Cosmetic Eyelid Surgery

Dermatochalsis is drooping or folding of excess eyelid skin. It is caused by the skin loosing its elasticity, usually due to age. It may be associated with prolapse of orbital fat causing the eyelid to bulge (eye bags).

Top - Before upper eyelid blepharoplasty.  Below - After upper eyelid blepharoplasty.

Specialists who perform this surgery:

Mr Austin McCormick

Blepharoplasty (Eyebag) Surgery

What is dermatochalasis?

Dermatochalsis is drooping or folding of excess eyelid skin. It is caused by the skin loosing its elasticity, usually due to age. It may be associated with prolapse of orbital fat causing the eyelid to bulge (eye bags).

What is an eyebag?

Some people develop bulging in upper and lower eyelids. This is often caused by orbital fat. Surgery can be carried out to remove or reposition this fat and therefore reduce the unwanted appearance of it.

What is Blepharoplasty Surgery?

Depending on an individual, blepharoplasty surgery is the removal or repositioning of eyelid skin, muscle or fat. The procedure can be carried out in the upper eyelid, lower eyelid or both.

Upper eyelid blepharoplasty:

At the beginning of the operation the amount of skin to be removed will be carefully assessed. Marks will be drawn on the eyelid with a sterile marking pen to assist the surgeon during the procedure.
After this, local anaesthetic will be injected under the skin.
The skin is removed with surgical instruments. Depending on your particular problem, the muscle beneath the skin may be preserved or partially removed. If there is fat prolapse in the upper lid this may be treated with partial fat removal.

Sutures are placed to reform the natural skin crease in the eyelid. The skin edges are sutured together with a continuous suture that is removed one week later.
This operation may be carried out under general anaesthesia, local anaesthesia plus intravenous sedation or simply local anaesthesia on its own.

Lower eyelid blepharoplasty:

There are 4 elements to lower lid blepharoplasty: skin, muscle, fat and eyelid laxity. The procedure you have will be tailored to suit your problem.
Fat prolapse in the lower eyelid gives the appearance of ‘eye bags’. This fat can be excised or repositioned over the orbital rim to create a smoother transition from the eyelid above into the cheek below as is seen in youth. Surgery on the prolapsed fat may be carried out without a skin incision from the inside of the eyelid – transconjunctival  or via a skin incision just beneath the eyelashes – transcutaneous.
The lower eyelid usually needs to be tightened at the time of surgery. Even a small amount of lid laxity can lead to postoperative lower lid retraction if not addressed at the time of surgery. This tightening is called ‘lateral canthal suspension’ and involves a permanent suture from the lid to the bony rim of the orbit.
The orbicularis muscle, which lies directly beneath the skin is often tightened by placing sutures from it to the bony rim of the orbit – ‘orbicularis suspension’.
Lower eyelid skin is excised in much smaller amounts than in the upper lid. This is to avoid the unwanted side effect following surgery of eyelid retraction.

This operation may be carried out under general anaesthesia, local anaesthesia plus intravenous sedation or simply local anaesthesia on its own.

What is Eyebrow Ptosis Surgery?

Eyebrow ptosis surgery is the fixation or elevation of the eyebrow to overcome the downward descent of the eyebrow that occurs with age or facial paralysis. It may be combined with blepharoplasty.

Internal brow fixation surgery:

Permanent suture(s) are placed underneath the eyebrow, fixing it above the bony orbital rim. This is performed through the same incision and at the same time as upper lid blepharoplasty.

External direct brow lift:

The skin is removed directly above the eyebrow in a crescent shape to lift a descended eyebrow. Before surgery the area to be excised will be carefully assessed with you sat up. Marks will be made on the skin with a sterile marker pen. This is a more powerful operation than internal brow fixation but has the disadvantage of a skin incision that may be noticeable. After the excision the skin is sutured together in a deep layer and separate skin layer.

What are the benefits of  Blepharoplasty and Eyebrow Ptosis Surgery?   

Surgery can produce a refreshed appearance of the eyelids and help to overcome the tired look that eyebags, excess eyelid skin and eyebrow ptosis can cause.
Dermatochalasis and eyebrow ptosis may reduce the visual field due to the hooding of skin over the eyelid. Surgery may improve this.
In an attempt to raise the eyebrow and excess skin, people often subconsciously over use the forehead muscle. Fatigue of the frontalis forehead muscle may cause discomfort, particularly at the end of the day and exacerbate forehead wrinkles. Surgery can improve this.

What are the risks and possible complications of surgery?

Infection might present as increased swelling and redness of the skin. There might also be yellow discharge from a wound. Infection is treated with antibiotics.
Bleeding may present as fresh blood oozing from the site of surgery or a lump appearing near the wound after the operation. Simple pressure on a skin wound is usually enough to control minor bleeding. In rare cases, a deeper haematoma may require a return to theatre to prevent loss of vision.
Loss of vision: Total loss of vision in an eye due to this surgery is extremely rare ( less than 0.1% or 1 in 1000 operations ). A blood haematoma collecting in the orbit, behind the eye, may compress the nerve of vision and threaten eyesight. It is extremely rare for this to occur. It presents as pain, loss of vision and a bulging forwards of the eyeball and is an emergency. If not treated quickly it can lead to permanent loss of vision.
Scar: Whenever the skin is incised a scar may form. Every attempt is made by the surgeon to minimise and hide scars but sometimes they can be visible.
Further surgery: Your surgeon will take great care to excise the correct amount of skin for your eyelid. It is possible for too much or too little to be excised. Under excision may be addressed by further surgery to excise more. Over excision of skin may cause eyelid retraction, ectropion, exposure of the eye, corneal ulceration, loss of vision and may require further surgery to correct this. Emergency return to theatre due to bleeding is extremely rare.

Dry eye: If you have a pre-existing dry eye problem or weakness of the eyelids, these symptoms may be made worse by blepharoplasty surgery. Your surgeon should investigate this prior to surgery and advise you accordingly.

Skin puckering: If deep sutures are placed, there is a risk of puckering of the skin above them or discomfort. This is usually temporary but may necessitate further surgery to remove the suture if persistent.

Loss of sensation: After surgery there may be numbness of some of the skin around the incision. This is usually temporary returning gradually over months. Rarely it is permanent and may involve larger areas like the forehead.

Inflammation: Swelling and bruising of the skin after surgery always occurs but in varying degrees. A big improvement will be noticed after 2 weeks, with most resolved 3 months later. Rarely inflammation may cause small lumps to form called granulomas. Most resolve spontaneously but some require further surgery.

Altered appearance: One of the goals of surgery may be to positively improve appearance. Some people may be unhappy with the appearance after surgery due to: asymmetry of facial features; hollowed appearance; eyelid contour or eyelid position changes.

What are the alternatives to surgery?

Non surgical treatments are available to rejuvenate the eyelids. Restylane filler can be used to help lower eyelid bags and Botox can be used to raise the eyebrow non-surgically. Some patients weigh up the risks and benefits of surgery and decide to put up with the problem, feeling that the risks of surgery are too great for them – it is an individual decision.

What will happen if I decide not to have surgery?

You will continue to have a dermatochalasis and eyebrow ptosis however this will not damage your eye in any way.

What will happen before surgery?

Before the operation you will attend a consultation with Mr. McCormick. He will listen to your problems, examine your eyes and face and explain treatment options including risks and benefits.

Mr. McCormick will ask you about your problem. He will also ask about other medical problems you have, medications you take (bring a list or the tablets themselves with you) and any allergies . 

He will examine your eyes and will determine if you are suitable for surgery. He will explain exactly what type of surgery he could carry out. If you are to proceed with surgery the operation will be discussed in detail. This will include any risks or possible complications of the operation and the method of anaesthesia.
You will be asked to read and sign a consent form after having the opportunity to ask any questions. You may also see a preoperative assessment nurse. He/She will carry out blood tests and an ECG (heart tracing) if required. They will also advise you if you need to starve before the operation.

What should I do about my medication?

In some cases you may be asked to stop or reduce the dose of blood thinning tablets like: warfarin, aspirin, clopidogrel (plavix), dipyridamole (persantin). This decision is made on an individual basis and you should only do so if it is safe and you have been instructed by your GP, surgeon or anaesthetist. This will be discussed with you before surgery.
Other medication should be taken as usual. You should avoid herbal remedies for 2 weeks prior to surgery as some of these may cause increased bleeding at the time of surgery. You should avoid non steroidal anti inflammatory medications for 2 weeks prior to surgery. Other medication should be taken as usual. 

What type of anaesthesia will I have?

Three types of anaesthesia are used for these procedures: local anaesthetic alone; local anaesthetic with intravenous sedation; general anaesthesia.
You will choose one of them based on the advice of your surgeon.
Local anaesthetic involves an injection just under the skin with a tiny needle. It is similar to dental anaesthesia. Initially the injection is painful but after 10 – 15 seconds the area becomes numb.
Local anaesthesia with Intravenous Sedation means that you are breathing for yourself and don’t have a breathing tube inserted but you are very relaxed and sleepy and often don’t remember the operation or the local anaesthetic injection.
General anaesthetic means you are completely asleep with a breathing tube inserted.

What are the risks of anaesthesia?

You will have the opportunity to discuss the risks of anaesthesia with your surgeon and anaesthetist prior to surgery. It is worth noting that modern anaesthesia in all its forms is extremely safe.
Local anaesthetic may cause bruising, bleeding and swelling. There is a theoretical risk of the needle penetrating the eye and causing loss of vision.
Intravenous sedation should be carried out by an anaesthetist in a controlled environment. In this way it is very safe. There is a risk of loss of airway, which theoretically could lead to brain injury or death.
General anaesthetic has an extremely low risk of heart attack, stroke and death. The risk very much depends upon your general health and will be assessed prior to surgery.
Anaesthetic risks can usually be greatly reduced by thorough pre operative assessment, which you will receive.

What should I expect after surgery?

After surgery you may experience some pain. Simple paracetamol is usually enough to control this. The eyelids will be a bruised and swollen. Bruising will take up to 2 weeks to settle. Swelling is greatly reduced after 2 weeks but may not completely resolve for 3 months.
Some people report not feeling ‘back to normal’ for up to 6 months after surgery. Initially it may feel difficult for you to close your eyelids and this will be managed with eye ointments.
It is important not to have surgery too close to important events, in case you have not fully recovered in time.
Each individual responds differently to surgery and of course the more extensive the surgery the greater the downtime. For some people the down time after upper and lower eyelid surgery is significant

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