Blepharoplasty Procedure
When eyelid surgery is performed by a qualified facial surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, including infection or a reaction to the anaesthesia. You can reduce your risks by closely following your surgeon's instructions both before and after surgery. The minor complications that occasionally follow blepharoplasty include double or blurred vision for a few days; temporary swelling at the corner of the eyelids; and a slight asymmetry in healing or scarring. Tiny whiteheads may appear after your stitches are taken out; your surgeon can remove them easily with a very fine needle. Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required. Blindness as an extremely rare complication in lower eyelid surgery.
Planning your Cosmetic Eyelid Surgery
The initial consultation with your surgeon is very important. The surgeon will need your complete medical history, so check your own records ahead of time and be ready to provide this information. Be sure to inform your surgeon if you have any allergies; if you're taking any vitamins, medications (prescription or over-the-counter), or other drugs; and if you smoke. In this consultation, your surgeon or a nurse will test your vision and assess your tear production. You should also provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them along.
You and your surgeon should carefully discuss your goals and expectations for this surgery. You'll need to discuss whether to do all four eyelids or just the upper or lower ones, whether skin as well as fat will be removed, and whether any additional procedures are appropriate. In selected cases lateral brow may need lifting. Your surgeon will discuss this with you.
Your surgeon will explain the techniques and anaesthesia he will use and the risks and costs involved. (Note: Most insurance policies don't cover eyelid surgery, unless you can prove that drooping upper lids interfere with your vision. Check with your insurer).
Don't hesitate to ask your doctor any questions you may have, especially those regarding your expectations and concerns about the results.
Preparing for your surgery
Your surgeon will give you specific instructions on how to prepare for surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Carefully following these instructions will help your surgery go more smoothly. While you're making preparations, be sure to arrange for someone to help you out for a few days if needed.
Where your surgery will be performed
Eyelid surgery may be performed in the clinic, or in the hospital. It's usually done on an outpatient basis; rarely does it require an inpatient stay.
Types of anaesthesia
Upper eyelid surgery is usually performed under local anaesthesia--which numbs the area around your eyes. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.) Some patients prefer general anaesthesia for lower eyelid surgery; in that case, you'll sleep through the operation.
The surgery
Blepharoplasty usually takes one to three hours, depending on the extent of the surgery. If you're having all four eyelids done, the surgeon will probably work on the upper lids first, then the lower ones. In a typical procedure, the surgeon makes incisions following the natural lines of your eyelids; in the creases of your upper lids, just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Working through these incisions, the surgeon separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures. If you have a pocket of fat beneath your lower eyelids but don't need to have any skin removed, your surgeon may perform a trans-conjunctival blepharoplasty. In this procedure the incision is made inside your lower eyelid, leaving no visible scar. It is usually performed on younger patients with thicker, more elastic skin. In standard lower eyelid surgery, the incision is placed just below the eyelashes and can extend 3 to 4 mm into the crowfoot area. After raising the skin flap, herniated fat is either repositioned or removed followed by haemostasis and excess skin and muscle is carefully excised. This follows further haemostasis and layered repair.
After your surgery, the surgeon will probably lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anaesthesia wears off, but you can control any discomfort with the pain medication prescribed by your surgeon. If you feel any severe pain, call your surgeon immediately. Your surgeon will instruct you to keep your head elevated for several days, and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Many doctors recommend eye drops, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision. Your surgeon will follow your progress very closely for the first week or two. The stitches will be removed approximately a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.
Adjuvant Procedure
The common adjuvant procedure along with upper blepharoplasty in correcting hooding of the upper eyelid is a lateral browlift.
Here, a diamond shape of the scalp is excised approximately 2cms into the temporal hairline. The possible complication here is damage to the frontal branch of the facial nerve which can result in drooping of the forehead. However, if the correct surgical procedure is followed, it is a very rare complication although patients are always informed of the possibility.
Carbon Dioxide or Erbium laser can be used to resurface the eyelid skin in selected cases. This procedure and associated complications including expected outcome will be explained by your surgeon during consultation.
If you have any other problems or are concerned in any way, please telephone The Wentworth Clinic on 01202 428773, or 01202 422171.
