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Stephen John McCulley MB CHB, FCS(SA)PLAST, FRCS(PLAST) Plastic & Reconstructive Surgeon Procedure: Blepharoplasty (eye-lid tuck)
Indications for surgery
Eye-lid bags are a combination of excessive skin on the lid with or without bulging fat from under the eye-lid. Thiscan make the eye look older, tired or ‘puffy. The changes may affect only upper or lower eyelids or all of them.
Procedure in brief
The eye-lid bags can be composed of both skin and fat. In older patients it is usually extra skin with variableamounts of fat while in younger patients it tends to be mostly prominent fat that is the problem. The standardblepharoplasty essentially relies on removal of the extra skin and then removal or re-distribution of bulging fat.
The incisions are just below the lid margin on the lower lid and in the lid crease on the upper lid. These incisionsalso give access to the bulging fat, which can be excised or re-positioned. In some younger patients the incisioncan be made inside the lid to remove fat only (Trans-conjunctival blepharoplasty).
Incisions
The incisions on the eye-lids heal extremely well and can be very difficult to see. This is particularly true in theupper lid. Although a very good operation for male and female patients the use of eye shadow and mascara doesmake it easy to hide the scars earlier in the female patient. Length of surgery
Operation takes 60 minutes for the upper eyelids and 90 minutes for the lower lids. The upper lids can be doneunder local anaesthetic, while if all four lids are done I recommend general anaesthetic.
Nights in hospital
Can be a day case or one night stay.
Dressings and stitches
You will have small stitches and some tape dressings on the incisions. The stitches will be removed at the day 5 visit.
Postoperative instructions and recovery
You should be taking it very easy! Either relax in the hospital or at home.
You can be up and about but your eyes will be swollen and have stitches that are visible. Some sunglasses may be useful.
Your stitches will be removed and most of the swelling and bruising will settle over this time. You will be feeling much better from here onwards. You can start exercising gently and build it up over the next 10 days. Nights in hospital
Although your result will be noticeable early it will continue to improve over the first three months.
Dressings and stitches
You will have small stitches and some tape dressings on the incisions. The stitches will be removed at the day 5 visit.
Postoperative instructions and recovery
You should be taking it very easy! Either relax in the hospital or at home.
You can be up and about but your eyes will be swollen and have stitches that are visible. Some sunglasses may be useful.
Your stitches will be removed and most of the swelling and bruising will settle over this time. You will be feeling much better from here onwards. You can start exercising gently andbuild it up over the next 10 days. Final outcome
Although your result will be noticeable early it will continue to improve over the first three months.
Follow up
Wound check and removal stitches at day 5. Then see Mr. McCulley at 3 months and one year. NB There are no charges for any follow up appointment relating to your surgery.
Medicines and smoking
All medical history will be sought before any surgery. Do not take herbal medicines prior to surgery or for 3 daysfollowing (arnica etc). Also avoid aspirin, ibuprofen, and voltarol-based tablets. It is always better if you do notsmoke. If you are a smoker try and stop for five days before and after surgery as it can reduce the chances of complications. Scars on the eyes tend to heal very well. Although a little pink initially in the first few weeks they then fade towhite. Most patients will form extremely good quality scars over time. Some reach this quickly while others takelonger. A very small number produce red or raised scars although this is very rare on the eyelids. Time off work and socializing
Allow 1-2 weeks. People vary in recovery. Most patients are very comfortable at one week and it is only thebruising and swelling that may make you feel uncomfortable about going to work. Time to exercise
Walking a distance at 3 days, swimming by 10-14 days (if fully healed). Strenuous exercise (aerobics etc) should beavoided for 4 weeks. Although you may feel able to drive by 3-5 days you need to be completely free of pain and have no restriction ofvision to be covered by your insurance. This may be in your second week.
Potential complications
This is a routine operation that is a great success for the vast majority of patients. However, it is very important youunderstand what can go wrong as well as right with an operation. With blepharoplasty the potential problems are listed.
Ectropion - This is very uncommon. It is where the eye-lid gets pulled down and does not rest on the eyeball. Itoccurs in the lower lid if it is weak or the skin closed too tight. Great care is taken in the lower lid to avoid this andchecks will be made to ensure you are not at risk. If you are, then variations in the technique will be discussedwith you at consultation. Small degrees of asymmetry - The same operation will be performed both sides. There is a small risk of minorirregularities in the skin surface on one side and not the other. Scars - Patients can vary in the quality of scars they produce.
Wound breakdown - Although very uncommon this can result in delay in wound healing and scar quality.
Bleeding - A blood clot can collect under the skin needing you to go back to theatre for its removal. Infection - Also very uncommon but if occurs you will need a course of antibiotics. Eye injury - Injury to the eye itself is protected against but can occasionally occur. The most common of these is asmall abrasion to the cornea (front of eye-ball) which although painful heals without detriment in a few days.
On a fixed price direct scheme that covers all costs of surgery and medicines and any problems in the first 28 daysincluding a return to theatre.
Prices vary depending on hospital preference £1765 - £1800 (local anaesthetic daycase)

Source: http://www.mapperleypark.co.uk/pdf/blepheroplasty.pdf