The operation is usually performed under local anaesthetic as an outpatient procedure.
The skin excess is estimated and marked before the operation in an upright position.
After injection of the local anesthetic the skin is incised along the markings, sometimes including a small strip of eyelid muscle. The lower border of the incision is placed about 8mm above the eyelid margin, so that the resulting scar comes to lie in a natural skin crease. If there is a lot of excess skin on the sides the incision may need to extend beyond the actual eyelid, but will also follow a natural skin crease making it hardly visible. If there is excess fat tissue in one of the pockets behind the eyelid, it may be also removed. The wound edges are then sutured together directly.
The skin incisions are usually closed with fine non-absorbing sutures, which are removed after 5-7 days.
What to expect after the operation
The skin around the eye is very thin and prone to swelling and discoloration. It is therefore completely normal for the entire eyelid, sometimes also the lower eyelids, to swell up and turn blue. This can be reduced by cooling the area immediately after surgery for 24-48 h and keeping the head slightly elevated.
The eyelid swelling can often also prevent the eyelid from closing completely. This is not dangerous and should subside after a couple of weeks.
The final result can usually be appreciated after about 6-8 weeks, once all the swelling has gone down.
The is an involuntary connection between the upper eyelid position, the brain and the eye brow position, whereby a person whose eyelid is weighed down by excess skin will automatically raise their eyebrows to increase the eye opening. Once the excess skin has been removed you may notice that the position of your eyebrows becomes lower. This cannot be avoided technically. If this compensation is significant your surgeon may advise you to have some form of brow lifting procedure as well.
Keep the head slightly elevated (at least 30 deg) and cool the eyelids (not with ice as it can cause thermal damage) for at least 48 h after surgery
The sutures will be removed 5-7 days after surgery and the dressings can be left intact until then.
Showering and washing your hair is allowed, however rubbing the eyelids should be avoided until the wounds have healed completely.
Makeup can be applied anywhere more than 1cm away from the wounds after 48h.
Everyday activities are usually possible immediately after surgery, however strenuous activities, including exercise should be avoided until the swelling has gone down.
Regular follow-up appointments with your surgeon will be scheduled at 1 week, 6 weeks, 3 months and 1 year after surgery.
As with every surgical procedure upper eyelid blepharoplasty is associated with both anaesthetic and surgical risks. Preexisting conditions such as Diabetes, obesity, heart and blood vessel diseases, immune diseases and smoking significantly increase the risk of complications.
The most common surgical complications after upper eyelid blepharoplasty include:
- postoperative bleeding, hematoma
- insufficient skin excision
- overexcision of skin excess
- unsightly or asymmetrical scars
- irritation of the conjunctiva
- dry eye
Rare complications after upper eyelid blepharoplasty include:
- delayed wound healing or wound breakdown
- corneal injury
- permanent incomplete lid closure
- bleeding into the eye socket, if left untreated subsequent blindness
Do I need to stop my own medication prior to surgery?
Most medication can be continued normally. Some drugs such as blood thinners (e.g. Aspirin or Warfarin/Marcoumar) can increase the risk of postoperative bleeding and may need to be stopped or replaced before the procedure. We ask you to bring a complete list of all your medication and their dosages to your first consultation.
Does my GP need to perform or organize any special investigations or tests before surgery?
Usually not. We ask you to provide as much detailed information on your past medical history as possible when you come for your preoperative consultation so we can coordinate any necessary tests with your GP.
Do I need to stop smoking before surgery?
We seriously recommend stopping all nicotine consumption, including smoking at least 6 weeks before any surgical procedure. One of the most common complications following any type of surgery is delayed wound healing or wound breakdown. The main cause of this is usually bad blood circulation to the skin and tissues in the operated area. Nicotine is a chemical substance, which causes blood vessels in the body to constrict (narrow). This lowers the blood circulation to the wound and significantly increases the risk of complications.
How long before I can go back to work after surgery?
This depends on your work. Light duties, such as office jobs can usually be resumed immediately after surgery. However, your eyelids will be quite swollen and discoloured for at least a week after the procedure, so it is advisable not to schedule your surgery immediately before any public events.
I already had an upper eyelid blepharoplasty some time ago. Can the procedure be done again?
Yes you can, provided there is actual skin excess. Sometimes other conditions such as eyebrow or eyebrow ptosis can make the eye look tired even when there is no skin excess. The overall risk of complications is slightly higher for every repeat-procedure.
My eyes are not the same size. Can this be corrected with a blepharoplasty?
Nearly every person’s face is asymmetrical to a greater or lesser degree. This also applies to the eye region. Naturally the aim of surgery is to achieve as much symmetry as possible. There are however many factors that cannot be influenced by surgery that may have an impact on the overall appearance and symmetry of face (e.g. bone structure, muscle activity etc.) so that despite meticulous technique it is never possible to create a 100% symmetrical result.
I would like an upper and lower eyelid blepharoplasty. Can they be done at the same time?
Yes, this is possible. Naturally it will increase the operation time to approximately 2 h and it is recommended that the procedure be done under general anaesthetic or at least with sedation.
What happens if too much skin is removed?
If too much skin is removed, you won’t be able to close your eye completely. A gap between the upper and lower eyelid of a few millimeters is absolutely normal immediately after surgery and in most cases settles completely over a period of 3-4 weeks. If the gap remains significant and causes discomfort such as a dry eye or increased tear production it will be necessary to re-open the surgical wound and correct the defect with a thin skin graft.
Can I wear make-up after the operation?
Once the wounds have healed completely (approximately 1 week after surgery) you can apply make-up freely. Before this time the wound itself should be kept clean and dry. You may apply make-up to the surrounding areas though.
Will I get a sick certificate for the time I am off work?
Only if the procedure is covered by your health insurance. Sick certificates cannot be issued for cosmetic procedures. You will need to take leave for the entire period that you are absent from work.
Will my health insurance cover the costs for the surgery?
In most cases not. If the skin excess is significant with a measurable decrease of the visual field (usually done by an ophthalmologist) the procedure may be covered by your insurance. In such cases written approval must be obtained by your surgeon prior to surgery.
Will my health insurance cover the costs of treatment if I develop any complications requiring medical treatment, hospitalization or even further surgery?
Yes, provided the complication is purely medical, e.g. an infection. Corrections of aesthetic complications (e.g. asymmetry, scarring, under- or overcorrection etc.) are not covered.