Lower blepharoplasty

A lower eyelid blepharoplasty can improve the fat prolapse and the loose folds of skin that can cause eye bags and a tired looking appearance. The aim is a refreshed, younger looking appearance.

Unfortunately it is not possible to remove all eyelid creases by this surgery alone and other treatments can be used to help with this eg wrinkle reduction injections or skin resurfacing with either a laser or a skin peel.

How is a lower lid blepharoplasty carried out?

A lower lid blepharoplasty can be carried out with either local anaesthetic, sedation or a general anaesthetic. It can be combined with an upper lid blepharoplasty or more extensive facial regenerative surgery. You may usually go home the same day. The approach is either though the lower lid skin (transcutaneous) or through the conjunctiva (transconjunctival). Prior to surgery the incision and eye bags are carefully marked whilst you are awake. If you are having sedation or a general anaesthetic this is carried out next, the local anaesthetic is then given.

The transcutaneous approach is used when excess skin is present in the lower lid. The skin incision lies just beneath the eyelashes and extends about 1cm laterally into a natural skin crease. During the procedure a small amount of skin is usually removed, some fat is removed or repositioned and the muscle and eyelid are tightened. The skin sutures are removed at approximately a week after surgery.

The transconjunctival approach avoids a skin scar but it is only used if there is no skin excess. Fat is removed during this approach.

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 happens after an lower lid blepharoplasty?

Ointment will be applied to your wounds and eyes; 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. The final result will be evident in 3-4 months. 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 just beneath your lashes and very subtle although the scar does extend to just past the eyelid. Sunlight can impair the healing of your scar it is therefore useful to wear sunglasses whilst you are healing in sunny conditions.

What are the complications of an upper lid blepharoplasty?

  • Lower eyelid retractionThis is a risk of the transcutaneous approach
  • Sunken eyeA sunken looking eye can occur if too much fat is removed, therefore nowadays we remove fat quite conservatively
  • DiscomfortThe lid will look tight after surgery and the bone at the corner of the eye may be uncomfortable for a number of weeks, rarely longer if a lid tightening stitch is used
  • AsymmetryThe human face and eyelid region is normally asymmetrical. There can be variation from one side to the other following blepharoplasty surgery
  • Further surgeryOccasionally 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
  • Double visionThere is muscle that moves your eye close to the site of surgery. There is a very small risk of damage or bruising to this muscle during surgery that could result in double vision this is usually temporary
  • InfectionThis is rare if you follow the post-operative wound care instructions
  • Bruising and swellingThis happens after the operation in everyone
  • Blurred visionThis is often due to the ointment used on your wounds
  • ChemosisSwelling of the clear covering of your eye (conjunctiva) can last a few weeks
  • WateringThis is common and occurs due to irritation of the eyes
  • Dry eyeYou will be advised to use artificial tears after the operation. Dry eye 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

The Face Surgeons