Eyelids - The best philosophy in eyelid surgery is “Less is more.”

What happens during a blepharoplasty?

Initially, I will mark out with a surgical pen an ellipse of skin to be removed from the eyelids. The anaesthetist will give you an injection to make you slightly sleepy and then, after skin cleansing, local anaesthetic will be injected. The lower edge of the marked ellipse follows the natural crease of the eyelid and extends from the area just above the tear duct on the inner aspect of the eye to the outer edge of the eyelid open- ing near to the temple. I will gently pinch the skin above the incision whilst the eyes are closed to determine the maximum amount of skin that can be safely removed without pulling up on the upper eyelid margin or down on the brow. In order to avoid an “overdone” look the amount of skin re- moved is always much less. The skin is removed with a special cutting and cautery tip. If there is any orbital fat bulging into the area this is thinned conservatively to avoid any hollowing under the skin. The muscle to the upper eyelid is always identified and avoided during this type of surgery and any bleeding is controlled meticulously with electric and thermal cautery. The skin incision is closed with a combination of interrupted and continuous non-dissolving stitches.

The best philosophy in eyelid surgery is that “less is more”. eyelid diagram In the past surgeons were keen to excise larger amounts of fat and muscle in the hope of achieving “better” results now it is apparent that this can give a “false” look with possible hollows were tissue has been moved to excess. The illustration on the right depicts the shape of the most common incision made during upper lid blepharoplasty. The yellow shading on the inner aspect of the eye represents the medial fat pocket which may or may not be trimmed depending on individual requirements. If only the nasal fat pocket is bulging and there is no excess skin this fat can be removed from the inside surface of the eyelid with no external scar.

The final result is usually best seen at approximately six to eight weeks later.

The vast majority of patients describe only very mild discomfort which is easy to control by taking regular paracetamol for 24 - 48 hours. Applying cool compresses regularly in the form of bags of frozen peas has been found to be the most effective. Occasionally a small amount of blood-stained fluid can ooze from the wound in the first few days. Swelling is at its worse the morning after surgery and then gradually resolves over the next 10 days. A small amount of puffiness can remain in some patients for several months. Most people have a moderate amount of bruising but this too fades quickly in about 2 weeks. You may shower or bath any time but avoid excess soap and water near the eyes. Normal daily activities can resume within 48 hours but avoid anything too strenuous for a couple of weeks

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