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Blepharoplasty FAQ

Blepharoplasty surgery needs little specific preparation. However, if you do take a medication that can thin your blood, such as aspirin or ibuprofen, and are able to stop it for a while, it is advisable to do so for two weeks prior to surgery. This helps to reduce the amount of bruising after surgery. Similarly some over the counter remedies, such as garlic, ginger and ginseng biloba can also increase your tendency to bleed and should also be omitted for two weeks before surgery. If you are on blood thinning medication that cannot easily be discontinued then this does not stop you from having surgery but it should be discussed with your surgeon. Finally, smoking is never good for wound healing and it is always advisable to stop prior to any surgery if possible. 

In general, most people chose to be awake for upper eyelid blepharoplasty surgery. This allows a faster post-operative recovery and also allows you to open your eyes when needed during the operation, giving the surgeon an opportunity to assess your eyelid shape in this position.  Although you are awake, you will have local anaesthetic administered to your eyelids (with a tiny needle) so you do not feel any of the surgery itself. This is similar to when you go to the dentist and they numb your teeth. Many patients also chose to have some sedation for the surgery. This is given by an anaesthetist through a vein in the back of your hand. The sedation makes you feel relaxed, happy and sleepy but you can still open your eyes when required. It also stops you from remembering much of the operation. If you prefer to be completely asleep for the procedure then you can have a general anaesthetic, although this does require a longer recovery period in hospital after surgery. 

No, you should not feel any of the surgery itself, even if you are awake, as you will be given an injection of local anaesthetic to your eyelids just before the procedure starts. You may feel a small sting or scratch at the start of the injection but then the eyelids will then become numb. You will also receive some eye drops that numb the front surface of your eyes. The rest of your face will not be numb though and, if you are awake, you will feel things gently touching your face elsewhere. This will not be painful. If you are having sedation and need the sedation to be increased during the procedure then this can be done. 

No, you will not see instruments coming toward you. For most of the operation you are likely to have your eyes closed. Sometimes, especially during lower eyelid blepharoplasty surgery you will have a corneal guard covering the front surface of your eyes, which will also prevent you from seeing anything. Even with your eyes open, the instruments are usually too close to your eye for you to be able to focus on them and see them.  

Yes, you can close your eyes for almost all of the operation. You may be asked to briefly open your eyes or to look up at certain points during the procedure.  

That is not usually a problem and some patients do fall asleep for a while during surgery, especially when they are having sedation. If you need to be woken up then you will be.

Blepharoplasty is not usually a painful procedure and most people do not require any pain killers at all after surgery. However, the eyelids do feel swollen and tender and some people prefer to take some mild painkillers such as paracetamol. The eyes themselves can also feel dry following surgery and you may need some lubricating drops to use at least four times a day to help with this. If you have had a lower eyelid tightening or supporting procedure with a stich to the bone, then this area can feel tender to touch for several weeks. Very rarely patients can get a small scratch or dry patch on the front surface of their eye following the surgery. This is termed an abrasion and can be extremely painful, causing a sharp stabbing pain. The pain is instantly relieved with the use of anaesthetic eye drops. Usually, the abrasion heals within 24 hours and has no adverse effect on the eye itself or the outcome of surgery. 

Usually both eyes are padded for a short while after surgery to mimimise and bruising and swelling. In addition, if you have had sedation you may need to remain in the hospital for a short while to ensure that you are not feeling drowsy or unsteady in any way. Once the nursing staff are satisfied that you are fit for discharge you can go home. One pad is removed before you leave the hospital and the other pad the next morning. In some cases you may be given a second eye pad for you to use at home that night if it is in the evening and you are going straight to bed. If you are having all four eyelids operated on and it is evening surgery, it is often advisable for you to stay overnight with both eyes padded until the morning. This allows you to recover from any sedation and also minimizes post operative swelling and bruising.  

It is quite normal to feel slightly tearful and upset the first week after surgery. You will have had surgery to your face which is always an emotional event. Your eyes may feel tender and bruised which can make you feel vulnerable. Your eyes themselves may feel slightly dry and it may be more of an effort to blink. You will also have drops and ointment to apply to your eyes. This all takes its toll and can make some people feel slightly low. However, by the time the sutures have been removed one week after surgery you will begin to feel a lot better and by the end of the second week most patients are feeling very positive and are happy to show off their new eyelid appearance. There will still be some small changes relating to surgery that you will be aware of which need longer to settle but these are more subtle. 

In general I would recommend two weeks off work or without formal socialising for any eyelid surgery. This is because the eyelids can remain bruised and swollen for the best part of two weeks. By that time most of the swelling and bruising will have settled, although more subtle changes will still occur over the next few weeks and months.  

In general non absorbable skin sutures are taken out around one week after surgery. Some superficial absorbable sutures are removed during this time too but some deeper absorbable sutures supporting the tissues, especially in the lower eyelid, may be left to dissolve. Occasionally a permanent suture may be placed deep to the skin to suspend a structure, and this is not usually removed. Suture removal is done in the outpatient clinic and does not require any form of anaesthetic. You may experience very slight discomfort as the stitches are pulled out but it is usually very well tolerated. 

You will generally not have any tablets to take after blepharoplasty surgery. However, you will be given some antibiotic cream to apply to the wounds three times a day and some lubricating eye drops to instill four times a day for around two weeks. The cream helps to keep the wounds moist, minimizing scarring, and also reduces the small risk of a wound infection. However, although harmless to your eyes it can make your vision slightly blurry if it gets into them. The lubricating eye drops keep the surface of the eye moist whilst the eyelids are stiff and eyelid closure is weak. Always wash your hands before instilling the eye drops or applying the ointment. Some people find it easier to apply the ointment using the tip of cotton bud. 

Most patients are able to go about their lives fairly normally straight after blepharoplasty surgery. However, some basic after care is needed. The first night after surgery it is advisable to sleep on two or three pillows and with your face forwards so as to minimize any post operative swelling. If all four lids have been operated on, it is also helpful to have both eyes padded overnight. The eye pads can be removed the next morning and do not need to be replaced. During the day, you will have some lubricating drops to put into the eyes four times a day and some antibiotic ointment to apply to the wounds three times a day (see Do I have any medicine to take after surgery?).

You will also be given a eye mask to use six times a day. For the first week the eye mask is placed in the freezer for 15 minutes before use and then applied to the eyes for 10 minutes over a clean flannel. This helps to reduce swelling. For the second week, the eye masks should be gently warmed in the microwave for 5 minutes and then applied to the eyes for ten minutes, once again over a clean flannel. Do not apply the eye mask directly to the skin.

Most patients are able to perform most activities of daily living straight after surgery. However, it is advisable not to do anything too strenuous for the first two weeks as strenuous activity can put your blood pressure up and cause a late bleed from one of the wounds. Similarly, it is advisable not to bend over for prolonged periods. You are able to read, watch the TV, go for a walk and do most domestic jobs without any problems. However, you should avoid any dusty or dirty environments as these do increase the risk of a wound infection. Similarly, it is advisable to wear sunglasses after surgery when out and about as these protect the eyes and also reduce any discomfort from bright sunlight and wind. 

It is no problem if water touches your eyelids, even straight after blepharoplasty surgery. However, it is not advisable for the skin to be soaked. You can therefore have a careful shower from the first post-operative day as long as you take care not to get your face and eye too wet. Some patients feel that a bath is more controlled and they can keep their face out of the water more effectively. You are able to wash your face but again, take care not to soak the eyelid skin too much and not to rub the eyelids as the wounds are very fragile at the beginning and you can cause bleeding or opening of the wound (dehiscenece).  

You can drive from the day following your surgery so long as you are happy that your vision and visual field is not impaired. 

You are able to go for a gentle walk from the day after surgery. However, you should refrain from anything more strenuous for the first three weeks after surgery as such activity puts your blood pressure up and can cause a small bleed from one of the wounds. Swimming should be avoided for at least four weeks as there is an increased chance of a wound infection and soaking of the skin is not good for the skin along the wound edges. Cycling can be undertaken from two weeks after surgery with good eye protection. 

You can wear make up from two weeks after surgery as long as the wounds are well healed. However, it is still preferable to avoid make up for a further two weeks as the application and removal of make up does traumatise the wounds a bit. 

You can fly after surgery but this should be after you first post operative check and suture removal to ensure that your eyelids are settling well. Some airlines may not feel comfortable about having a passenger who has recently had surgery and therefore may refuse to let you on board, especially if bruising or swelling is visible. During any flight, people‚Äôs eyes do become dry due to the air conditioning so it is advisable to take extra lubricant drops and to apply these to both eyes regularly during the flight as your eyes will be vulnerable to dryness after blepharoplasty. 

Complete wound healing takes at least nine months to occur and scars continually change in their appearance over that time. Scars usually get increasingly red over the first three months as the wound healing process peaks. During this time they can also get slightly thickened and occasionally slightly lumpy. Following this, the scars begin to fade and usually end up as very fine pale lines that are extremely hard to spot or which look like a fine wrinkle. Very rarely some people can have an abnormal scarring reaction and may have some further treatment for this after blepharoplasty. If there are deep absorbable sutures in the wound, these usually dissolve around three months after surgery and can cause an increase in redness at this stage. Some patients may develop a small pustule caused by inflammatory cells removing the suture. This usually completely settles.

It is important to look after your scars and massaging them three or four times a day with some unperfumed moisturising cream does help to reduce thickening and keep the skin supple. This is not usually required along the thin upper eyelid skin but can be helpful at the outer corners of both eyes where the skin is thicker, especially if the type of surgery you are having requires deep sutures. In addition, it is advisable to protect fresh scars from the sun as this can make them slightly more red and they are also vulnerable to sun damage.