Blepharoplasty

Blepharoplasty or eyelid reduction is surgery for rejuvenitation of the eyelids, with the aim of improving the appearance of the eyelids ( upper or lower or both) as a result of the ageing process or due to some previous disease or trauma. It is commonly done as an operation by itself or can be combined with other operations like a facelift or with other treatment modalities such as dermal filler or filler injections.

Why have a blepharoplasty

Upper blepharoplasty: For some people as they age, the upper eyelid skins start to hang down over the eyelid margin. The eyes look tired and people have to look up to see sometimes. The eyelid skin that hangs down can impede vision.

Lower blepharoplasty

With age or in some disease processes, the lower eyelids can weaken and sag, or form bags that may or may not cause physical symptoms.

Sometimes people dont have any symptoms but do not like the shape of the eyes and would like them to look younger.

When to have a blepharoplasty

The decision to have blepharoplasty should be carefully made by you and in conjunction with the plastic surgeon. It is important to have an examination with Dr Mahajani who will also like to know a detailed history of any eye problems including vision, dryness, any eye changes. Sometimes blepharoplasty is not suitable and other procedures are suitable. It may be necessary for you to see your optician or eye surgeon ( ophthalmologist)

What would contra indicate blepharoplasty surgery?

A patient should be both medically and psychologically well for this surgery. There should be no significant eye conditions that prohibit the surgery, and the patient should be physically well or any medical problems under control. A blepharoplasty does not solve any social or psychological problems. Any patient who does not have realistic expectations is also not a good implant candidate.

Is the blepharoplasty a cosmetic procedure or is a medicare benefit available?

The answer is both, when eyelids lie over the lash margins for the upper eyelids, there is a medicare rebate. In the lower eyelids, unless there is some pathology, or there has been previous surgery, the blepharoplasty is cosmetic. A discussion with Dr Mahajani will help address this concern. If it is deemed purely cosmetic, then there is no rebate for that part of the operation.

Before the operation

Discuss any queries regarding the operation and post operation requirements with Dr Mahajani and his staff. Any fee enquiries please discuss with the practice administration. Do not smoke 2 weeks before the operation to 3 months after the operation. Smoking significantly affects the outcome of the blepharoplasty operation. Stop any medications you have been advised to by the anaesthetist. Go to your anaesthetic appointment. We will give you the name of your anaesthetist so you can make contact with them. We will give you your operation date and time. Please bring the completed consent form with you.

What does the operation involve?

The upper or lower blepharoplasty is usually done as a day surgery operation but if both are done together, I would tend to admit you for 1 night. Before the operation, we mark the incisions on the eyelid and photos are taken.

For the upper eyelid, an incision is made in the upper eyelid crease along the fold.

The overlapping excess skin is then removed. The skin is sutured in the skin crease. Some of the incision ends up on the side of the eyelid for a cm or so in the crease lines. The excess fat underneath the eyelid is cauterized. We do not cauterize the fat on the outer aspect of the upper eyelid as the tear gland lies in this area. Bleeding is controlled and the skin stitched. Dressings are applied.

For the lower eyelid, an incision is made under the eye lash margin and the excess skin and fat are similarly addressed as the upper eyelid. In addition, the tear duct is avoided in the inner lower eyelid. Occasionally for a sagging eyelid, the eyelid needs to be tightend and hitched up to the side of the orbit wall. Again some of the incision will follow the crease to the side of the eyelid.

After the operation

In most instances you go home or are admitted for one night. The vision is a little blurred that night because we have used some ointment to protect the eyeball during the operation.

We will give you specific instructions which include:

1. Resting over the next few days
2. Sleeping head up.
3. Take the antibiotic ointment and and any pain killers
4. Put some frozen peas into a towel and put that on the eyes.
5. There is an important symptom that you should be aware of - if you develop severe eyepain or there is vision loss, it could be a significant bleed behind the eyeball and needs emergency surgery - go to the emergency department ASAP and phone Dr Mahajani ( however this is extremely rare)

The practice will give you instructions to come back for dressings and for you to have the sutures removed after 1 week. Dressings are worn for 1 week and sunglasses for 1-2 weeks. Smeer the ointment over the suture or dressings line twice a day, and take pain relief as required.

Risks complications and expectations of blepharoplasty surgery

For most patients, the blepharoplasty is a safe and successful operation but we would like to discuss what to expect after the operation along with risks and complications.

The eyelids are initially swollen and will bruise. This bruising can extend down to the lower eyelids or upper cheeks also. Most swelling and bruising settles over 1-2 weeks but occasionally can take longer. 90% is gone by about 2 weeks but the rest of the swelling can take weeks to settle, the majority over 6 weeks.

The scars usually heal very nicely and are generally inconspicuous including the scars that are in the side eyelid creases. We cannot always predict outcomes of scars and occasionally scars stretch or thicken.

Asymmetry

There may be a little asymmetry after the blepharoplasty. Often this is a reflection of pre operative asymmetry and there is always asymmetry in between the eyelids. This is usually not noticeable and doesn need correction. Sometimes we tend to be more conservative than aggressive and a minor trimming of the upper eyelids or lower eyelids at ends of the incision are needed. This can be done under local anaesthetic and is the most common minor adjustment required after blepharoplasty.

With the ointment, the eyelids may be a little blurry. This does settle.

Pain

This is not usually a painful operation but there is some pain that takes 1-2 weeks in most to settle, sometimes a little longer. It is unusual to have more severe pain, this may mean some other problem and may need investigation including a referral to an eye surgeon ( this is rare)

Infections are very uncommon and usually settle with ointment or antibiotics. Severe infections like necrotic infections requiring surgery are extremely rare.

Bleeding

There may be a little bleeding but this should be slight. A very very rare complication is a bleed behind the eyelid called a retrobulbar haematoma. This causes significant eye pain and swelling and cause vision loss. So far Dr Mahajani has not seen this complication.

Blindness after blepharoplasty

It has been suggested that the risk of blindness is about 1 in 40000. Dr Mahajani has not seen or heard of this complication in his experience, but is due to retrobulbar bleeds. Even this is a most remote complication, with any operation on the eye or eyelid, blindness or injury to the globe should always be mentioned as a complication.

Other complications are rare, this include dry eyes requireing artificial tears on a permanent basis, injury to the lacrimal duct requiring surgery to address, problems with excessive tears.

In some blepharoplasty operations, too much skin is removed and may require an operation to fix. Dr Mahajani has not encountered this problem to date.

For the lower eyelid, the eyelid may not correct or evert causing a condition called ectropion. This causes the eyelid to show too much white of the eye or pink of the eyelid. Whislt uncommon, it needs explanation. If this occurs, it may correct over a few weeks but if it doesnt, then it needs correction with another operation. This is an uncommon but known complication of lower eyelid blepharoplasty. In addition, in the lower eyelids there may be some trimming required if a little part of the bags of the eyelids remain or there is significant asymmetry.

Realistic expectations from a blepharoplasty

It is important for your expectations to be realistic. We will try as far as possible , within the constraints of your physical health and the state of the eyelids and your wishes to help you achieve your goals. The surgeon cannot guarantee all expectations and nor can guarantee the longlasting effect as the ageing process continues and there may be other variations. Sometimes minor trimmings are required, and infrequently sometimes severe complications are encountered. We will endeavour to the best of our ability to help you where possible. Rarely, it may be required to seek the help of other specialists. If you however have any concerns at any time please feel free to contact the practice. You are always entitled to second opinions at any stage and we are happy to help facilitate this for you if you so desired.