Blepharoplasty (eyelid surgery)

Daniel Judd BSc, MBiol

What is Blepharoplasty (eyelid surgery)?

Blepharoplasty is the medical term for eyelid surgery. This can be for either cosmetic reasons or to help restore eyesight affected by overly droopy eyelids. While current techniques were introduced fairly recently, historic cases of eyelid surgery date back as far as 1^st century Rome.

As a cosmetic surgery technique, blepharoplasty is used to counter the aged and tired appearance that can be caused by sagging skin around the eyes. Excess skin in the upper eyelids can cause them to droop over the eye while excess in the lower eyelids can pull them down, exposing more of the eye below the iris. Your body can also store fat around the eyes, leading bags under your eyes when the surround skin stretches with age.

Eyelid surgery is a very popular technique is Asian countries like South Korea, where it is used to introduce a fold or crease in the upper eyelid, a feature that doesn’t usually appear naturally in many East Asian ethnic groups.

How does it work?

While the exact procedure depends on what the patient wants altered, all blepharoplasties are done through a cut made in the eyelid. This is usually done in the fold of the upper eyelid and on the inner surface of the lower eyelid so as to conceal any surgical scars.

Once the initial cuts are made, tissue will be removed. This might be sections of skin, fat stores called ‘adipose tissue’, small amounts of muscle or any combination of the above. By removing sections of skin, the remaining skin can be stretched and stitched back together to give a less saggy appearance. Removal of fat in adipose tissue can decrease the appearance of bags under the eye.

It’s also possible to combine the surgery with a resurfacing laser treatment at the same time. This will give the remaining skin a more youthful appearance once recovered.

What is it like?

The surgery should take between 1 and 3 hours depending on which eyelid is being treated and the extent of the alterations. It can be done under local or general anaesthetic. Once the removals and alterations have been done, the remaining skin will be stitched closed and a temporary stitch will be made in the muscle of your lower eyelid to hold it in place during the healing process. Suture strips may be stuck to your face as well to provide support during the early steps of the healing process. You will usually be allowed to go home the same day as the treatment.

What is the recovery time?

You won’t be allowed to drive for a few days following the surgery and it’s usually recommended to take a week off of work. As your eyelid heals you should avoid strenuous activity including swimming, and also things that may irritate your eyes like smoking, rubbing or putting in contact lenses.

It’s recommended to keep your head propped up to reduce swelling and you may want to use an icepack and painkillers like paracetamol. You may be prescribed eye drops and prescription painkillers to use as well.

What are the side effects?

The typical side effects following eyelid surgery include swollen eyelids and bruising, sensitive, irritated and watery eyes and some scarring that may decrease in visibility over time. More serious side effects include obvious scarring, pooled blood forming a haematoma (a solid swelling of clotted blood), and temporarily affected eyesight such as blurred or double vision.

Severe but rare side effects include permanent damage to the muscles around the eye, weakened and drooping eyelids and even blindness.

As a surgical technique, blepharoplasty also comes with the side effects common to all surgeries: considerable bleeding, formation of blood clots, infection and an allergic reaction to anaesthesia.

How much does it cost?

In the UK, blepharoplasty can cost between £2000 and £6000.

So is it worth it?

Drooping eyelids and heavy bags under the eyes can contribute heavily to how aged a face looks. If you’re interested in giving your eyes a more youthful appearance blepharoplasty could well be worth it but it’s important to consider the possible side effects listed above as well as understanding the limitations of the treatment and maybe considering some alternatives.

In terms of limitations, eyelid surgery is only going to improve the appearance of skin within the eye socket. Sagging skin on the cheeks below the cheekbone will need its own treatment to improve. Depending on the scope of the alterations you want done, surgery might not even be necessary. Similar effects of tighter and more youthful looking skin around the eyes can be achieved with Botox or fillers that only require injections and may also be cheaper.

If what you’re looking for is an improvement to the skin around your eyes that simply can’t be achieved by alternative methods but still falls within the limits of this technique then blepharoplasty may be for you.