Cosmetic Eyelid Surgery

Cosmetic Eyelid Surgery

There are many elements to aesthetic eyelid surgery, and very many different treatment options. It is most important to have a clear idea of what you would like to achieve and to find someone who can discuss the options with you.

As we age our face loses its elasticity and volume, it then stretches and is pulled downward by gravity. Our range of facial expressions repeatedly creases our skin to give us the classic deepening wrinkles of an older face. Many of these lines are welcome as they give “character” to our faces. Many, however, are less welcome, especially if they make us look older than we feel, or crease the brow to suggest that we are concerned when we feel carefree.

While botox and fillers remain very useful, if the skin has stretched too much, or the deeper tissues have been pulled too far downward by gravity, then a surgical approach is required. An eyelid lift (Blepharoplasty) is the most popular facial surgery in both the UK and USA. The upper lids and lower lids can be lifted and tightened with the scars hidden in the upper eyelid crease or the sub-ciliary line.

Your initial consultation is crucial to the success of any treatment.

It is your chance to explain and discuss your hopes and fears, so it may help if you write down a list of ideas and questions in advance. You may want to bring along a friend or family member for moral support or to ask additional questions.

It allows Mr Kamalarajah to review your medical history and lifestyle, photograph you (with your permission), assess your suitability for treatment and explain your options.

Finally, you can discuss possible procedures together so that you have a thorough understanding of what can be achieved and what risks there might be.

After the consultation, Mr Kamalarajah will write to your GP summarising the consultation.

Ten days prior to surgery, if safe to do so, stop regular aspirin to minimise the risk of bleeding (I would have discussed this with you at your initial consultation). Avoid using ibuprofen or other non steroidal anti-inflammatory agents.

I would see you again immediately prior to surgery to allow you to ask any final questions. I usually perform eyelid surgery under local anaesthesia, which numbs the area around your eyes, sometimes with intravenous sedation. The initial 10 seconds of the injection sting before the eyelid becomes numb. You’ll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)

If you are having general anaesthetic or sedation, a vein in the back of the hand has a needle inserted, after which there should be no pain at all.

After surgery, I lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anaesthesia wears off, but you can usually control any discomfort with paracetamol. If you feel any severe pain, call me immediately.

Post-operatively, I recommend you to keep your head elevated for several days, and use ice packs (10 minutes in every hour) to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.)

The wound may ooze slightly, if there is profuse bleeding you should contact me.
The stitches will usually be removed a week after surgery. Once they’re out, the swelling and discolouration around your eyes will gradually subside, and you’ll start to look and feel much better.

Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing, you’ll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and sunblock when you go out.

Keep your activities to a minimum for three to five days, and avoid more strenuous activities for about three weeks. It’s especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. Minimise alcohol, since it causes fluid retention.

Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they’ll fade to a thin, nearly invisible white line.

  • Infection of the wound. This is minimised with sterile technique and by using antibiotic ointment to the stitches and antibiotic tablets. Wound infection can be minor but can lead to a worse scar.
  • Large bruise or haematoma. This is minimised by taking it easy for 2 weeks after surgery, stopping aspirin and other anticoagulants if safe so to do, and regular use of ice packs. A haematoma may mean you have to go back into theatre to have the blood clot evacuated and then be re-sutured with the risk of a worse scar.
  • Visible scar. The cuts to the skin should fade to a thin white line. Not every scar heals equally well. A thickened or reddened scar can be improved with silicone scar remodelling gel, but the treatment needs to be continues for months to have a good result.
  • Dry eye. The surgery can cause inflammation to the eyelids that affects the oil producing glands in the eyelids. This can lead to a dry eye or can make a pre-existing dry eye worse. You may need to use additional lubricant drops for weeks to months post-op if affected.
  • Theoretical risk to vision. Any eyelid surgery carries the risk that an undiagnosed infection or bleed could damage the optic nerve. This is so rare that in comparison a normal car journey is a much greater risk to your vision.