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    Blepharoplasty: This is the medical term for the operation, which corrects baggy eyelids.







Who should have a blepharoplasty?

The appearance of puffy or baggy eyelids occurs as a result of herniation (protrusion) of the small fat pads, which protect the eye from trauma. The fat pads protrude from within the bony cavity of the orbit into the soft tissues of the lid. This herniation is then followed, with the passage of time, by stretching of the skin of the lids and the result is the baggy eyelid. This bulging and drooping of the eyelids creates an impression of permanent tiredness in those who suffer from this problem even when that is not the case. While the condition is fairly common in most people with the passing of time, some families have a tendency to develop bagginess of the eyelids even in young people and here it is due to an inherited weakness in the supporting tissues of the lower eyelid. The time for doing this operation is, therefore, when the problem occurs irrespective of age.





How is the operation done?

The operation involves the removal of the excess skin and fat referred to above. Incisions are made on the upper lid in such a way as to allow the final scar to lie in the natural fold, which is seen when you open your eye and on the lower lid just below the eyelashes where there is a natural crease.

After the excess skin is removed, the surgeon's attention is turned to the fat. In each eyelid there are three or four pockets of fat which bulge forward out of the eye socket. These create the puffiness, which is a characteristic of this problem, and in order to correct this, the excess portion of the fat pads (as they are known) is removed. The skin is then sutured with a fine continuous nylon suture on the upper lid and fine individual silk stitches on the lower lid. The stitches are usually removed on the fourth or fifth postoperative day.

When the bulging of fat is present in teenagers, only the fat would need to be removed without any external skin incisions. This is done by making incisions on the inside of the eyelids where they will never be seen.

What form of anaesthesia is required? This operation is customarily performed under general anaesthetic but may be done under local anaesthesia with sedation.





How long does the operation take?

One hour.





Is the operation very painful?

No. There is some pain involved and you will be given an injection for pain if you need it on waking from the anaesthetic,

There is discomfort because of the swelling of the eyelids and the use of ointment in the eyes. The swelling increases to a maximum at about twenty four to thirty six hours and then subsides rapidly over the next two to three days. The bruising is usually gone by seven days.




How long will I need to remain in hospital?
You will be able to go home on the day of the operation. It is very rarely necessary for a patient to remain overnight in hospital.





How long will I need to hide from friends or miss work?

For five to seven days. Bruising differs from person to person but in the vast majority of cases is gone by seven days. Makeup can be used to disguise the bruising below the lower lids from the third day but must be avoided on the lids themselves for at least three to four days after the stitches have been removed to avoid the makeup entering the small holes in the skin made by the stitches before they heal.





What about exercise after the operation?

You should avoid strenuous exercise for at least seven to ten days after the operation.





Are there any complications associated with this operation?

Apart from the possibility of problems with the anaesthetic which are rare in healthy people who are in the care of a specialist anaesthesiologist and the occasional occurrence of small haematomas after the operation, the most significant potential complication is the removal of too much skin during the operation.

If this occurs on the upper lid, the patient will have difficulty closing the eyes, particularly during sleep. If on the lower lids, the eyelid margin may be dragged down creating a blood hound appearance.

Happily, in the hands of well-trained and experienced specialist Plastic Surgeons, these complications are extremely rare. If they do occur, however, they are easily correctable by the replacement of the missing skin with small full thickness skin grafts usually taken from behind the ear.

Blindness has been described after this operation but the incidence is so rare in world literature as to be regarded as statistically insignificant.

Blepharoplasty is one of the most effective aesthetic operations and the results last for many years.



What sort of anaesthetic is used for this operation?
While the operation can be performed under local anaesthesia with sedation, it is usually performed under a general anaesthetic.



Will I be very bruised and swollen?
The amount of bruising differs from person to person but most people are quite bruised and swollen for up to five to seven days.



How long will the operation last?
This operation, if performed by a trained and experienced plastic surgeon, will last for many years and is seldom redone.