What is a blepharoplasty: the benefits and risks.

21 Jun

Blepharoplasty, commonly known as Cosmetic Eyelid Surgery, is a cosmetic procedure aimed at rejuvenating the appearance of the eyelids by removing excess skin, and if needed muscle and fat. It can be performed on the upper eyelids, lower eyelids, or both, depending on the patient's needs and desired results. The outcome of this procedure is a rejuvenated, youthful look and increased alertness to the eyes, and in some cases improved field of vision.

Woman holding around her eye with two fingers

Congenital factors and ageing can lead to excess skin of the upper lids, which can even hang over the lash line. In addition, deep tissue becomes weaker, and the pads of fat protectively surrounding the eyes protrude with age, becoming sack-like. Both phenomena lead to a tired and sagging facial expression and can lead to pressure on the eyes, asymmetric eyelids or droopy skin of the eyelids restricting the visual field, in particular when looking sideways.

Benefits of Blepharoplasty

A Blepharoplasty procedure can have many benefits for patients. The most common benefits include:

Youthful Appearance: One of the primary benefits of Blepharoplasty is its ability to restore a more youthful and refreshed appearance to the eyes. As we age, the skin around the eyes can become loose and saggy, creating a tired or aged appearance. Blepharoplasty can tighten and smooth the skin, giving the eyes a more vibrant look.
Improved Vision: In some cases, excess skin on the upper eyelids can actually impair vision by obstructing the field of view. By removing this excess skin, Blepharoplasty can improve peripheral vision and enhance overall eyesight.
Boost in Confidence: Many individuals who undergo Blepharoplasty report feeling more confident and satisfied with their appearance after the procedure. By addressing concerns such as under-eye bags or droopy eyelids, Blepharoplasty can help patients feel better about their appearance and improve their self-confidence.

What to expect during a blepharoplasty procedure

Blepharoplasty is typically performed as an outpatient procedure under local anaesthesia with sedation or general anaesthesia, depending on the extent of the surgery and the patient's preferences. The specific technique used will vary based on the individual's anatomy and aesthetic goals, but generally, the following steps are involved:

Incision: For upper eyelid Blepharoplasty, the surgeon will typically make incisions along the natural crease of the eyelid, allowing for discreet scarring.
Tissue Removal: Excess skin, sometimes muscle and fat are carefully removed or repositioned to achieve the desired contour and appearance.
Closure: The incisions are closed with sutures or surgical adhesive, and any excess fluid or blood is drained from the area.

I use a very fine electric surgical needle for the eyelid surgery, resulting in less bleeding and post-operative haematoma. Sutures are removed 7-10 days after the operation. Very occasionally, a small haematoma may still occur.

Cosmetic eyelid surgery recovery process

Following Blepharoplasty, patients can expect some swelling, bruising, and discomfort around the eyes. However, these symptoms typically subside within a week or two, and most individuals are able to resume normal activities within 7 to 10 days. During the initial recovery period, it's important to follow your surgeon's post-operative instructions. It is advised that you rest and keep your head propped up with pillows when you are lying down for the first few days after surgery.

Cold compresses can help reduce swelling and discomfort in the days following surgery. We suggest using an ice pack or bag of frozen peas hourly for 10-15 minutes on the operated eyelid.
It is important to avoid activities that may strain the eyes or increase blood flow to the area, such as heavy lifting or vigorous exercise.

Your surgeon may prescribe pain medication or antibiotics following the procedure to help manage discomfort and prevent infection.

Do not wear contact lenses for two weeks to avoid irritation of the eye.
Wearing dark glasses when you are outside may reduce your sensitivity to sunlight, wind, and other irritants.
You can start driving and go back to work once the swelling has gone down and your vision is clear.

You will be seen for a follow-up appointment two weeks after the surgery to remove the stitches and assess the healing process.

Potential Risks and Complications of eyelid surgery

Like any surgical procedure, Blepharoplasty carries some inherent risks and potential complications. These may include:

Over resection and under resection: In upper blepharoplasty, over-resection refers to the removal of too much skin, fat, or muscle, leading to complications such as difficulty closing the eyes, dry eyes, and an unnatural appearance. Under-resection, on the other hand, involves removing too little tissue, which may result in minimal cosmetic improvement and persistent issues like excess skin or puffiness. Both conditions require careful evaluation and may necessitate additional corrective procedures to achieve optimal results and function. Proper surgical planning and technique are crucial to balance aesthetic outcomes with the functional preservation of the eyelids.

Bleeding: Excessive bleeding during or after surgery is rare but can occur. Your surgeon will take steps to minimise this risk, such as avoiding blood-thinning medications before surgery.
Infection: Infection is a potential risk with any surgical procedure. Your surgeon will provide instructions for keeping the incision sites clean and monitoring for signs of infection. If the site becomes infected, you may need further treatment with antibiotics.
Scarring: You may be left with minimal scarring following your Blepharoplasty, however this will usually be hidden under the crease of the upper eyelid.
Dry Eyes: Temporary or permanent dryness of the eyes is a possible side effect of Blepharoplasty, particularly if the procedure involves the lower eyelids.

Bruising and inflammation are common after the operation, however this should clear up one to two weeks after the surgery.

Overall, the results of this type of surgery are usually successful and long-lasting. Nonetheless, with ageing, further loss of elasticity may occur and sometimes further surgery may be required to achieve the best results. However, in most cases the skin excess will not be as much as it was before the first surgery.

I am a leading Rhinologist, ENT and Facial Plastic Surgeon with over 17 years of diverse surgical experience, and a speciality in rhinoplasties and facial plastic surgery, including upper Blepharoplasty. I am an active member of respected professional associations, including the Rhinoplasty Society of Europe (RSE), the European Academy of Facial Plastic Surgery (EAFPS), and the German Society of Otorhinolaryngology, Head and Neck Surgery. I pride myself on delivering high quality patient care and tailor each procedure to the specific needs of the individual patient.