Blepharoplasty

Blepharoplasty is the medical name for the surgical removal of excess eyelid tissue. The excess tissue is most commonly skin (dermatochalasis – excessive upper eyelid skin), but often fat and muscle are additionally removed from the eyelid, depending on the needs and appearance of each specific patient.

Excess skin and/or protruding fat can be present in one or both upper or lower eyelids, but is most common in the upper lids. The excess skin can droop in front of the eye, blocking the upper vision and can be a cosmetic problem.  It can also cause an uncomfortable heavy, tired sensation, particularly when reading or concentrating. Sometimes the skin can sit on the eyelashes causing discomfort, pushing the eyelashes into the area of vision or making it difficult to apply make-up. Finally, excess skin on the outer side of the upper eyelid sometimes tracks tears in the wrong direction (‘wicking’) causing a watery eye.

Excess skin most commonly occurs with aging, but sometimes occurs in younger age groups and can run in families. It is sometimes associated with ptosis (drooping of the upper eyelids).

Sometimes the eyebrow also descends with age and it may also be advisable to lift the eyebrow as well, which is often done with an internal hidden suture (internal brow pexy).

What will happen at my clinic appointment?

In clinic, Mr. Saul Rajak, who is an oculoplastic surgeon will examine your eyes, eye movements and eyelids. It can be helpful if you have old photographs (for example passport or driving licence). If ptosis is also detected, sometimes some further tests are occasionally required. Mr. Rajak will discuss the risks and benefits of surgery with you and the desired post-operative appearance as the surgery will be tailored to your eyelids. Then, Mr. Rajak  will take photographs of your eyes as both a clinical record and to help plan the surgery.

How is excess eyelid skin treated?

The most common blepharoplasty operation involves carefully assessing and marking the excess skin and excising (cutting out) it. The incision for the surgery is almost always hidden in the skin in the existing eyelid crease (skin fold) and is invisible a few weeks after surgery. The skin incision is closed with sutures that are removed 1-2 weeks after the surgery.

Upper lid blepharoplasty surgery takes about 20-35 minutes per eye and is almost always a day case procedure. It is usually done with local anaesthetic (injections to numb the eyelid skin). However, occasionally, for example for patients with severe tremor or anxiety, sedation may be recommended, which makes one very sleepy during the anaesthetic injections and relaxed and a little sleepy during the operation. If both eyes require blepharoplasty surgery, it is usually best to operate on both sides at the same time to give the highest likelihood of a symmetrical result.

Lower Eyelid Blepharoplasty

The lower eyelids can develop excess skin and fatty tissue and lower eyelid blepharoplasty can dramatically rejuvenate the appearance. Lower eyelid blepharoplasty is more invasive operation that is generally done either local anaesthetic with sedation or under general anaesthetic (asleep).

Drooping, In-turned and Out-turned Eyelids

Over time it is relatively common for the upper eyelid to become droopy (ptosis) or the lower eyelid to turn inwards (entropion) or outwards (ectropion). These conditions can be uncomfortable, unsightly and even impair the vision and can be corrected with routine surgical procedures conducted by an oculoplastic (eyelid plastic) surgeon.

What is eyelid Ptosis?

Ptosis is the medical name for drooping of the upper lid, which can be present in one or both eyes. A low lying upper lid can interfere with vision by affecting the top part of the visual field and may also be a cosmetic problem.

It might cause difficulty keeping the eyelids open, eyestrain or eyebrow ache from increased effort needed to raise the eyelids, and fatigue, especially when reading.

Ptosis most commonly occurs with aging, but can also be present from birth (congenital). It can also be caused by long-term contact lens wear, trauma, eye  surgery (including cataract surgery) and occasionally from neurological or muscle disease.

In clinic, Mr Rajak,  our oculoplastic surgeon (eyelid plastic surgeon) will assess your eyes, and eyelids. If you have ptosis it can be helpful if you show us old photographs (for example passport or driving licence). We will take photographs of your eyelid in clinic as a record of the eyelid position before treatment and to help plan the surgery.

Surgery for ptosis involves re-attaching/shortening/tightening of the muscle that raise the lid (the levator palpebrae superioris muscle). This is usually made through an incision in the upper lid which is hidden in a skin crease and will be invisible within a few weeks after the surgery. The skin incision is closed with sutures that are removed 1-2 weeks after the surgery.

Entropion

Entropion is the medical term used to describe an inward turning of the eyelid. It is usually a problem that occurs in older age and mainly affects the lower eyelid except in the Developing World where a disease called trachoma causes the upper eyelid to turn inwards.

Entropion causes the lower eyelid lashes to rub on the surface of the eye leading to excessive tearing, redness, mucous discharge and irritation and pain in the eye.  There is also a risk of permanent damage to the surface of the eye from the eyelashes scratching the surface of the eye.

At your clinic appointment, our oculoplastic (eyelid plastic) surgeon will assess your eyes and eyelids. You may receive treatment such as gels, drops or creams, and it is likely to be advisable to have surgery to return the eyelid to its normal position where the eyelashes face outwards and do not rub against the eye.

Ectropion

Ectropion is the medical term used to describe the outward turning of the eyelid. It is usually a problem of older age and mainly affects the lower eyelid. Most commonly it result from either the laxity and loss of elasticity of the skin that happens with ageing and/or from sun damage to the skin of the eyelid and cheek over many years.

Ectropion can lead to excessive tearing, redness, mucous discharge, irritation of the eye and be cosmetically unsightly. Very occasionally severe ectropion can cause permanent damage to the surface of the eye.

In clinic, our oculoplastic surgeon will assess your eyes and eyelids. Ectropion does not always need to be corrected and some individuals may prefer not to have intervention, but it may be advisable to surgically correct ectropion to improve the symptoms and appearance of the eyelid.

Ptosis, Entropion and Ectropion Surgery

Ptosis, entropion and ectropion surgery takes about 30-45 minutes per eye and is almost always a day case procedure.  It is usually done with local anaesthetic (injections to numb the eyelid skin) as this enables the surgeon to assess the eyelid position during the operation (by asking you to open and close your eyelids) and make adjustments as required. However, in some operations, for example for patients with severe tremor or anxiety, we may recommend sedation, which makes one very sleepy during the anaesthetic injections and relaxed and a little sleepy during the operation. If both eyes have ptosis, entropion or ectropion it is usually best to operate on both sides at the same time, in which case you may need a patch for an hour or so after the surgery but these would be removed before you go home so you will be able to see comfortably out of both eyes.