Blepharoplasty Surgery in London

Eyebag and droopy eyelid surgery with or without canthopexy

Blepharoplasty is a type of surgical procedure that repairs droopy skin of the eyelids that develops with time. It is eyelid surgery that may involve a reduction excess skin, muscle and sometimes some of the underlying excess fat. As you age, your eyelids stretch and the muscles supporting them weaken. This results in the underlying normal fat to gather above and below your eyelids, causing the eyebrows to develop a sagging appearance , a drooping and aged appearance of the upper eyelids and the appearance of bags under your eyes. This is what some people consider to be an eyelid lift.

This combinations gives an appearance that makes you look older. The effect of the sagging skin around your eyes and block your side and upper vision (peripheral vision). Blepharoplasty can reduce these visual problems by a reduction of the skin and commonly eliminates them entirely.It can also give a more youthful appearance and make you look more alert.

As an oculoplastic surgeon I specialise in the blepharoplasty procedure and cosmetic eyelid surgery. I deal with plastic surgery around the eyes as well as other cosmetic procedures, cosmetic surgery and reconstructive surgery in this area. A plastic surgeon may offer similar procedures but an oculoplastic surgeon specialises in this area alone.

Is blepharoplasty is right for you? To find out what you can expect realistically from blepharoplasty surgery and explore the benefits and risks of blepharoplasty please read on.

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

There are different approaches to the procedure:

TRADITIONAL BLEPHAROPLASTY

The traditional approach that also address the extra skin with upper eyelid surgery and lower eyelid blepharoplasty is the transcutaneous approach that is discussed on this page. Eyelid surgery to the upper eyelids is known as upper blepharoplasty while the lower eyelid surgery is known as lower blepharoplasty.

TRANSCONJUNCTIVAL APPROACH BLEPHAROPLASTY

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

SKIN PINCH BLEPHAROPLASTY

The skin pinch blepharoplasty is a useful technique to address any excess skin to the lower eyelid with less surgery than the traditional approach and a quicker recovery.

CANTHOPEXY

In addition to blepharoplasty a canthopexy may be required to tighten the lower eyelid and to lift the lower eyelid slightly to give a more almond shape to the eye.

BROWPEXY

A browpexy is commonly done in combination to an upper eyelid blepharoplasty to stabilise and slightly elevate the outer brow to give a more pleasing look. It is the minimal brow lift done at the same time. An internal browpexy means that there is no additional scar with this procedure.

How does the eyelid change with time?

With the aging process, skin loses its elasticity, creating an excess of skin that starts to sag. The underlying muscle, known as the orbiculares oculi loses its tone causing it to loosen which can create further sagging with the excess lax muscle underlying the skin. Under the muscle is a layer known as the orbital septum. This folds back pockets of fat the surround the eye. With age the septum can also loosen allowing the fat to come forward giving the appearance of eye bags in the eyelids. This process occurs not only in the eyelids but the loosening of the tissues occurs in many parts of the body including the face. The cheeks can also start to descend in the face giving a more tired appearance with dark circles and prominent lines that run down from the eyes to the cheek which are also known as tear trough lines. Another aspect of ageing that occurs with time is the loss of fat in general. When we are younger the area around the eye is full of fat volume giving a young appearance and as we age there is a loss of fat and volume in general which is an ageing hallmark. Interestingly, the fat in the upper eyelid nearer the nose tends to lose less volume than the fat on the outer aspect of the upper eyelid and this can also give an appearance of upper lid eyebags near the nose. It is important not to just get rid of this fat during surgery but to move it to the outer part of the upper eyelid to try and restore some of the fat volume lost during ageing and give a more youthful looking result.

Why is blepharoplasty done?

You may consider visiting blepharoplasty surgeon if you suffer from drooping or sagging of the eyelid skin that prevents your eyes from completely opening or notice a pull down effect on the lower eyelids. If you suffer from eyeballs alone with no extra skin a conjunctival blepharoplasty may be more suitable. A reduction of the skin and removal of the excess skin from the eyelids can help improve the vision. Blepharoplasty of the upper and lower eyelids can also give the eyes a younger and more alert appearance.

Blepharoplasty is an option if you have:

Insurance coverage for blepharoplasty surgery may depend on your policy and if the surgery is to help improve the blocked vision caused by the excess skin. If the surgery is only to improve the cosmetic appearance to give a younger and brighter look the most likely won’t be covered by your insurance policy. Lower lid blepharoplasty is almost always done for cosmetic reasons as the lower eyelid bag appearance does not affect the peripheral vision and cannot be used to improve vision.

What are the risks?

Possible risks of blepharoplasty surgery include:

To know which risks most apply to you talk to your doctor to understand more about blepharoplasty as well as the benefits and if they apply to you. At the initial consultation you will be assessed and given an indication at what can be achieved with realistic expectations as well as learn more about the healing process and recovery process. You will be told when you will be able to resume normal activities following the procedure. This way you can decide with your doctor if blepharoplasty is a good option.

How you prepare for blepharoplasty surgery?

Before having a blepharoplasty you will meet your Oculoplastic surgeon who specialises in blepharoplasty to discuss:

Your medical history including any previous surgery and current eye conditions.
Your expectations with an honest discussion about what can be realistically achieved.
A vision examination to check the eyes prior to surgery.
A physical examination of the eyelids to ensure that this is the correct procedure.
Eyelid photography which can help with surgical planning and to provide evidence for any insurance claim.

It is preferable to stop taking any blood thinner medication such as aspirin, ibuprofen, warfarin, apixiban and any other medication that can cause increased bleeding during blepharoplasty surgery. Your doctor will discuss these with you to ensure that it is safe for you to do so prior to your blepharoplasty and will tell you how long before the operation.

Stoping smoking several weeks before surgery can help improve the healing after blepharoplasty.

You should arrange for someone to take you home after the procedure and stay with you for the first night following the operation.

What can you expect before the procedure?

Blepharoplasty is usually done as a day case with Mr Ahmad Aziz in Central London where you can go home the same day. Your surgeon will inject local anesthesia into your eyelids to numb the area and you can also have medication through a drip to help you relax. General anesthesia can be used but it less common.

What can expect during the procedure?

Your surgeon will make an incision along the fold of the eyelid, removing some excess skin, possibly some underlying muscle and possibly fat, and closes the incision to give a natural appearance and hiding the scar within the eyelids natural creases to hide the scar as best as possible.

What can you expect after the procedure?

After surgery you are monitored for complications. You are able to leave later that day to recuperate and begin the 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?

Many patients are satisfied with the results of blepharoplasty and benefit from a more youthful appearance, better vision if the peripheral field was being obstructed and more self confidence with the reduction of the excess skin. The results of the surgery can last a lifetime but for others the drooping may recur with time. The surgery is not an outpatient procedure but you do go home the same day.

The bruising and swelling noticeably settle within 2 weeks resorting a more natural look giving you confidence in going out publicly and subtle swelling that the patient may notice will generally resolve over a period of 2 months in the majority of cases. Dark circles from skin pigmentation and crows feet from aging may still persist after the surgery.

Scars from the surgery can take months to fully fade but should be within the skin crease and well covered. You should protect your eyelids from too much sun exposure as you should do for the rest of your skin.

TransConjunctival Blepharoplasty

Lower eyelid eye bag surgery with no skin scar

Transconjunctival blepharoplasty is a relatively newer technique of performing eyelid surgery to the lower eyelid. Blepharoplasty is the eyelid surgery done to address the eye loose wrinkled skin and protuding excess fat that causes bulges to the eyelid. It is a more challenging technique that requires a comprehensive knowledge of the anatomy of the lower eyelid and upper cheek in order to be performed correctly The more traditional approach is the transcutaneous approach which leaves a small scar hidden in the lower eyelashes. This traditional approach is more useful for people who have excess skin that also needs to be removed at the same time.

WHAT HAPPENS DURING THE PROCEDURE?

TransConjunctival and transcutaneous blepharoplasty are both different approaches to eyelid surgery which aims to improve the appearance and rejuvenate the lower eyelids. An eyelid skin incision is created in the transcutaneous approach to remove or redraw the excess fat underneath and sometimes to remove any excess muscle and skin. With the transconjunctival approach, the incision is hidden on the inner surface of the eyelid so that the skin is left without any scar. The procedure is is used to remove or reposition any of the excess fat in the lower eyelids and to soften the lower eyelid wrinkle that is commonly known as the tear trough. This only works well when there is only a minimal amount of excess skin that does not require removal. As a result it is useful in younger patients with a small amount of excess fat and do not need any skin removal as well as old patients with minimal laxity in their skin where the aim of the surgery is just to correct the bulging or tear trough caused by the excess fat.Tr

ARE THERE ADVANTAGES TO TRANSCONJUCTIVAL BLEPHAROPLASTY?

Transcutaneous blepharoplasty limitations include a scar that usually hides under the lower eyelid lashes and malposition of the lower eyelids. Having a transconjunctival blepharoplasty can reduce the risk of these complications occurring. Transconjunctival blepharoplasty is also not without risk however and can have its own complications. The main advantage of the conjunctival blepharoplasty is there is no external incision and so there are no visible scars on the eyelid following the procedure.

WHAT ARE THE LIMITATIONS?

Transconjunctival blepharoplasty on its own will not treat the skin and remove any of the excess skin and fine wrinkles. For the excess skin and fine wrinkles, other treatments may be needed such as laser resurfacing to peel away the dead cells of the skin. If there is a lot of excess skin however, the transconjuncitval approach is not recommended and a transcutaneous approach is more suitable with can remove the excess skin as well as treat the underlying excess fat.

HOW MUCH DOES A LOWER EYELID BLEPHAROPLASTY COST?

We work on a fully open and transparent pricing model so that you are aware of all the costs involved before proceeding with your treatment. For a complete list of prices including blepharoplasty costs please visit our prices page.

ARE THERE ANY SIDE EFFECTS?

Transconjunctival blepharoplasty can always address problems of bulging fat by taking it out or repositioning it. As there is no surgery performed on the skin the procedure limitations include being unable to remove the extra skin, smoothing any fine wrinkles on the skin or lifting the outer corner of the eyelid. To correct these issues other treatments are required such as a chemical peel to the skin, laser skin resurfacing or a transcutaneous approach to the surgery and Mr Ahmad Aziz can advise you on what is most suitable during your consultation at the Central London clinic. Canthopexy is the procedure that helps to tightening the corner of the eyelid that can become lax with time or from prior Tightening up the corner of the eyelid due to aging, or from a prior surgery, is best managed by another type of eyelid surgery known as canthopexy.

Side effects of the surgery including eyelid swelling and bruising for the first week. The use of contact lenses immediately following the surgery should be avoided to allow the incision not he inside of the eyelid to heal. A serious side of effect of this approach to the surgery is bleeding from the site where the extra fat has been removed. This can cause pain. the eyeball to protrude forward and decreased vision. If there are any of these signs following the surgery you need to see your ophthalmologist urgently. As with all eyelid surgery the eyelid itself does continue to age with time and over the years raging changes may begin to show again.

HOW FAST IS THE RECOVERY?

After the surgery, the patient is advised to keep his head and upper body elevated for the first few days (particularly when sleeping). This helps the bruising and swelling around the eye to subside. A sterile strip will also be applied to the lower lids to keep them suspended and to provide pressure while healing. The strip can be kept in place for 2 to 3 days or until the inflammation of the lower conjunctiva is gone. Cold compresses may also be used to assist in the relief of bruising and swelling for the first 24 to 48 hours. Aside from inflammation, the patient’s vision will be slightly blurry for the first 24 hours due to the ointment that the practitioner will put onto the eyes.

Patients can have ointments, antibiotics and pain medication as needed. Massaging of the treated area must be done periodically in order to promote faster healing. The recovery period is about 5 to 6 days. After that period, the patient can put on a bit of makeup and go back to work without anybody knowing they underwent Conjunctival blepharoplasty.

WHEN WILL I SEE THE RESULTS?

Results of can be seen after a few days when the eyelid starts to heal although there will still be some significant swelling.. There will be further improvements over the following 2 months as the swelling settles and the eyelid recovers. . For this reason, further surgery to the lower eyelids should be avoided for at least 2 months.

IS IT SUITABLE FOR ME?

Most oculoplastic surgeons would say that blepharoplasty to the lower eyelid still remains one of the most technically difficult types of eyelid surgery to perform. Patients should seek an oculoplastic surgeon who is very familiar with this procedure and not a cosmetic surgeon who occasionally does it. Be sure to choose an oculoplastic surgeon who has trained in the area around the eye to ensure that they have the knowledge, training and experience to give you the best possible outcome.

Skin Pinch Blepharoplasty

Lower eyelid blepharoplasty to reduce complication risk

The skin pinch blepharoplasty is a blepharoplasty doe to the lower eyelid that is modified from the traditional approach. In the traditional approach the eyelid skin is operated on as well as the fat under the skin and muscle to give a smoother lower eyelid. The skin pinch is where the extra skin is operated on with a pinch procedure and the underlying fat and muscle is left alone and not interfered with.

In younger patients the most common lower eyelid concern is the appearance of bags in the lower eyelid with little or no extra skin. Mr Ahmad Aziz advises that the skin pinch tends not to be suitable in these cases and can advise you in his Central London clinic.

WHO IS THE SKIN PINCH BLEPHAROPLASTY SUITABLE FOR?

This procedure tends to be more suitable to people who have developed laxity of the lower eyelid skin with time and possibly some lower lid wrinkles. They tend to not have prominent eye bags or at least are not concerned with them if they are present and prefer to treat the eyelid skin alone.

WHY DO A SKIN PINCH BLEPHAROPLASTY?

The skin pinch tries to minimise complications of lower eyelid surgery as it is less invasive. In some patients having traditional lower lid blepharoplasty the lower eyelid can end up being pulled down giving an eyelid malposition. As there is less surgery involved in the skin pinch blepharoplasty the risk of this is less as there is less surgery being performed to the deeper layers of the eyelid. Surgery on the deeper layers results in more swelling to the eyelid, more scar formation inside the eyelid and a higher risk of malposition. The skin pinch blepharoplasty does however require a surgeon who knows how to assess and take just the right amount of skin so that there is enough not to cause malposition. There should also not be too much skin left otherwise the problem of excess skin will remain.

WHAT ARE THE PROCEDURE LIMITATIONS?

This procedure corrects the excess skin alone. 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 has lower complications, there is still a risk of malposition. Whilst there is a lower risk of scarring to the deeper layers of the eyelid everyone is different and some patients can develop more significant scarring and malposition. There is also the risk of taking too much skin but this is assessed with the pinch first to make sure there is no eyelid malposition prior to removing any skin. Although the effects tend to last a lifetime there are some patients who need further procedures in the future particularly if there is generalised laxity to the lower eyelid.

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

As the deeper layers of the eyelid are not involved in this procedure, it is associated with a shorter recovery time. People with the skin pinch tend to recover after about 2 weeks although there still maybe some residual swelling. Of course every person is different and some people heal quicker than others.

AM I A SUITABLE PERSON FOR THIS?

The skin pinch is a useful technique used to manage excess skin in the lower eyelid. It is not useful in dealing with excess fat or prominent eyebags. For these cases a traditional or conjunctival approach might need to be considered.