Upper Lid Blepharoplasty

Consultant Oculoplastic & Ophthalmic Surgeon, Mr Lin at Oaks Hospital answers the frequently asked questions around upper lid blepharoplasty.

What is an upper lid blepharoplasty?

Also known as an eyelid lift, blepharoplasty is an operation which removes excess skin (dermatochalasis) and sometimes muscle or fat from the upper eyelids. This is different to ptosis surgery where the eyelid itself has dropped over the eye. 

What are the causes of excess upper lid skin?

  • The collagen in skin changes with exposure to the sun and over time. Sometimes episodes of swelling of the eyelid due to infection or allergy can stretch the skin.
  • The septum which is a layer of tissue that holds fat back gradually weakens over time and this can lead to fullness of the upper lids.
  • The brows which normally sit above the bony ridge (women) or on the bony ridge (men) can gradually drop which leads to the appearance of excess skin on the upper lids. In this case a brow lift is required rather than a blepharoplasty.

It is important all of these factors are taken into account in your assessment.

What are the potential benefits of blepharoplasty surgery?

  • The appearance of bigger and more youthful eyes and more alertness
  • Improving symmetry with the other eyelid
  • An improvement in the upper part of your field of vision
  • Reduced headaches. Some patients compensate for low eyelids by using their forehead muscles constantly, which can cause a headache.

What does the blepharoplasty operation involve?

Your surgeon will use a surgical pen to mark out the skin to be removed, which is the most critical part of the operation. Anaesthetic is then injected under the skin, which feels sharp and stings for about ten seconds. After this the eyelid will be numb and the surgery should not hurt, but you may still feel touch, fluid or pressure.

The excess skin is cut away. If removal of muscle/fat is needed, the operation will take longer and the recovery time is also longer. The wounds are then closed with stitches that minimise scarring. The scar - if there is any - is usually hidden in the natural skin crease of the eyelid.

What problems can occur after the operation?

Eyelids normally heal very well and the wound is usually hidden in the natural skin crease of the lid.

  • Bruising and swelling of the eyelids is normal. The surface of the eye may also swell. These changes will settle after a few weeks, and will take longer to resolve in patients with blood thinners.
  • Dry, gritty, sensitive eyes for a few weeks can be helped with lubricant eye drops. The vision may be slightly blurred for a few days. A dry eye problem should be diagnosed and treated before surgery as it may be worsened by the surgery.
  • Bleeding after the operation is usually slight and stops within a short time. If bleeding continues you should contact the hospital in case further treatment is required.
  • A post-operative infection may rarely develop in the lids when they would become tender, red and more swollen and the wound may open and discharge. If this happens then you should contact the hospital as antibiotic tablets may be needed to help correct this and allow the lids to heal.
  • Occasionally some loose skin or asymmetry persists, often at the outer end of the eyelid and further surgery may be required.
  • Very rarely, too much skin or muscle is removed and this may stop the lid from closing and the eye becomes dry.
  • Extremely rarely, severe bleeding can spread behind the eye that can cause loss of vision. This is why aspirin and physical exertion are discouraged for the few weeks after the operation. This requires emergency treatment from an eye surgeon. 

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