Eyelid surgery (blepharoplasty)

What to expect from your blepharoplasty consultation and procedure?

Eyelid lift (blepharoplasty) is a commonly performed type of plastic surgery to remove excess skin or fat from upper and/or lower eyelids. Understanding what the whole treatment process involves can help to put your mind at ease.

At your initial consultation

Your consultant will take a full and thorough medical history to ensure any medical conditions that may affect your ability to undergo surgery are taken into consideration. They will also discuss in detail with you the risks and benefits of the surgery for you, the expected outcomes as well as talk you through the procedure. Clinical photographs may be taken, and a detailed examination of the eye, eyelids, facial skin and underlying tissues will be undertaken to ensure that the surgery will not compromise the health and integrity of your eyes.

During your consultation, you will have ample opportunity to ask questions about the surgery and follow up care.

Another consultation up to two weeks later is sometimes arranged to discuss any areas of concern before proceeding. This is often referred to as a “cooling off” period.

What to bring to your initial consultation

  • Old photographs from 5 – 10 years ago (or older if clear)
  • Passport or driving licence photographs can be examined using a special lens
  • Photographs of parents and siblings
  • List of your current medication
  • Pre-operative Instructions

Once you decide to go ahead with the blepharoplasty, you will be provided with detailed pre-operative information which may include fasting instructions if you are undergoing a procedure under sedation or general anaesthetic.

Patients are asked to refrain from taking any non-steroidal anti-inflammatory (NSAID) medication, such as ibuprofen and aspirin, for a week prior to their surgery.

You will need to inform your consultant if you are taking blood thinning medication, such as aspirin, apixaban, clopidogrel, aspirin and warfarin. The consultant may need to change the composition of your local anaesthetic to compensate for these or have the blood thinning medication reduced if your GP deems it safe to do so.

It is advised to refrain from alcohol consumption 2 days either side of surgery.

On the day of your surgery

Blepharoplasty is normally done in an outpatient setting. You are usually able to return home on the same day depending on the level of surgery required. When you come in for your treatment, you will be greeted by a nurse who will do the pre-operative assessment and go over the procedure with you. You will be asked to sign a consent form. Again, any questions you have will be answered prior to your surgery.

The following is advised

  • Bring in all your current medication and take them as usual unless otherwise advised.
  • Wash the face to remove makeup to reduce your chance of an infection.
  • Dress in comfortable clothes.
  • Remove your contact lenses.

The eyelid surgery itself

After meeting your consultant on the ward, a nurse will take you to the theatre anaesthetic room. Your surgeon will put very specific marks on the eyelid skin to guide the surgery. Soothing eyedrops will be applied to numb the eyes. The anaesthetist will then put a small cannula into your hand to give you sedation as needed. Once sedated, a little gentle local anaesthetic is given to the lids. You will not feel any discomfort.

You will then be taken to the operating theatre. Your consultant will drape your head and put in protective opaque contact lenses.

The surgery is usually performed using a very fine radiofrequency instruments and the procedure is painless. Fine skin stitches (the width of a human hair) are placed as needed. At the end of the procedure, the protective contact lenses are removed, then, antibiotic ointment, a soothing jelly gauze and soft eye pads are applied.

The procedure itself is very comfortable and patients can choose to have soothing music played in the operating theatre during their surgery. Many patients comment on the procedure being relaxing and restful, done in a calm environment.

After your eyelid surgery and follow up

Your surgeon will give you blepharoplasty aftercare instructions. They usually include:

  • After your eye procedure, you’ll be asked to wear a firm eye pad. The pad stays on until the doctor instructs to remove it, which depends on your surgery. Normally, if both eyes are operated on, one of the pads will be removed by a nurse one hour after the procedure, before you are discharged to go home, while the other pad can be removed the following morning at home. The overnight pad helps to reduce bruising in the more affected eye.
  • Immediately after surgery, you may have blurred vision due to antibiotic ointment, which is applied to your eyes.
  • You will be given eye drops and eye ointment for the wound before you are discharged.
  • You will also be given saline and sterile gauze to help clean the lids once the pad is removed.
  • A follow up appointment will be made for you.
  • If stitches need to be removed, they are done at a follow up appointment, usually 10 – 14 days post-surgery.
  • It is advised not to pick any crusts on the wound as this is healing. Just keep the wound moist with the antibiotic ointment.The stitches are designed to self-unravel and some will fall out by themselves.Cool compresses to the eyelids reduce any swelling after the dressing has been removed.
  • You can start wearing eye makeup between two days and two weeks after your stitches are removed, depending on your surgery’s complexity.
Dasbhaumik, Raj

Written in association with

Mr Raj Das-Bhaumik

Consultant Ophthalmic Surgeon

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