Mr Neil Toft

Consultant Plastic Surgeon

BSc MBChB MD FRCS (Plast)

 

0845 094 5657

 

 

LOWER BLEPHAROPLASTY INFORMATION

General Background

Blepharoplasty is the medical name for the operation which removes eye bags. The prefix "lower" simply refers to the lower eyelid, and hence lower blepharoplasty is also known as lower eyebag removal. With advancing age many people develop redundant skin on the lower eyelid, and some of the fat from within the eye socket prolapses (moves forward) making the situation worse. This operation removes the loose skin and excess fat which appear below the eye, generating a younger, fresher look to the eyes. Blepharoplasty is a relatively common procedure performed in both men and women, and can be performed in combination with other cosmetic procedures.


Before the operation

There is nothing special or complicated to be done by the patient. If you are on the oral contraceptive pill or HRT you should continue to keep taking it, and inform the surgeon or anaesthetist in the hospital. It would be advisable to stop any herbal medicines and avoid aspirin or ibuprofen-like drugs for 2 weeks before and after the operation.


The operation itself

Patients normally come into the hospital on the morning of surgery. The operation is usually performed under general anaesthetic and takes between one and two hours.
There are two main types of operation to remove lower eyebags. In the "traditional" operation there is a small incision just below the eye lashes, and the excess skin and fat are excised, removing the eyebag appearance. This type of operation is used in 90% of cases. In some young people, the main problem is of excess fat prolapsing forward rather than loose skin. Such patients benefit from the "trans-conjunctival" operation which is only suitable for younger patients who have no extra skin on their lower eyelids. The "trans-conjunctival" operation uses an internal approach to excise the fat and remove the eyebag appearance.
There will be no big dressing at the end of the operation but there will be small steristrips (paper stitches) over the lower eyelids. Patients are advised to stay overnight and go home the following day.


Post-operative follow-up and after care.

The steristrip dressing should be left alone and not interfered with. You will be given eyedrops to take home with you and it is important to use them as prescribed. It is vital that you rest and take it very easy for at least 2 weeks after the operation and it is essential to avoid all strenuous activity during this period - this includes all sexual activity. You wound be advised to take 10 days off work to allow any swelling and bruising to settle. It is critical that you do not bend down and lower your head as this increases the possibility of bleeding and bruising. Vigorous sport such as jogging or the gym should be avoided for 4 weeks.
At between 5 and 7 days you will be seen in the clinic and the steristrips and stitches removed. A check-up clinic appointment at 3 months after the surgery will be arranged for you.


Complications

All operations carry a risk of complications, and in lower blepharoplasty is no exception. If the "traditional" operation is performed there will be small scars just below the eyelashes which heal extremely well and with time become almost invisible. Very occasionally the scars may be red for a few months but they usually settle down by themselves without any treatment. They can be easily covered by make-up during this time. The "trans-conjunctival" operation uses no external incisions and therefore no scar is made.
The risk of infection is very low, about 1 %, and responds well to antibiotics. Many patients will notice that there is bruising of the lower eyelid area, the amount of which varies between individuals. This bruising resolves by 10 days. The most serious complication is of severe bleeding behind the eye itself after surgery. This is called a "haematoma" (collection of blood) and can interfere with vision. Great care is taken to avoid this extremely rare problem.
Some patients complain of dry or gritty eyes after the operation. This is related to changes in lubrication of the eye or swelling of the lining of the eye. Fortunately, these changes are temporary and resolve spontaneously. If the dryness or grittiness is a problem during this period simple lubricating eye drops can be prescribed.
One of the problems associated with lower blepharoplasty is of pulling down of the lower eyelid after surgery. In mild cases this is called "scleral show" when the white of the eye is visible above the lower eyelid, with the eye in its resting position - (some patients have this appearance naturally before any surgery has taken place). In more severe cases the pulling down of the eyelid is known as "ectropion", which is fortunately rare. At the time of surgery special stitches are used under the skin to avoid this happening.



Summary

Blepharoplasty is a procedure designed to reduce the extra skin and fat of the lower eyelid, and remove the eyebag. It gives good, predictable results and improves the appearance of the eyes.

Operation Time 1 - 2 hours
Anaesthetic General
Nights in hospital 1
Time off work 10 days
Return to normality/exercise 4 weeks