to the outside corner (lateral). Clean the eyelashes from their base to tips.

After the first clean, continue twice daily cleans for 1 week then once daily for the second week.

Sutures (stitches)

If "absorbable sutures" have been used these may not require removing.

Sometimes, even when "absorbable sutures" were used, the Doctor will decide to remove these between 4 and 21 days after surgery.

If "permanent" or "non-absorbable" sutures are used, these are removed between 4 and usually 10 days after surgery.

How to put in your eye-drops

Before putting in your eye-drops, please wash your hands.

After upper eyelid surgery, it is easy to put in your eye-drops, if you gently pull down your lower lid and look up, then instill the drop into the gap between the lower lid and the eye. Do not touch the eye with the eyedropper.

After lower eyelid surgery, it is best to put in your eye-drops by gently pulling the upper lid up and looking down. Then instill the drop onto the eye taking great care not to put any pressure on the lower lid with your fingers.

Other instructions

Avoid aspirin for at least 10 days after surgery - take paracetamol tablets for mild discomfort or ache.

Avoid exercise and especially swimming for 2 weeks after surgery.

Do not apply makeup for the first 2 weeks after surgery.

You may fly from 3 days after surgery.

Avoid homeopathic medicines which promote fast healing.

Light camouflage creams containing "green" colour applied on the cheeks hides bruising. Bruising takes between 10 - 21 days to disappear and first drops down into the cheek and even the neck.

Eyelid Surgery Recovery

Length of surgery is usually 30-90 minutes and the Location of operation can be the office or hospital.

Anesthesia is often sedation (twilight) but can be performed under local anesthesia, which means that you receive no sedatives.

Length of stay: This is an outpatient procedure, which means that you go home on the same day. As for discomfort, Expect mild pain, which will be controlled with prescription oral pain medication. After about 3 days, you probably will no longer require prescription pain medication. Swelling and bruising improve within 3-14 days, depending on the extent of surgery. Bandages are not used. You will be instructed to place ice compresses on your eyes for 1-3 days. Stitches will be removed in 2-4 days. Contact lenses may be worn in 7-14 days. Glasses may be worn immediately. Eye make-up may be worn in 7-10 days. You will be presentable in public in 3-14 days with the help of make-up, depending on the extent of surgery. As for Work, you may feel capable of returning within 3-7 days, but your appearance will be the limiting factor. Exercise may be resumed in 2 weeks. Sun protection should be worn for 6 months (SPF 30 or higher if available). You will see your final result in 2-6 weeks.