Cosmetic eyelid surgery

This factsheet is for people who are considering having cosmetic eye surgery.

Cosmetic eyelid surgery, or blepharoplasty, is an operation to remove excess skin, fat and muscle from around the eyes to produce a more alert and youthful appearance. The procedure can be performed on the upper and lower lids, at the same time or separately.

Why have cosmetic eyelid surgery?

As we age, the skin around our eyes loses its elasticity. You may develop loose folds of skin on the upper eyelids and deep creases on the lower lids. At the same time, your muscles in this area may also slacken so that any fat bulges forward and looks baggy.¹ Cosmetic eye surgery can remove the excess skin, fat, or both, from around your eyes.

Sometimes you can develop baggy eyes in your 20s before your skin changes. You can inherit this trait from your family.¹

Cosmetic eye surgery may also improve your sight if saggy skin in the upper lids hangs over the eyelashes to obstruct vision.

The surgery can also remove wrinkles, but only those in the skin that is cut away in the operation. It will not remove "crow's feet" and cannot change the colour of dark shadows under the eyes.¹

It is important to discuss with your surgeon what you are hoping to gain from the operation, and the result you can realistically expect.

What are the alternatives?

In some cases, wrinkles around the eyes may be reduced using chemical or laser treatments, or by a forehead, or brow, lift. For more information ask your doctor for advice or see the separate BUPA factsheets, Laser facial resurfacing and Facelifts.

Many creams, gels and beauty treatments claim to be able to tighten the skin around the eyes. However, there is no scientific proof that they work on a permanent basis.

What happens before cosmetic eye surgery?

You will have a consultation with your surgeon before your operation. He or she will ask about your general health and discuss how to prepare for your operation.

Your surgeon will examine:

• your eyelids
• your vision
• your tear film (a layer of tears covering the surface of your eye)
• the front of the eye
• your retina - an area on the rear wall of your eyeball
your whole face to see the condition of your skin
• the position of your eyebrows and eyelids, which will be measured²

What should I expect in hospital?

Before surgery you will talk to your surgeon about the operation and you will be asked to sign a consent form. This confirms that you understand the risks, benefits and possible alternatives to the procedure and have given your permission for it to go ahead.

Your eyelids will be examined and you will probably have a photograph taken of your face before the operation so that the results of surgery can be compared with your original appearance.

If you are having a general anaesthetic, you will be asked to follow fasting instructions. Typically, you must not eat or drink for about six hours before a general anaesthetic. However, some anaesthetists allow occasional sips of water until two hours beforehand.

The operation

The operation lasts one to three hours, less if just the upper or lower lids are being done.^1,3 It can be performed as a day case, which means that you can have the operation and go home the same day. However, you may need to stay one or two nights in hospital for observation.

The surgery can be carried out under a local anaesthetic, in which case the area around your eyes will be numb but you will be awake. It can also be done under a general anaesthetic, which means that you will be asleep throughout the procedure and will feel no pain.

Your surgeon may use either conventional or laser techniques.

For surgery on the upper eyelids, cuts are made:

• into the natural lines and creases in your eyelid
• into the laughter lines at the corner of your eye

For surgery on the lower eyelids, cuts are made:

• just below your eyelashes, which means the scars will run along your eye's natural folds, hiding them as much as possible

Excess fat, muscle and loose skin are then removed, and the cut is closed using fine stitches. These are generally removed two days to a week after surgery.³

If only fat is being removed, the cut can be made on the inside of the lower eyelid, leaving no visible scar. This is called a transconjunctival blepharoplasty.¹

After the operation

After the operation, your eyes may be covered with gauze pads. The surgeon will apply some sterile paper tape to support the eyelids after surgery, which is normally removed after three to five days. Sometimes you will be advised to use the support for the lower eyelids for a week or so.¹ An ointment will be applied to your eye area to prevent it from drying out.

You will be given painkillers to help with any discomfort as the anaesthetic wears off.

If the operation has been planned as a day case, most people go home once they have made a full recovery from the anaesthetic. If you have had a general anaesthetic you will need to arrange for a friend or relative to drive you home and stay with you for the next 24 hours.

Before you leave hospital, a nurse will give you some advice about how to care for the eye area and you will usually be given an eye ointment to use at home.

Recovering from cosmetic eye surgery

Once you are home, you may take further painkillers if you need to. Follow the hospital's advice.

Applying a cold compress, such as an ice or a bag of frozen peas (both wrapped in a towel) can help to reduce the swelling and bruising. You should not apply ice directly to your skin as it can give you an "ice burn".

There are some important things to remember while recovering from cosmetic eyelid surgery.

• Keep your head higher than your body by lying propped up on pillows, and avoid bending over for a few days. This will help to reduce swelling and bruising.¹
• Clean around your eyes and use any ointment that the hospital staff gave you as they instructed.¹
• Avoid wearing eye make-up until a couple of days after the stitches have been removed, or for as long as your surgeon tells you to.¹
• Avoid wearing contact lenses for two weeks (they may still feel uncomfortable for a while after that).³
• Avoid driving until your vision has returned to normal and your eyes have stopped watering.

Most people are able to read or watch television within a few days. People usually feel like returning to work after a week to 10 days.³

Deciding on treatment

It's important not to rush into the decision to have a cosmetic operation. And, it's sensible to discuss the issue with your GP, who may be able to recommend reputable surgeons or give advice about how to choose where to be treated.

Cosmetic eye surgery is a commonly performed and generally safe surgical procedure. For most people, the benefits in terms of improved appearance are greater than any disadvantages. However, in order to make a well-informed decision and give your consent, you need to be aware of the possible side-effects and the risk of complications.

Side-effects are the unwanted but mostly temporary effects of a successful procedure. For example, feeling sick as a result of the general anaesthetic. Anyone having cosmetic eye surgery can also expect:

• soreness around the eyes, which can be helped by taking painkillers³
• bruising and swelling for up to a month after the operation, which might make your eyes feel tight and difficult to close when going to sleep^1,2,3
• sticky, dry and itchy eyes for the first week^2,3
• watery eyes for a few weeks^1,2,3
• double or blurred vision for a few days - you should contact your hospital or a GP if this lasts longer than three to four days^2,3
• sensitivity to light for a few weeks³
• tiny whiteheads along the line where the stitches were - your surgeon can remove these with a very fine needle^1,3
• pink scars for a few months, but eventually they become almost invisible^1,3

Complications are unexpected problems that can occur during or after the procedure. Most people are not affected. The main possible complications of any operation are bleeding during or soon after the procedure, infection, or an unexpected reaction to the anaesthetic.

Specific complications of cosmetic eye surgery are uncommon but can include:

• a haematoma where a pool of blood collects under the skin around the eye, which may need to be drained in a second operation if it doesn't disappear on its own or if it is large¹
• swelling that pulls the lower lid away from the eye, which usually settles on its own after a couple of days, but occasionally another operation will be needed¹
• damage to the surface of the eyeball or the surrounding muscles²
• acute glaucoma, an eye condition requiring treatment by an eye specialist²
• unusually red or raised scars (called keloid scars) which some people have an inherited tendency to form
• sunken appearance if too much fatty tissue is removed²
• a difference in appearance of the two eyes - they may not be identical²
• partial or complete blindness, but this is very rare^1,2

The chance of complications depends on the exact type of procedure that is being performed and other factors such as your general health. Your doctor will be able to explain how these risks apply to you.

References

1. British Association of Aesthetic Plastic Surgeons (BAAPS), Eyelid reduction.
   www.baaps.org.uk
   viewed 25 January 2005
2. British Oculoplastic Surgery Society, What is cosmetic eyelid surgery?
   www.bopss.org
   viewed 16 February 2005
3. American Society of Plastic Surgeons, Blepharoplasty.
   www.plasticsurgery.org
   viewed 26 January 2005

Published by BUPA's health information team, healthinfo@bupa.com, April 2005