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Upper blepharoplasty

An upper lid blepharoplasty removes the loose folds of skin from the upper lid, sometimes fat is also removed. There will be some skin folds remaining to ensure that you can close your eyelids. If your skin has a crepe appearance this cannot be resolved with a blepharoplasty.

It can also be associated with an eyebrow ptosis, where the brow droops, or an upper lid ptosis where the upper lids are droopy. These problems can sometimes be addressed at the same time as an upper lid blepharoplasty or on a separate occasion.

Why do I need an upper lid blepharoplasty?

Excess upper lid skin can cause visual problems by blocking the vision it may also press on the lashes and cause a heavy sensation or fatigue. Some people feel that their excess upper lid skin looks cosmetically unacceptable.

How is an upper lid blepharoplasty carried out?

In most cases upper lid blepharoplasty surgery can be carried out under local anaesthesia as a day case. This involves an injection of local anaesthetic to the upper lid to numb the area and you may go home the same day. It may also be carried out under local anaesthetic with sedation or a general anaesthetic an anaesthetic consultant will need to be present for this option.

Prior to surgery the excess skin is marked with a pen, ensuring that there is enough skin left to close the eyes. The local anaesthetic is then given. The excess skin is then removed, if you also have bulges of fat this may also be removed. The skin is the sutured (stitched). These usually need to be removed later.

What happens after an upper lid blepharoplasty?

Chloramphenicol ointment will be applied to your wounds; your surgeon will decide whether you need a pad on your eyes after the operation.

After surgery you should avoid makeup and contact lenses for 1-2 weeks. You should keep the incision clean using clean cotton wool and sterile saline or boiled cooled water.

You will be given Chloramphenical ointment to apply to your wounds twice a day for 2 weeks. You will also need to use artificial tears 4-6 times a day for at least 2 weeks to keep the eyes lubricated.

Resolution of post-operative swelling and bruising can vary between patients. Bruising will usually resolve over 2-3 weeks. Swelling takes longer most will resolve over 3-4 weeks. Please take this into account if you are planning a holiday or social event.Try to avoid strenuous activity for 2 weeks after surgery to help your wounds heal. The lid scars fade to white lines over a number of months. Most of the scar will be hidden in your upper lid crease although the scar does extend to just below your outer eyebrow. Sunlight can impair the healing of your scar it is therefore useful to wear sunglasses whilst you are healing in sunny conditions.

What should I do prior to surgery?

If you are taking aspirin or any other blood thinners you will need to inform your doctor and you may need to consult with your GP regarding stopping these. Some anti-inflammatories such as ibuprofen and nurofen can also make you more likely to bleed.

All herbal medicines should be stopped at least 14 days before surgery.

Smoking impairs healing and if possible you should try to stop 6-8 weeks prior to surgery.

If you have high blood pressure ensure that this is well controlled as it will make you more likely to bleed and bruise.

You should bring a list of your current medications and any allergies with you.

You will not be able to drive yourself home after the procedure. Please arrange an alternative mode of transport or someone to help you.

 

What are the complications of an upper lid blepharoplasty?

  • Blurred visionThis is often due to the ointment used on your wounds.
  • Chemosis Swelling of the clear covering of your eye (conjunctiva) can last a few weeks.
  • Bruising and swelling This happens after the operation in everyone.
  • Watering This is common and occurs due to irritation of the eyes.
  • Dry eye You may have a reduced blink for a few weeks after surgery and reduced eye closure this can cause dry eyes and you will be advised to use artificial tears. This will resolve in most people, if you had dry eyes prior to the operation they may be worse and you may need to use artificial tears long-term.
  • Corneal abrasionA scratch to the front of the eye this can be painful but it will normally heal very quickly.
  • HaematomaA sudden bleed around the eyeball, the eye would be pushed forward, the vision often reduces and it is usually painful. This is very rare but a bleed can crush the optic nerve and cause loss of vision long term. This needs urgent treatment.
  • ScaringWounds heal very well in the majority of people. However, abnormal scars may occur both within the eyelid and deeper tissues. In rare cases, abnormal scars may result. Scars may be unattractive and of a different colour to surrounding skin. There is a small possibility of visible marks in the eyelid or small skin cysts from sutures these may be temporary or permanent.
  • Ptosis This is a droopy upper lid, this can be caused by stretching of the tissues due to the post-operative swelling. Sometimes a ptosis which was already present can become more noticeable after the excess skin is removed.
  • Inability to close the eyelids This happens often for a short period after surgery and is treated with artificial tears. If too much skin is removed you may have difficulty closing your eyes fully long term. If this happens you may need further surgery to resolve this.
  • Sunken eye A sunken looking eye can occur if too much fat is removed, therefore nowadays we remove fat quite conservatively.
  • Asymmetry The human face and eyelid region is normally asymmetrical. There can be variation from one side to the other following blepharoplasty surgery.
  • Further surgery Occasionally it is necessary to have a further operation.
  • Loss of sensationAny incision can cut through nerves, it is possible to have some numbness around the incision site. This usually resolves over a number of months occasionally it may be permanent.
  • InfectionThis is rare if you follow the post-operative wound care instructions.
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