Blepharoplasty Surgery in London

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Eyebag and droopy eyelid surgery with or without canthopexy

Blepharoplasty is a surgical procedure performed on the eyelids. It removes the excess droopy skin of the eyelids that develops with time. The surgery removes the excess skin to the eyelid and may also involve the, muscle and fat in the eyelid. As one ages, the eyelid skin stretches and the muscle beneath can weaken. This results in a sagging or eyebag appearance to your eyelids, causing the eyebrows to lift in some cases giving a wrinkled forehead appearance , a drooping or an aged appearance to the upper eyelids and the appearance of bags under your eyes. This surgical procedure is what some people call an eyelid lift.

This changes that occur can make you look older. The sagging skin around the eyes can block your upper and side vision (peripheral vision). Blepharoplasty surgery can reduce these visual problems by removing the overhanging skin and commonly eliminates these visual problems entirely.It can also give a more refreshed and youthful appearance and make a person look more alert.

As an oculoplastic surgeon I specialise in eyelid surgery and the blepharoplasty procedure. An oculoplastic surgeon is trained in cosmetic eyelid surgery. I deal with plastic surgery around the eyes as well as other cosmetic procedures that deal with this area. Oculoplastic surgeons also perform reconstructive surgery in this area which may be needed following trauma or cancer. A plastic surgeon may offer similar procedures but an oculoplastic surgeon specialises in this area alone and their training has been focused on this.

Here you can learn more about blepharoplasty, what you can expect realistically from blepharoplasty surgery and explore the benefits and risks of blepharoplasty to see if it is suitable for you.

What are the different types of blepharoplasty (scar or no scar)?

There are different approaches to the procedure:

TRADITIONAL BLEPHAROPLASTY

Skin incisions are made to the eyelid. This type of blepharoplasty is the transcutaneous approach. Upper blepharoplasty is the eyelid surgery to the upper eyelids and the lower eyelid surgery is known as lower blepharoplasty.

TRANSCONJUNCTIVAL APPROACH BLEPHAROPLASTY

Another approach is the transconjunctival blepharoplasty that leaves no scar on the eyelid skin and is performed on the lower eyelid.

SKIN PINCH BLEPHAROPLASTY

The skin pinch blepharoplasty addresses any excess skin to the lower eyelid. It is less invasive than the traditional approach and a quicker recovery.

CANTHOPEXY

A canthopexy can tighten the lower eyelid and helps lift the lower eyelid slightly to give a more almond shape to the appearance of the eye.

BROWPEXY

A browpexy is usually performed in combination to an upper eyelid blepharoplasty to slightly elevate the outer brow. The advantage of an internal browpexy means that there is no additional scar with this procedure.

How does the eyelid change with time?

As we age, our skin loses its natural elasticity, which results sagging. The underlying muscle, known as the orbicularis oculi starts to weaken which contributes to more sagging. The orbital septum is a layer under the muscle. This layer provides support and holds back the fat the surround the eye. With time the septum can weakens allowing the fat to bulge forward resulting in eye bags to the eyelids. This process occurs around the eyelids, the face and in many parts of the body. The cheeks start to descend in the face giving a more tired appearance. Dark circles can develop and lines that run down from the eyes to the cheek, known as tear trough lines become more obvious. With ageing there is a loss of fat in general. In youth the area around the eye is full of fat giving volume and a young appearance. With age there is a loss of fat and volume in general. This an ageing hallmark that others are able to notice easily. Interestingly, the fat in the upper eyelid nearer the nose tends to lose less volume than the fat on the outer upper eyelid. In some people they can develop an appearance of upper lid eyebags nearer to the nose.More modern techniques in surgery mean we no longer remove this fat during surgery but transpose or move it to the outer part of the upper eyelid to restore volume. The aim of this is to give a more youthful looking result.

Why is blepharoplasty done?

People consult a blepharoplasty surgeon if they have sagging or drooping of the eyelid skin.This can impact your eyes by making it difficult to completely open them or you may notice a pull down effect of the skin on the lower eyelids. If you notice you have eyebags alone to the lower eyelids with no extra skin a conjunctival blepharoplasty may be worth considering. An to remove the excess skin from the upper eyelids can help improve the vision whilst this is not the case on the lower lids. Blepharoplasty to treat the upper and lower eyelids can help restore confidence by giving a more younger and more natural appearance to the eyelids and face as a whole.

Blepharoplasty is an option if you have:

Blepharoplasty surgery may be covered by your medical insurance and depends on your policy. If the surgery is to help improve the blocked vision caused by the excess skin there is a possibility that it is covered.Surgery for cosmetic purposes to improve the appearance and give a younger and brighter look probably won’t be covered. Lower lid blepharoplasty is rarely done for medical reasons and is almost always done for cosmetic improvement. In the lower eyelid a bag appearance does not affect the peripheral vision and cannot be used to improve vision.

What are the risks of having a blepharoplasty?

Possible risks of blepharoplasty surgery include:

It is important to consult with your doctor to understand more about the procedure and to discuss the risks and benefits and if they apply to you. At the consultation with your surgeon you will be assessed and be advised on what can be achieved with realistic expectations. You should also be advised on the healing process for the eyelids as well recovery process and what to expect. Usually you can resume normal activities 2 weeks following the procedure although this will vary from person to person.

How you prepare for blepharoplasty surgery?

Before having a blepharoplasty you should choose a surgeon with extensive experience in the procedure. An Oculoplastic surgeon specialises in blepharoplasty and has had rigorous training in this. You should discuss:

Your medical history including what conditions you may have, and any previous surgery you have had..
Your expectations from the surgery with an open and honest discussion with your surgeon on what can be achieved.
An assessment of the eyes prior to surgery.
An assessment of the eyelids to ensure that you are suitable for the procedure.
Photography taken to assist with surgical planning and to provide necessary documentation for your medical insurer.

It is advisable to stop taking blood thinning medication such as apixiban, aspirin, warfarin, ibuprofen, and any medication that can cause increased bleeding during blepharoplasty procedure if it is safe to do so. This will be discussed with you to ensure that it is safe for you to do so and your surgeon will advise you how long before the operation this will be needed for..

If you are a smoker, try to stop smoking for 6 weeks before your blepharoplasty as this can help improve the healing.

It is best for someone to escort you home after the surgery and not to stay home alone following the operation for the first night.

What can you expect before the procedure?

Blepharoplasty is a day case procedure where you can go home the same day. Mr Ahmad Aziz, your surgeon will inject local anesthesia into your eyelids to numb the area prior to the surgery. If you are nervous a sedative can be given. General anaesthesia is less commonly used put is down to patient preference.

What can expect during the procedure?

Incisions are made along the fold of the eyelid to remove the excess skin. In some cases the underlying muscle and possibly fat will be operated on. The incisions are closed with sutures to give a natural appearance. The scar is usually placed into the eyelid skin crease to make it less visible.

What can you expect after the procedure?

All patients are monitored for complications for a short while following the surgery. You are able the same day to start your recovery and healing at home.

After surgery you may temporarily experience:

Blurred vision from the lubricating ointment applied to your eyes at the time of blepharoplasty
Watering of the eyes
Sensitivity to light
Double vision
Puffy, numb eyelids from the anaesthetic and blepharoplasty surgery
Swelling and bruising similar to having black eyes which will settle within a week
Pain or discomfort

Your doctor will likely suggest you take the following steps after surgery:

Use ice packs on your eyes every hour the night you go home after the operation. The following day, use ice packs on your eyes four to five times throughout the day to help reduce the swelling
Gently clean your eyelids and use prescribed medication.
Avoid straining, heavy lifting and swimming for a week after blepharoplasty.
Avoid strenuous activities, such as aerobics and jogging, for a week.
Avoid smoking.
Avoid rubbing your eyes.
Not to use contact lenses for about two weeks after surgery.
Wear darkly tinted sunglasses to protect the skin of your eyelids from sun and wind.
Sleep with your head raised higher than your chest for 3 days after the surgery.
After a few days, return to the surgeon to have stitches removed, if needed.

Seek medical attention immediately if you experience any of the following:

What are the results of surgery?

Most people are pleased with having had a blepharoplasty and benefit from a more refreshed appearance, no blockage of vision from overhanging skin and have more self confidence. The results can last for many years but the drooping may recur with time we we continue to age.

Bruising and swelling will mostly settle within 2 weeks allowing you to go out publicly. A reduced amount of swelling that persistswill generally resolve over a period of 2 months in most cases. The surgery does not address dark circles from skin pigmentation and crows feet from aging and these may persist following surgery.

Surgical scars can take months to fade fully and are within the skin crease to make them less noticeable. Protecting your eyelids from sun exposure is important to give the best results possible.

TransConjunctival Blepharoplasty

Lower eyelid eye bag surgery with no skin scar

Transconjunctival blepharoplasty is a technique that is gaining popularity in performing eyelid surgery to the lower eyelid. It requires more surgical skill as well as a comprehensive knowledge of the anatomy of the lower eyelid and upper cheek in order to be performed correctly. The standard transcutaneous approach leaves a small scar hidden just under the lower eyelashes. For those that have excess skin to the lower lid the traditional approach may be considered to address this.

WHAT HAPPENS DURING THE PROCEDURE?

TransConjunctival and transcutaneous blepharoplasty are the approaches used to rejuvenate the lower eyelids when it comes to eyelid surgery. The transcutaneous approach involves an eyelid skin incision the reach the eyeballs and address the eyelid fat and muscle as well as remove any excess skin. The transconjunctival approach involves an incision on the conjunctiva. This is the lining on the inner surface of the lower eyelid. The skin is left without a scar. This approach allowed the fat in the eyelid to be repositioned or removed. Repositioning the fat is helpful in softening the tear trough that becomes more prominent with age. This is an excellent procedure where the main concern is the eyeballs and there is little excess skin. For those that have excess skin the trans-conjunctival approach can be combined with a skin pinch blepharoplasty. It is thought that combining skin pinch with a transconjuncitval blepharoplasty has lower long term complications that a traditional transcutaneous blepharoplasty. Having said that the traditional approach still gives excellent results in most well selected cases.

ARE THERE ADVANTAGES TO TRANSCONJUCTIVAL BLEPHAROPLASTY?

The main advantage to a transconjunctival blepharoplasty is avoiding a scar to the skin of the lower eyelid. It is thought to have a lower risk of eyelid retraction which can develop early or years after surgery. This is because the orbiculares muscle is not disturbed during this approach and it is believed that surgery to this muscle can lead to retraction. Transconjunctival blepharoplasty is not without risk and any surgical procedure can have complications. In essence, with a conjunctival blepharoplasty is there is no external incision and and no visible scars on the eyelid.

WHAT ARE THE LIMITATIONS?

Transconjunctival blepharoplasty alone does not address any of the excess skin and fine wrinkles. For fine wrinkles, other treatments such as laser resurfacing may be of benefit. For excess skin only without eye bags, a transconjunctvial blepharoplasty is not recommended. A skin pinch blepharoplasty might be more suitable to remove the excess skin although this will not address any of the underlying excess fat if present.

HOW MUCH DOES A LOWER EYELID BLEPHAROPLASTY COST?

Pricing for blepharoplasty is open and transparent and you should be aware of all costs involved before having your surgery. An upper eyelid blepharoplasty might be covered entirely by your medical insurance if it blocks your vision. For a list of prices on blepharoplasty costs please visit our prices page.

ARE THERE ANY SIDE EFFECTS?

Side effects of surgery include swelling and bruising to the eyelids for the first 2 weeks. Contact lens wearers should avoid wearing their contact lenses for 2 weeks to allow the incisions to heal. Bleeding from where the eyelid fat has been manipulated can be a potentially serious side effect but this is rare. If it occurs it can lead to pain, profusion of the eyeball and decreased vision. If you develop any of these signs would would need an urgent medical opinion. Ageing is something that does not stop following surgery and although the clock may have turned back with your surgery, the ageing process will continue. With time changes may begin to show again.

A limitation of the trans-conjunctival blepharoplasty is that it does not address the skin, eyelid laxity or the outer corner of the eyelid. Fine wrinkles on the skin can be addressed with botulinum toxin injections such as Botox and laser resurfacing. Canthopexy is the procedure that addresses the outer corner of the eyelid by tightening the corner that may become loose with time.

HOW FAST IS THE RECOVERY?

You can do a few things to help speed up your recovery. This includes sleeping on a few pillows to keep the head elevated for 3 days following the surgery. This helps with the swelling and bruising. Ice packs used hourly on the day of the surgery and 4 times a day following this will also help with the swelling. Generally the bruising and swelling will develop over the first 4-5 days and settle after that. Most swelling and bruising should have settled after 2 weeks with minimal signs visible for up to 2 months. This of course varies from person to person.

You can use simple pain medication as needed. After 1 week makeup can be applied and you can go back to work without anybody knowing they underwent Conjunctival blepharoplasty. Contact lenses are best avoided for 2 weeks.

WHEN WILL I SEE THE RESULTS?

You will start to see the results after two weeks although there will still be some swelling.. Over time the appearance will continue to improve and the final result will be around 2 months following the surgery. It is best to avoid fourther lower eyelid surgery for 2-3 months following an initial procedure.

IS IT SUITABLE FOR ME?

Most oculoplastic surgeons would agree that blepharoplasty to the lower eyelid is one of the most challenging procedures to perform. This is because a lot of factors need to be taken into account such as the skin, the fat, the eyelid tone and laxity, if there is a positive or negative vector and combine these with the patient expectations. Patients should seek a surgeon experienced in this procedure and not a cosmetic surgeon who occasionally does it.

Skin Pinch Blepharoplasty

Lower eyelid blepharoplasty to reduce complication risk

The skin pinch blepharoplasty surgery to the lower eyelid that is modified from the traditional approach. The skin pinch is where the excess skin is removed leaving the muscle and fat underneath undisturbed. It is more commonly now combined with a transconjunctival blepharoplasty. For those with excess skin and little eyelid laxity a skin pinch alone may be suitable. Mr Ahmad Aziz is able to advise you at his clinic in Central London during the consultation.

WHO IS THE SKIN PINCH BLEPHAROPLASTY SUITABLE FOR?

This procedure is suitable to those with excess lower eyelid skin and no evidence of eye bags. The Lower eyelid itself should not be lax and in these cases a skin pinch alone may be sufficient. It is increasing being combined with other procedures such as a canthopexy if there is eyelid laxity or a transconjunctival blepharoplasty if the eye bags are prominent.

WHY DO A SKIN PINCH BLEPHAROPLASTY?

The skin pinch tries to remove excess skin in lower eyelid surgery without disturbing the underlying muscle to reduce the risk of complications. As the deeper layers of the eyelid in this procedure are left undisturbed the risk of lower eyelid retraction is theoretically lower although it can still happen. Surgery on the deeper layers results in more scarring inside the eyelid under the skin, more eyelid swelling and a greater risk of malposition or eyelid retraction. Taking too much skin in a skin pinch can also lead to eyelid retraction and it is therefore essential that the surgeon is able to take just the right amount and not too much.

WHAT ARE THE PROCEDURE LIMITATIONS?

This skin pinch only addresses the lower eyelid skin. For some patients they do not just have skin laxity but also have laxity to the lower eyelid itself and need the eyelid tightened with a canthopexy. Patients with significant eyelid laxity that is not treated at the time of blepharoplasty have a higher risk of developing eyelid malposition.

ARE THERE ANY COMPLICATIONS?

Although the skin pinch blepharoplasty is less invasive, all surgery has risks. The skin pinch has a lower risk of internal eyelid scarring but everyone is different and some can develop more significant scarring and malposition despite the deeper layers being left untouched. There is always a small risk of removing too much lower eyelid skin but this is assessed with the pinch beforehand. This is to ensure that the eyelid position does not change with a pinch prior to removing any skin. Although the results of the skin pinch blepharoplasty can last a lifetime some patients may have excess skin develop with time and develop eyelid laxity as the eyelids continue to age.

WHO FAST IS THE RECOVERY AND WILL I SEE THE RESULTS?

This skin pinch has a shorter recovery time than a traditional trans-cutaneous blepharoplasty and many can see good results after about 2 weeks. Like any eyelid surgery there will still be some residual swelling that will take longer to heal and some people do heal quicker or slower than others.

AM I A SUITABLE PERSON FOR THIS?

If you have excess skin to the lower eyelids with good eyelid tone and this is your only concern, then the skin pinch may be the correct procedure for you. It is not able to treat eyelid laxity, prominent eyebags or excess fat to the lower eyelid. Other approaches may need to be considered for these cases.