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Cosmetic blepharoplasty

Blepharoplasty is one of the most common oculoplastic procedures. It involves reshaping of the eyelids to a more acceptable contour. It may involve removal of tissue but tissue may occasionally be added to fill unacceptable hollows in the skin.

Excess eyelid tissue may cause visual problems and may cause ocular discomfort. Blepharoplasty can alleviate these symptoms but it is often performed for cosmetic reasons. The eyes and eyelids have a major influence on the cosmetic appearance of the face and rejuvenation of this area alone can be of great benefit to the facial appearance.

Various types of blepharoplasty may be performed depending on patient requirements. In some cases a simple excision of skin or muscle may be all that is needed but in some cases some fat may need to be removed in order to improve the bulgy appearance. Occasionally the height of the lids needs adjustment at the same time as the blepharoplasty and this will be discussed with you before your operation.

Upper lid blepharoplasty

An incision is made in the upper eyelid skin in the natural crease. The required amount of skin is removed along with some underlying muscle. If fat prolapse is part of the problem some fat may also be removed. Fine sutures are then placed in the skin. The eye may be padded for a few hours after surgery.

Lower eyelid blepharoplasty

Most eyelid sugery is performed under local anaesthetic. If you prefer, some sedation may be given or a general anaesthetic can be arranged.

With skin removal An incision is made below the eyelashes in the lower eyelid to the outer corner on the eye. The required amount of skin is removed along with a small amount of muscle. If fat prolapse is a problem, some fat may be removed and the remaining fat may be placed in a way that smoothes the surface contour of the lower eyelid and prevents a hollow appearance or the appearance of a trough at the lower part of the eyelid. The outer corner of the eyelid may be supported with a suture to prevent sagging. Fine sutures are placed in the skin.

Without skin excision If there is no excess skin, any excess fat may be removed without a skin scar. This is done by making the incision on the inside of the eyelid and removing fat through it. Small dissolvable sutures are placed on the inside of the eyelid.

After the operation

The eyes may be padded for an hour or so after surgery and you will asked to sit up to minimise swelling. You will be helped to have something to eat or drink by a nurse. The pads will be removed and the vision and wounds will be checked. You will then be allowed to go home. At this stage the vision may be slightly blurred and the eye may be watery. This is quite normal and will improve over the first few days. For the first few nights I advise patients to sleep with an extra pillow. This helps to reduce swelling. For the first few days the eye may appear slightly red and may water. It may also feel slightly gritty. These symptoms are very common and settle over the first week or two. You may be asked to use some eye drops for the first week to make the eyes more comfortable. If you have stitches in the skin, these will be removed between 5 and 10 days after surgery, depending on the type of stitch used.

You will be able to discuss your progress at this visit. Do not worry if the lid is not how you would like immediately. It is likely to settle with time.

After your eyelid surgery, bruising and swelling of the lids can be expected. The amount and severity is variable. If you have had upper eyelid surgery, some bruising of the lower lid may take place. The bruising and swelling may be at its worst on day 2 after surgery. After this, it usually settles over a week or so. There may be some minor residual swelling which can take a few weeks to settle and in some cases, the lid is not at its best for a few months.

Some people like to take Arnica preparations in the hope of minimizing bruising. Please feel free to do this, although the medical evidence that it actually helps is lacking.

  • Do take life gently over the first few days
  • Don't swim for three weeks
  • Don't strain or take heavy exercise over the first week

If you have any undue pain or worsening swelling or any other concerns, please do not hesitate to contact me through my secretary.

Complications of surgery

In the hands of an experienced oculoplastics specialist, complications are few but even in the hands of the most experienced surgeon, they may occur.


Infection of the wounds is rare and steps are taken at the time of surgery to minimize this risk. If the eyelid swelling increases two to three days after the surgery and is associated with increasing pain, please seek advice without delay.


Bleeding into the eye socket is a very rare complication of blepharoplasty (about 1 in 2500 cases). It may have a marked effect on the vision if it is not detected or treated appropriately. This complication does not tend to occur with skin-only blephahroplasty but is a rare complication of a fat blepharoplasty. It occurs a few hours after surgery and causes marked bruising and swelling of the eye and eyelids, severe pain and reduced vision. Emergency treatment of the problem is needed and it is important to seek the advice of the surgeon without delay.

Double vision

This is also a rare complication and is caused by damage to the muscles around the eye. It usually settles spontaneously over the first few weeks.


The wounds tend to heal very well but occasionally the tissues beneath the skin scar more than usual. This may lead to an unacceptable eyelid position which may settle spontaneously or may require further surgery. An oculoplastic surgeon is trained to prevent and manage such a problem.

If you have any questions regarding this information, please ask your eye doctor.


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