Blepharoplasty (Eyelid Reduction)

Eyelid reduction is another term for blepharoplasty, but is specifically used to refer to techniques designed to tighten the eyelids and reduce, reshape or lift the eyelid skin around the eye to achieve a refreshed, rejuvenated appearance.

It is possible to tighten the eyelids and reduce, reshape and lift the eyelid skin in just 45 minutes, and this treatment is appropriate for both men and women.

It is very common after surgery to have puffy eyelids for a while, but significant complications are rare. You might have more trouble in the evening when trying to shut your eyes to sleep the first few nights. Your eyes may be irritated or watery for several weeks following the surgery, but this will return rapidly to normal. You may also have bruising resembling a black eye, and some light pink scarring that will fade over time.

Blurred vision immediately after surgery due to persisting local anaesthetic and ointment applied to the eye at the end of the procedure.

Our surgeons will explain all the risks, the likeliness of them occurring and any possibilities of complications upon consultation. 

Blepharoplasty is a straightforward surgery which is carried out as a day case. It is usually done under Total Intravenous Anaesthesia (TIVA), a light anaesthetic, but smaller procedures may only require local anaesthetic. The surgery takes between 30 minutes and one hour, depending on the particular type of blepharoplasty which is being carried out.

There are three different types of procedure that our blepharoplasty surgeons carry out at the Cadogan Clinic:

• Upper eyelid blepharoplasty: This surgery eliminates vision problems caused by age-related drooping eyelids. Upper eyelid blepharoplasty also restores a youthful appearance. Your surgeon will make an incision along the eyelid crease before removing excess skin, fat or sagging muscle from the area. The skin is stretched in order to smooth out any wrinkles and the incisions are closed. The beauty of this procedure is that the scar is well hidden in the natural fold of the eyelid.
• Lower eyelid blepharoplasty: This particular type of blepharoplasty is concerned with the elimination of wrinkles and puffiness below the eye. In lower eyelid blepharoplasty, the surgeon will make an incision just below the eyelashes, the cut extending into the crow’s feet, or inside the lower eyelid before taking out or repoisionting fat from under eye bags. Sometimes the surgeon will also do this to the skin supporting the muscles and tendon of the eyelid if required. The skin is stretched to smooth out the wrinkles and the incision is then closed. 
• Double eyelid blepharoplasty: Some people have visible eyelid creases, known as double eyelids, while others were born without eyelid creases. Although there is nothing medically wrong with this, some people opt for double eyelid blepharoplasty for a more ‘wide eyed’ appearance. In this particular surgery, several small incisions are made on the double eyelid line and skin is removed. The orbicularis oculi muscle (the muscle which closes the eyelids) and fat tissue will be removed between the incisions. The incisions are then closed. 

Double eyelid blepharoplasty is particularly popular in East Asia.

Blepharoplasty is a safe surgical procedure, and you will be in the hands of a world-class, highly experienced, blepharoplasty surgeon here at the Cadogan Clinic.

However, like any other surgery, blepharoplasty is not entirely without risk.

Common side effects include:

• Puffy, numb eyelids that are difficult to close at night
• A black eye (bruising)
• Irritated or watery eyes

If you already suffer from irritated or dry eyes which require regular eye drops, it is quite likely that you will need to use even more eye drops, post-surgery. Watery eyes are temporary and should clear up in a couple of weeks.

An eye lift can very occasionally result in:

• Temporary blurred or double vision
• Blood pooling under the skin (haematoma)
• Asymmetrical eyes

Very rarely, a blepharoplasty may result in more serious problems, such as:

• Infection
• Eye muscle injury
• Drooping of the eyelid
• Lower eyelid pulling downwards, showing the white of the eye below the iris (eyelid retraction)
• Lower eyelid drooping away from the eye and turning outwards (ectropion)

Ectropion is caused by post-operative swelling and usually settles as the swelling subsides.

Visual impairment is an extremely rare side effect of blepharoplasty and many people find that their vision improves in the long term.

Your surgeon will give you all your pre-operative advice at your consultation. This may include having an eye test, if you have eye health issues, as well as a physical examination and eyelid photography from all angles. 

You will need to stop taking blood thinning medication such as aspirin, ibuprofen, naproxen, and any other medication or herbal supplement associated with increased bleeding. Your surgeon will advise how long before surgery you need to stop taking these medicines.

You are advised to stop smoking for at least two weeks before your surgery. Smoking reduces healing and increases the risk of complications. Arrange for someone to drive you to and from surgery on the day.

Blepharoplasty is basically skin deep and there is little pain in the post-operative recovery phase. Any discomfort is minor and can be controlled with simple pain relief and eye ointments provided by your surgeon.

Most patients need no analgesia at all after this surgery. Any feeling of grittiness after surgery can be treated with the eye ointment given to you at the time of surgery. Although patients may look bruised and have visible dressings, they can often work from home the next day, and be back to their daily activities after a few days. The pain is minimal. 

Recovery from Blepharoplasty is quick but because surgery is in the middle of the face, the dressings and any bruising will be visible. There are a few patients who disregard this and continue normal life, however, we would suggest that exercise is a bad thing as it will delay recovery from bruising and swelling. Working from home is a good option, but it will take 10 days for bruising of the lower eyelids to settle, the upper eyelids generally settle rather quicker. Bruising can be disguised with make-up and we can advise you about cosmetic camouflage. If you are at all sensitive, you should take two weeks before appearing at work. Stitches are removed in the first week. You should also remember that vision can be a little blurred the first day. This is partly due to the surgery and local anaesthesia used, even when you have a general anaesthetic, but also the ointment applied inside the eyelid morning and night does to some extent obscure vision.

On occasion surgery to the lower rather than the upper eyelid can cause swelling which is a nuisance for longer. There is always swelling of tissues after surgery and if this extends under the conjunctiva and on to the eyeball, this is called chemosis. It makes the eye look watery and this can take several weeks to completely settle. In addition, any bruising under the conjunctiva gives bright red ‘haemorrhages’. Chemosis and haemorrhages are of no significance other than the appearance, it does eventually settle.

Swelling can also push the lower eyelid away from the eyeball causing an ectropion, which is annoying but in most cases settles spontaneously within a few days or weeks.

This really depends on your tolerance to of your appearance. All the surgery is in the middle of the face and therefore rather obvious. There will be some small dressings for about a week and a little bruising of the cheeks below the eyelids. There may be some minor pain and swelling around the incision areas, and your eyes will tend to water.

Alternatively, there may be some dryness that occurs, which is easily relieved with some ointment that your surgeon will provide. Occasionally the ointment will cause the patient to have slightly blurred vision, so you may want to rest and take some extra time off work to just relax at home where you’ll be comfortable. Some patients may have added sensitivity to light temporarily following eyelid surgery, so bare that in mind if your work involves bright lights.

Longer term you may develop chemosis, which is oedema (swelling) of the conjunctiva covering the white of the eye. It settles, but it may take a week or two. Those people who have malar pads or festoons of the upper cheek will find that these swell and persists for a month or two.

We would advise you to rest, avoid putting your head down and ad an extra pillow at night, so that any swelling or bruising settles quicker. We do have patients, who completely disregard this advice, without long-term issues and go back to full work or off on holiday the following day. We do however, like to see the patients to remove stitches a few days later. We will advise on make-up or in the form of cosmetic camouflage which does allow you to get out and about with confidence.

Blepharoplasty surgery can give life-changing results and an experienced expert surgeon will not change the shape of the eyes, unless this is the aim. Surgery has evolved in recent years and less muscle fat and skin are being removed.

Fat may be repositioned rather than removed. There will be no tell-tale signs that it has been removed, you will have a natural, face new look to your face. In addition, we aim for an extra youthful vitality which is achieved by fat grafting of the brow, temple, cheekbones, lower eyelids that surround the eye. Fat grafts include stem cells, which improve skin quality as well as contours This is a very specialised technique which makes all the difference in achieving incredible results you’ll be happy with. 

Blepharoplasty leaves minimal scarring. Any upper blepharoplasty scars will be well hidden in the fold of the eyelid, while lower blepharoplasty scars heal very well, disguised by the eyelashes and in the crow’s feet.

However blepharoplasty scars may potentially be visible when there is a hood of skin extending into the eyelashes to be removed. However this scar fades to be virtually invisible on most people.

It is vital that you follow all the aftercare instructions issued by your surgeon to help aid the scarring process.

We advise total rest for several days after treatment, including taking at least one week off work.

You should avoid UV light for between two and four weeks and quit smoking, as this irritates the eyes, delays healing and can cause scars to be more noticeable.

Typical genetic causes for eyelid surgery include an array of cosmetic issues such as lumps on the eyelid, sunken eyes, droopy eyelids (ptosis).

Some individuals are also genetically predisposed toward dark circles under the eyes, and the early formation of bags under the eyes.

All of these genetic conditions can be addressed by eyelid surgery and blepharoplasty.

Blepharoplasty, eyelid surgery, is a highly specialised area. So it is important that you choose an expert in this field to carry out any surgery on this most delicate of areas.

An oculoplastic surgeon is an ophthalmologist, otherwise known as an eye doctor, who has undergone many years of specialised training in eyelid and facial plastic surgery. Although plastic surgeons are highly trained and are able to carry out aesthetic eyelid surgery, they do not possess the depth of knowledge or expertise of the eye as an oculoplastic surgeon does.

As a trained ophthalmologist, an oculoplastic surgeon is able to examine the eye, identify any pre-existing eye disease and deal with any functional eyelid disease such as eyelid cancer, lid malpositions and entropion, a condition which turns the eyelid inward. These specialists are also able to examine the eye after blepharoplasty to ensure there are no eye complications and expertly manage any complications should they arise after surgery. A plastic surgeon will not be able to carry out these examinations as they have not undergone the same level of training in the eyes and have no training in the basic equipment used to carry out eye examinations. As a result, a plastic surgeon cannot provide the same level of expert care as a trained ophthalmologist.

These specially trained oculoplastic surgeons are responsible for eyelid surgery in hospitals across the UK.

As well as blepharoplasty, oculoplastic surgeons can carry out other eyelid surgery including repairing an eyelid which is turning in or out, correcting drooping eyelids (ptosis) and removing eyelid cysts (also known as chalazion or meibomian cyst).

Here at the Cadogan Clinic, we would highly recommend that an oculoplastic surgeon carries out any eye-related surgery, be it for functional or purely aesthetic reasons.

Eyelid reduction surgery, also known as blepharoplasty, is a highly specialised area, so it is important that you choose a surgeon who is an expert in their field to carry out this type of surgery.

The best surgeon to carry out eyelid reduction is an oculoplastic surgeon, an ophthalmologist who has undergone many years of specialised training in eyelid and facial plastic surgery.  Although highly qualified, a plastic surgeon does not possess the same  expert knowledge about the eye and has not undergone the same level of training as an oculoplastic surgeon.

A good surgeon should be able to explain the procedure in great depth, as well as the recovery period and any potential risks or complications. They will also be honest about potential outcomes and help you to manage your expectations.

When you have your initial consultation, make sure the surgeon has an extensive portfolio of before and after photographs that they can share with you so you can get a good idea of how the results of your surgery will look. Be sure to check out testimonials from previous patients.

If you are not physically and psychologically fit and healthy, an ethical surgeon will not attempt to perform the procedure.

You can check if a surgeon is a registered doctor or surgeon on the General Medical Council (GMC) online register.

Some surgeons may be members of professional associations, such as the British Oculoplastic Surgery Society (BOPSS). However there are some qualified surgeons who are experts in their field but choose not to sign up to a trade body for their own reasons.