What happens before eyelid surgery?

Before your eyelid surgery, you will meet with your surgeon to discuss why you want the surgery and what you want to achieve by going under the knife. During this chat, the surgeon will make a note of any illnesses you may have and your medical history. In particular, you should inform your surgeon if you have ever had any history of thyroid disease, diabetes, high blood pressure, or an eye disorder.

The surgeon will also make a note of any medications that you are taking, including any herbal remedies that are not prescribed by your doctor. They will then examine your face, skin, and eyes and may take some photographs for your records. Additionally, the surgeon will measure your height and weight to ensure it's safe for you to go through with the surgery. If you are pregnant or overweight, your surgery may be delayed.

How is the surgery performed?

Blepharoplasty surgery can often be performed under a local anaesthetic with sedation, but it may require a general anaesthetic. Your surgeon will need to know if you are taking any medications to reduce the risk of blood clots.

Upper eyelid surgery usually involves the following:

• A cut is made along the eyelid crease in the natural skin fold of your eyelid
• Excess skin, fat, or muscle is removed
• The incision is closed (the natural fold of the eyelid will usually hide scarring)

Lower eyelid surgery will usually involve the following:

• An incision is made either just below the lower eyelashes or on the inside of the lower eyelid
• Fat in the bags under the eyes is either repositioned or removed (the surgeon may also remove a small amount of skin)
• Muscles and tendons are supported if necessary
• The incision is then closed

The surgeon will usually apply some thin, sticky strips to the area called suture strips. These help support the eyelids after surgery and are most commonly removed around one week later.

Upper eyelid surgery tends to take around one hour, while lower eyelid surgery will take up to two hours on average. Most patients will be able to return home on the same day as the surgery.

How can I help the operation succeed?

The best thing you can do to ensure the operation is successful is to be as healthy as possible. It's important that you keep your weight steady with a healthy diet and regular exercise. Your doctor can provide advice on how to be healthy and ready for surgery.

If you smoke, you should aim to stop around six weeks before the surgery. This will help to reduce the risks of complications. You don't need to worry about removing any hairs or eyelashes near where the cuts will be made. However, you should have a shower and wash your face before the operation to ensure you're as clean as possible.

What are the risks or possible complications of eyelid surgery?

As with all operations, there are some risks involved with eyelid surgery. Although these risks are unlikely, it’s important to be aware of them before you go through with your surgery. Discuss potential post-eyelid surgery problems with your surgeon beforehand to ensure you understand the possible risks and complications and what you can do to prevent them.

The possible eyelid surgery problems that you should be aware of include:

• Scarring - You can expect scars from the surgery. These will usually be quite red and prominent at first, but they should eventually fade over time. Occasionally, scars may become thicker, wider, redder, or more painful, and you may need surgery to correct them.
• Bleeding - Although rare, bleeding is possible and can range from a mild inconvenience to an emergency. You may need additional treatment or surgery to stop the bleeding. If there is bleeding into your eye socket, you should contact a doctor at once, as the increased pressure in the eye socket can cause blindness. A build-up of clotted blood underneath the surgery site can delay the healing process or cause additional scarring, and you may need another operation to remove this.
• Swelling, pain, or bruising - There will be some bruising and swelling around the eyes after the surgery, and this can take several weeks to settle. There may be some long-term pain, but this is uncommon.
• Infection - If the wound becomes infected, you may need another operation or a course of antibiotics. This can affect the final result of the operation.
• Extrusion - This is where deep stitches protrude out through the skin. Your surgeon can easily rectify this side effect.
• Healing problems - Sometimes, wounds may take longer than expected to heal. This problem is usually fixed by dressing the wounds but in extreme cases, you may need a further operation to remove the unhealed tissue. Smokers are more likely to have problems with healing.
• Cysts - In some cases, small white cysts may appear along the stitch line. These are nothing to be concerned about, but may require treatment to remove.
• Asymmetry - Sometimes, the eyes may not be symmetrical after the surgery. Most people have a degree of asymmetry in the eyes. However, the surgery may make this more noticeable.
• Reduced or increased sensation - After the operation, the skin close to the scar may become more or less sensitive. In some rare cases, this change in sensation may be permanent.
• Eyelid position problems - For the first couple of days after the surgery, the eyelash line of the lower lid may be slightly pushed away from the eye because of the swelling. This will usually settle down on its own. However, some people require a further operation to fix this issue. If too much skin has been removed, this can cause your eyelid to become so tight that it can't close properly, a condition called lagophthalmos. This can lead to dryness of the eye, and you may need a small skin graft to fix this problem.
• Damage to deeper structures - On rare occasions, surgery can damage deeper structures than fat, such as the nerves, eyes, blood vessels, or muscles. This damage may be temporary or permanent. In extremely rare cases, blindness may occur. Any temporary effects from the surgery should disappear within six months. The surgeon may scratch the surface of your eye during surgery, and you may have to use an antibiotic ointment for a few days. If the operation involves removing some fat from your lower eyelid, this can damage the eye muscle within the fat and can cause double vision. This may be permanent, and you will likely need a second operation in this case.
• Changes over time - The results of eyelid surgery will usually last for 5-10 years, or sometimes longer. Your eyelids change over time due to ageing, sun exposure, or other causes, and so you may need additional surgeries in the future to maintain the results.
• Unsatisfactory results - In some cases, you may not be satisfied with the results of the surgery. This could be due to the appearance of the eyelids, the way they feel, or the shape of the eyelids. If this is the case, you may need a second operation to ensure you are satisfied with the result.
• Allergic reaction - In rare cases, allergic reactions to the tape, solutions, or stitches may occur. This may result in a need for additional treatment.

You should report any negative side effects or symptoms to your surgeon if you are concerned, and certainly

What are the side effects of eyelid surgery?

After your eyelid surgery, it is likely that you will temporarily experience the following side effects:

• Irritated, watery, or sensitive eyes, lasting for several weeks
• Numb, puffy eyelids that are difficult to close at night
• Scars that will eventually fade
• Bruising that has the appearance of a black eye

All of these side effects should reduce over time, but if you find that they persist, speak to your doctor as this might be a sign that something has gone wrong with your surgery, or that you need further treatment.