Eyelid surgery - cosmetic

About cosmetic eyelid surgery

As you get older, the skin around your eyes loses its elasticity and the muscles become looser. Your skin can develop into loose folds on your upper eyelids and deep creases under your lower lids. As the muscles become looser, the fat around your eye may also bulge forward and make your lower eyelids appear baggy. Cosmetic eyelid surgery can remove the excess skin and fat from around your eyes giving you a more youthful appearance.

Getting advice about cosmetic eyelid surgery

Talk to your GP about cosmetic surgery. He or she will know the specialists in your area and may be able to help you choose a surgeon or hospital.

Before deciding whether to have cosmetic eyelid surgery, talk to your surgeon about what you’re hoping to gain from the operation and the result you can realistically expect. For example, this kind of surgery can’t remove wrinkles at the corners of your eyes (crow's feet) or the dark shadows under your eyes.

What are the alternatives?

Wrinkles around your eyes can also be reduced using botulinum A toxin (eg Botox), chemical peels or laser treatments.

If you have cosmetic problems with other parts of your face, for example if your eyebrows are also drooping, a forehead or brow lift may be suggested to you instead.

Preparing for cosmetic eyelid surgery

Your surgeon will ask you about your health and your medical history. If you have thyroid disease, high blood pressure, diabetes or eye problems such as dry eye or glaucoma, your surgeon may ask you to see an ophthalmologist before your operation. An ophthalmologist is a doctor who specialises in eye health, including eye surgery.

Your surgeon will examine your eyelids and eyes, including testing your vision. He or she may also do a test to see how well your eyes produce tears.

Cosmetic eyelid surgery can be done using local or general anaesthesia. A local anaesthetic will completely block pain from your eyelids and you will stay awake during the procedure. If you’re having a general anaesthetic, you will be asleep during the procedure.

If you’re having a general anaesthetic, you will be asked to follow fasting instructions. This means not eating or drinking, typically for about six hours beforehand. However, it’s important to follow your surgeon’s advice.

Your surgeon will discuss with you what will happen before, during and after your procedure, and any pain you might have. This is your opportunity to understand what will happen, and you can help yourself by preparing questions to ask about the risks, benefits and any alternatives to the procedure. This will help you to be informed, so you can give your consent for the procedure to go ahead, which you may be asked to do by signing a consent form.

What happens during cosmetic eyelid surgery?

The time it takes to carry out your surgery will depend on the technique your surgeon uses and whether you’re having your upper or lower eyelids, or both, operated on.

Your surgeon will make cuts along the natural lines in your eyelids – along the creases in your upper eyelids and below your eyelashes in your lower eyelid. This means your scars will run along the natural folds of your eyes, which helps to hide them.

Excess fat, muscle and loose skin are removed, and the cut is closed using fine stitches. If only fat is removed and there is no excess skin, the cut may be made inside the lower eyelids, leaving no visible scar. Your surgeon may also use a laser to tighten any loose skin and reduce wrinkles. Using a laser this way doesn’t leave a scar, though the skin may be red for a few months afterwards. Excess fat may be made to shrink by application of heat (through cautery).

If you’re having the procedure done using a local anaesthetic, your surgeon may ask you to open and close your eyes at the end of the operation. This is to check that your eyelids are level on both eyes.

Your surgeon may apply ointment to your eye to stop it from drying out or to reduce the risk of infection. Small strips of sterile tape (steri-strips) may also be used to support your eyelids and hold the ends of the stitches in place.

What to expect afterwards

If you have had a local anaesthetic, you will usually be able to go home when you feel ready. If you have had a general anaesthetic, you may need to rest until the affects of the anaesthetic have passed.

You may need pain relief to help with any discomfort as the anaesthetic wears off.

You will need to arrange for someone to drive you home. Try to have a friend or relative stay with you for the first 24 hours after your operation.

General anaesthesia temporarily affects your co-ordination and reasoning skills, so you must not drive, drink alcohol, operate machinery or sign legal documents for 24 hours afterwards. If you're in any doubt about driving, contact your motor insurer so that you're aware of their recommendations, and always follow your surgeon's advice.

Your nurse will give you some advice about caring for your eyes before you go home. You may be given eye ointment to use at home and a date for a follow-up appointment.

Recovering from cosmetic eyelid surgery

The length of time it takes to fully recover from cosmetic eyelid surgery varies between individuals, so it's important to follow your surgeon's advice.

If you need pain relief, you can take paracetamol. Always read the patient information that comes with your medicine and if you have any questions, ask your pharmacist for advice.

Your stitches are usually removed three to five days after your operation. You may need to continue using sterile strips of tape to support your eyelids for about a week.

You will have some swelling around your eyes after the operation. You can help to reduce the swelling by applying a cold compress, such as ice wrapped in a towel. Don't put ice directly on your skin as this can damage your skin.

Your surgeon or nurse may give you other advice about what to do once you’re at home. The main points are listed below.

  • Keep your head up for a few days, for example, sleep propped up on pillows and don't bend down. This helps to reduce swelling and bruising.
  • Clean around your eyes with plain water.
  • Use any ointment or drops your surgeon has given you.
  • Don't wear eye make-up until your surgeon tells you it's safe to do so.

Your eyes may be blurry for a few days after the operation. Don't drive until your vision returns to normal.

What are the risks?

As with every procedure, there are some risks associated with cosmetic eyelid surgery. We have not included the chance of these happening as they are specific to you and differ for every person. Ask your doctor to explain how these risks apply to you.

Side-effects

Side-effects are the unwanted but mostly temporary effects you may get after having this procedure. Side-effects of cosmetic eyelid surgery include:

  • swelling – this may last for several weeks, though many people find that most of the swelling goes down within a week
  • bruising – this usually gets better between seven to 10 days after the operation
  • dry, itchy eyes
  • watery eyes
  • sensitivity to light and wind – wearing sunglasses may help
  • blurred vision – this usually improves after a few days.  

Complications

Complications are when problems occur during or after the operation. Most people aren’t affected.

Complications of cosmetic eyelid surgery are uncommon. They are listed below.

  • Bleeding under your skin (haematoma). This usually gets better on its own within a few weeks. However, if the haematoma is large, you may need an operation to drain it.
  • Small, white cysts can develop along the line where the stitches were. Your surgeon can remove these with a needle.
  • Bleeding behind your eye. This causes swelling, which can press on the optic nerve and cause partial or complete blindness. This is very rare.
  • Uneven appearance. Your eyes may not look identical or level, or the folds of skin and creases may be uneven. You may need another operation to correct this.
  • Blindness, although this is exceptionally rare.
  • Overcorrection of your drooping upper lid. This can lead to damage to your cornea and will need to be corrected with further surgery, otherwise your sight may be affected.
  • Bacterial infection, a risk with any sort of surgery. A sudden increase in redness, swelling and tenderness may be a sign that you have an infection. Treatment using antibiotics is usually required.

How long will it be before I see the full results of my surgery?

Answer

It can take up to a few months for the full results of your surgery to be seen. Swelling and bruising can take a few weeks to go down and any scars can take a few months to fade fully.

Explanation

The aim of cosmetic eyelid surgery is to make you look more rested and refreshed and to give you a more youthful look. It can take several weeks for swelling and any bruising to go down and for the full results of your surgery to be seen.

Any cuts made to your skin will form scars. These will look red to begin with, but will gradually fade over a few months until they become almost invisible. Your surgeon will also have made cuts in the natural folds and creases of your skin to hide any scars.

The changes to your eyelids after surgery should last for a long time. Any fat that you had removed won’t come back, so you should find that puffiness and bags won’t return. However, as you get older your skin continues to age and become less elastic. This means that your brow may droop or you may notice lines and wrinkles around your eyelids in the future. Some people have further surgery to correct this.

What qualifications should my surgeon have?

Answer

There is no single qualification for cosmetic surgery, so it’s important to get good advice and research surgeons and hospitals or clinics. Talk to your GP and make sure your surgeon is registered with the General Medical Council (GMC).

Explanation

If you’re thinking of having cosmetic surgery, a good place to start is to talk to your GP. He or she may know of surgeons in your area and will also be able to pass on any important health information from your medical records to the surgeon. If you don't want to involve your GP, you can find a surgeon yourself, but it's important to get as much information as possible about your surgeon's qualifications and experience. The Royal College of Surgeons advises people thinking of cosmetic surgery not be guided by price alone, and to be wary of advertising claims.

Consultant plastic surgeons are listed on the GMC’s Specialist Register and are fully trained in their speciality. Most surgeons who do cosmetic surgery have been trained in plastic surgery. However, surgeons from other specialities such as ENT (ear nose and throat), ophthalmology (eyes) and dermatology (skin) may also carry out some cosmetic surgery.

There are currently no regulations covering the training of cosmetic surgeons. However, all doctors setting up as cosmetic surgeons for the first time from April 2002 must be on the GMC's Specialist Register. You can find the Register on the GMC web site, by contacting the GMC directly or by asking for the information at your local library.

Before deciding to go ahead with cosmetic surgery, you should have an initial consultation with your surgeon. Don't be afraid to ask the surgeon questions about his or her qualifications and experience. Ask whether he or she belongs to a professional association, such as the British Association of Plastic Reconstructive and Aesthetic Surgeons or the British Association of Aesthetic Plastic Surgeons.

Will I have to pay for cosmetic eyelid surgery?

Answer

Cosmetic surgery isn’t usually available on the NHS. You will have to pay for an initial consultation with a surgeon to discuss your treatment. If you decide to go ahead with surgery you will have to pay for the operation. The cost usually includes your hospital stay, the use of the operating theatre and any tests.

Explanation

It’s unusual for cosmetic surgery, which is done to alter your appearance, to be funded by the NHS. This means that if you wish to have this type of surgery you will have to pay for it yourself.

When you first see a surgeon for an appointment you will spend time with him or her, discussing your problem and the options available to you. This may include surgery as well as other treatments. You will have to pay for this appointment.

If you then decide to go ahead with surgery you will be quoted a package price. This is the cost of all the treatment you will need before, during and after your operation. This includes your stay in hospital, the costs of the operation itself (including staff and operating theatre costs) and any recovery time or tests that are needed. The cost of this package price will vary from surgeon to surgeon and clinic to clinic.

It’s important not to base your decision about surgery, or any other treatment, on cost alone. Always consider the experience and qualifications of your surgeon and the quality of the hospital or clinic when making your decision.