Blepharoplasty

The definition of the surgical term blepharoplasty is the reduction of bagginess around the upper and/or lower eyelids.

The aim of surgery is to improve their cosmetic appearance and often to rejuvenate. There are many causes of baggy eyelids. Perhaps the most common are lack of sleep, too much drinking and stress. There are also some medical conditions that result in eyelid swelling such as problems with the thyroid, heart and liver. It is therefore important that causes other than “cosmetic” and ageing are excluded. It is also important to make sure the patient does not have any intrinsic tearing problem or dry eyes and that a standard eye check at an optician has been performed.

The anatomical reasons for bagginess of the eyelids are complex and there are differences between the upper and lower eyelids. The clinical examination of the upper lids will determine how much the downward drift of the brow, known as brow ptosis, is contributing to the appearance. Sometimes this may be the main cause of the cosmetic problem. Also ptosis (lack of intrinsic movement of the upper eyelid) must also be excluded. Bagginess of the eyelids themselves can be due to excess skin of ageing (called dermatochalasis), change of tone or thickness of the intrinsic circular muscles within the eyelids (the orbicularis muscle) or ageing of the deep layer of the lower eyelid. This layer is called the orbital septum and as it becomes stretched and flabby it allows some of the fat contents surrounding the eye to herniate forward and contribute to the swelling.

The management of baggy eyelids therefore needs careful judgement. Surgically, if the problem were “anatomical” as discussed above, then the aim would be a balance between reducing the amount of excess skin, and adjusting the amount of fat affecting the shape of the eyelids or improving the tone of the lower eyelids. This latter approach involves altering the tension of the orbital septum and sometimes actually removing some fat, although this has to be done with care, as the too much removal will make the eyelids look even more aged. It is relatively rare that bagginess is actually due to too much fat. It is usually due to fat being in the “wrong” place. Too much fat in the lower lid can be an inherited condition and when a young fit patient presents with lower eyelid bagginess this is one of the possible causes, in my experience. Sometimes the lower eyelids have to be tightened, especially in older patients, but the aim in the elderly group is to rejuvenate and sometimes this may mean a change in the shape of the lower lid. In younger patients a change of shape is usually not desirable although unfortunately this, along with asymmetry, are possible complications. The surgery is carried out through incisions that follow natural crease lines in the shadows of the upper eyelid and just below the eyelashes and into the “crow feet” laughter lines of the lower lids.

The surgery requires experience. Too much of “anything” and the results can be poor such as the development of ectropion or lower lid drooping (if too much skin has been removed). Very rarely injury to the opening mechanism to the upper eyelid causing surgically induced ptosis. With any operation around the orbit, damage to the eye itself can occur, but this is really rare. Patients who have the medical and general conditions described above should not undergo blepharoplasty. At The Westbourne Centre, the surgery is carried out under local anaesthetic and sedation as a day case. Recovery after upper lid blepharoplasty is usually fast and normal activity should be possible in under ten days. If all four eyelids are treated, then recovery will be longer and up to three weeks may be needed before the patient is confident to participate in normal everyday activity and work. As with all cosmetic surgery selection, informed consent and understanding are the keys to success.

Frequently Asked Questions (FAQs) View all

Will a blepharoplasty improve my peripheral vision?

If there is excess skin in the upper lid, an upper lid blepharoplasty can improve upper field vision. This should be discussed during consultation.

Will there be a scar near my eyes or eyebrows?

Following eyelid surgery (blepharoplasty), the scar should run within the eyelids.

In the upper lid it should look like a natural crease line. It will not be in the eyebrow.

In the lower lid it will run just under the eyelashes.

In trans-conjunctival blepharoplasties the scar will be hidden. These blepharoplasties are designed just to address fat excess in the lower eyelids.

Can I have my eyelids done at the same time as a facelift?

Yes, there are many procedures that can safely performed at the same time. Eyelids and facelift are two.

Can I see before and after pictures of patients considering the same procedure?

Most certainly! During consultation I am happy to share before and after photos with you of people who have had the same procedure(s) you are considering. By doing this during the consultation, and in person, I have the opportunity to relate the example specifically to your situation, highlighting outcomes and helping with expectations.

How can I avoid complications from eyelid surgery?

Complications from cosmetic eyelid surgery are relatively infrequent. However, problems with symmetry, unwanted changes in shape, the quality of scars and overcorrection of the original problem such as the looseness of skin or bagginess of the eyelids due to the amount of skin or fat removed can occur.

Watery eyes, asymmetry and blurred vision can sometimes be temporary as they can be caused by changes in muscle tone following surgery. Disturbance of function such as ptosis (upper eyelid damage) and eye injury are very rare.

Complications can be reduced by the proper selection of patients and of course careful technique. This can only be achieved with the proper training, judgment and experience.

So my recommendation is to always do you research when choosing a surgeon, ask for recommendations, and actively participate in your consultation.

View all other FAQs