What it corrects and when it is considered
With age, the tissue of the upper eyelid thickens, gathers fat and the skin droops. The lower lid collects fat, the familiar bags, and its skin loses tone. These changes usually begin after 35, although in some people they appear earlier or more markedly because of heredity.
Surgery may be considered for aesthetic reasons and also for functional ones: when the upper eyelid droops far enough, it can narrow the field of vision. The extent of each case is assessed at the consultation.
When the problem is not the eyelid
A lowered brow pushes the eyelid skin down and gives the same look. If lifting the brow with a finger opens up the eyes, the cause is the brow and the right procedure is a brow lift. Operating only on the eyelid in that case leaves the problem half solved. A tired look can also have other causes, such as loss of volume in the cheek.
Techniques
The technique for each case is decided at the in-person assessment, according to the anatomy of the eyelid, medical history and the tone of the eye muscles.
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Technique: Upper blepharoplasty
- What it treats
- Excess skin and laxity of the upper lid; drooping that narrows the field of vision. Incision inside the natural crease.
- Usual anaesthesia
- Local, outpatient
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Technique: Lower blepharoplasty
- What it treats
- Fat bags and lax skin under the lashes. Incision just below the lash line.
- Usual anaesthesia
- Local, with sedation if the case requires it
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Technique: Transconjunctival approach
- What it treats
- Fat bags with no associated excess skin. Access from inside the lining of the eyelid, with no skin incision.
- Usual anaesthesia
- Local
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Technique: Upper and lower in one operation
- What it treats
- Excess skin above and bags below at the same time.
- Usual anaesthesia
- Local with sedation
The indication for each technique is set at the in-person assessment.
It can be combined with a brow lift or a temporal lift when the assessment advises it.
The process
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Assessment consultation
Study of the eyelids and the area around the eyes, medical history and the tone of the eye muscles. This leads to the indication and the plan, or to the advice not to operate if the case does not need it.
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Anaesthesia
It is usually an outpatient procedure under local anaesthesia. Sedation is added when the upper and lower eyelids are operated on in the same procedure.
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Surgery
It takes between 40 minutes and an hour and a half, depending on whether the upper lids, the lower lids or both are treated.
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Recovery and follow-up
Bruising in the first days is common, and anti-inflammatory and antibiotic medication is prescribed. As a guide, patients return to work after 7 to 10 days. Swelling and bruising go down within a few days and marks can take two to three months to fade; each patient has their own pace.
Risks
Like any surgery it has risks, and they are explained at the consultation before any decision. That is why the assessment checks whether the patient is a candidate and whether the tone of the eye muscles is good: removing too much eyelid skin cannot be undone. It is performed in an operating theatre, with the safety conditions of any surgery.
Frequently asked questions
What anaesthesia is used?
Usually local anaesthesia, as an outpatient. When the upper and lower eyelids are operated on together, sedation is often added. The choice is made after assessing each case.
How long does the operation take?
Between 40 minutes and an hour and a half, depending on whether the upper lids, the lower lids or both are treated.
When can I go back to work?
As a guide, after 7 to 10 days, although it depends on each patient and on the extent of the surgery. Bruising in the first days is common.
Where are the scars?
On the upper lid the incision runs inside the natural crease. On the lower lid it can run just below the lash line or, with the transconjunctival approach, inside the lining of the eyelid. Healing depends on each person's skin.
At what age is it usually done?
Eyelid changes usually begin after 35, and most patients who have surgery are between 45 and 65. The indication is set by the examination, not by age.
How do I know if it is the eyelid or the brow?
Lift your brow with a finger in front of a mirror. If your eyes open up and the eyelid no longer looks heavy, the cause is the brow. This is a guide; the assessment at the consultation is what decides.