Eyelid Reduction (Blepharoplasty)

Blepharoplasty (also known as eyelid reduction, eye lift or eye bag removal), refers to the surgical rejuvenation of the eyelid which is often used in conjunction with non-surgical procedures. It applies to both the upper and the lower eyelids but is commonly used to counteract the effects of ageing on the skin muscle and fat around the eyes.

Young people, however, can also require eyelid surgery either because patients wish to lessen the oriental features or to remove bulging pockets of fat (eyebags). There are also some children born with drooping upper eyelids called Ptosis, who also require surgical assistance.

Blepharoplasty surgery is customised to every patient and no two are the same. It can be performed alone, involving the upper, lower or both eyelids or in conjunction with other surgical procedures of the face, brow or nose. The most common supplementary procedure would be fat grafting for the ageing face and is now included in most cases to achieve youthful vitality. 

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 or eyelid reduction is highly effective and is the one lifting procedure which rarely needs to be repeated. There may be non-surgical touch-ups in the future but having another skin excision is less likely.

The skin of the eyelids is excellent at hiding scars, and any scars will be hidden in the fold of the upper eyelid. Making them nearly invisible on most people. The only way the scars would potentially be visible, is when there is a hood of skin to be removed which extends beyond the eyelid, however, again for most people this scar becomes invisible. The scar of the lower eyelid will heal very well, and it is disguised under the eyelashes and in the crow’s feet.

The folds of skin beyond the lower eyelid overlying the cheekbone are often called Festoons and are more difficult to eliminate. There are a few different ways we will work at removing Festoons, either through skin removal, excision, fat or filler, liposuction and steroid injection. 

Your surgeon will need to be aware of any medical eye conditions you may suffer from as there are some occasions when surgery is contraindicated. In particular, dry eye can appear worse after surgery. Your experienced surgeon will also need to ascertain whether it is just the eyelids, which are of concern, or whether the surrounding brow, temple, cheekbones and tear trough are also requiring treatment.

All surgery can be carried out as a day case. Usually under Total Intravenous Anaesthesia (TIVA) with the patient only lightly anaesthetised. Smaller procedures can be carried out under local anaesthetic. Your eyes will not be bandaged at the end of the procedure and although vision may be slightly reduced because of the local anaesthesia used, this is only temporary. You should not drive a car for 24 hours. The eyelid skin heals very quickly and in a few days, any stitches can be removed. Bruising varies but like all bruises settles, and will become less visible over 10 days. Swelling accompanies all surgery and on the eyelid, this may give a watery look to the eye (chemosis) which can be annoying and last a few weeks. If patients have festoons or swelling over the cheekbones, then this can remain swollen for a month or two. Patients should be reassured that all this swelling does eventually settle.

Finally, the surgery itself is not painful and the only restrictions are intended to reduce temporary swelling. Wearing a cold compress immediately after surgery and sitting propped up in bed for the first night are useful, but probably do not affect the final result. The eye is also watery because the swelling around the tear ducts which naturally drain tears into the nose, swell up and become blocked, again this is only temporary and usually lasts a day or so. You will probably not wish to go to work the next day because of the appearance of dressings, swelling and bruising, but working from home is reasonable for many.

Blepharoplasty or eyelid surgery is safe in expert hands; however, every surgical procedure involves a certain amount of risk and it is important that you understand the risk before proceeding. You should discuss any existing medical problems with your surgeon, for instance, patients taking blood thinning agents are at risk of bruising which in certain types of lower eyelid surgery could cause bleeding behind the eye and in the exceptionally rare occasion, blindness. It is wise to avoid any aspirin or anti-inflammatory medications for 10 days before surgery as this too can increase the risk of bleeding.

Dry Irritated Eyes - Individuals who normally have dry eyes, may be advised to use special caution in considering Blepharoplasty surgery. If patients do use eye drops before surgery, they are quite likely to be using more afterwards.

Infection – Infection is rare and can be treated with antibiotic eye drops and ointment.

Watery Eye (Epiphora)- the tear ducts normally draining into the nose will temporarily block due to swelling. In addition, the swelling may give a watery appearance to the eye due to fluid under the conjunctiva. This is called Chemosis and may last a week or two.

Ectropion – Swelling after surgery can cause drooping of the lower eyelid and push the eyelid away from the eyeball. This usually settles as the swelling goes down and will be helped by massaging the swelling away from the eye and taping the eyelid upwards onto the eyeball. This can be a problem in the older patient and may be pre-existing to any surgery. There are operative procedures to correct it.

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 procedures start from £4,000, however every individual is different, and an accurate price will be quoted depending on your individual needs on consultation with your surgeon. Book a consultation today at our clinic to find out exactly what your surgery will cost and what will be required for your particular case.