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The elasticity of the eyelid skin and muscle can reduce in varying degrees over the course of your life. This is what causes the typical signs of ageing like wrinkles, saggy eyelids or even the so-called "tear-bags". By means of this operation either just redundant excess skin or also the underlying slack muscle tissue can be removed for the smoothing out of wrinkles and saggy eyelids and tightened with appropriate sutures. By removal or repositioning of fatty tissue tear bags can be removed.
Most commonly the upper lid but also the lower lids are affected. Even though the original elasticity cannot be restored completely, a younger appearance can be achieved through this operation. It is important to realise that it is never possible to remove all eyelid creases. This would produce an over-correction resulting in a staring appearance with possible complications. As well as the sagging of the lid skin other manifestations can influence the appearance and function of the eyelid, for example sinking of the eyebrows, drooping of the tissues of the cheeks and on the temple, change in the lip muscles or other malfunctions in nerves, muscles and circulation. These must be detected by your doctor before surgery. Further methods of treatment may be available such as face lift, forehead and eyebrow lift and laser skin resurfacing. Mr Solomons will discuss these with you if appropriate.
Before surgery the surgeon will make a drawing on the eyelids marking the skin excess. This will give him references for the removal of skin, muscle tissue, fat and for the position of the sutures. The incision runs along natural skin creases of the upper lid and inside the lower lid if necessary. Laughter lines and crows feet require a 5 to 20 mm long cut lateral to the corner of the eye. This cut will be placed in the natural lines of the skin so that it won't be very noticeable. In appropriate cases a transconjunctival tightening of the lower lid can be done from the inside of the eyelid needing no skin incision.
The procedure can be done under local or general anaesthetic.
After the Operation
Please follow the instructions under all circumstances. You will get exact instructions before your discharge from hospital. Please organise a responsible adult to collect you after surgery. You should not drive, operate machinery or take important decisions on the day after surgery. Contact Mr Solomons if the dressing becomes dislodged or your health deteriorates (for example continuing pain, temperature or other concern). Immediately after surgery and for at least three days cooling compresses are helpful. Avoid physical exercise for the first few days and avoid over exertion. Do not wash your eyelid region until after the sutures are removed. Make up can be worn after the sutures have been removed, usually a week post operatively. You need not worry if you notice discolouration through bruising, a feeling of tightness, swelling, that you are not able to close your eyes completely, or that the lower lid is sticking out slightly. This is normal provided it disappears within the first few weeks. A feeling of tightness and disrupted sensations in the scar area will sometimes subside only after several months. If you are concerned about any of these please talk to Mr Solomons. We can also advise you on the use of camouflage make up.
Risks
- Bleeding into the skin, muscles and fatty tissues that usually does not need treatment.
- Temporary aggravation of the conjunctiva or the cornea caused by antiseptic solutions, drying or touching - these usually subside on their own accord.
- Swelling of the connective tissue with painful increased pressure behind the eyeball - this usually subsides through general oedema reducing methods (general rest, cooling). Sometimes additional medication if required.
- Secondary haemorrhage and bruising even several days post-operatively that usually do not require treatment - only in rare exceptions operative haemostasis is required.
- Separation of the wound edges due to mechanical stress, for example when washing your hair or laughing/crying - this has an undesirable effect on the scar formation and in rare cases may even make a scar correction necessary.
- Inflammatory reactions of the wound are rare.
- Scars - the operation cannot be carried out without leaving scars. The scars will however be placed along the natural folds of the skin so that they will be least noticeable and well hidden. The natural reddening of a fresh suture line will disappear after two to three weeks but occasionally may persist for several months. In the scarred area small cysts may form that are simple and easily treated.
- Disruption in scar formation - some people have a tendency to form scarring that is wide, proud, discoloured, painful or itchy (proud flesh or keloid). Even this type of scar will reduce with conservative treatment so the need for repeat surgery in very rare.
- Over correction - excessive removal of skin or scar pull after inflammation may result in disruption to the flow of tears or the ability to close the eye completely. During the first few weeks after surgery the lid closure will improve spontaneously. Persistent disruption would require further surgery.
- Permanently dry eyes - caused by a reduction in the flow of tears or disrupted lid closure can be improved through eye drops.
- Damage to the eye including blindness after blepharoplasty has occasionally been described in medical literature but is such an extremely rare complication as to be significantly irrelevant.
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