Eyelid surgery
Eyelid Reduction Surgery, also known as blepharoplasty, removes the excess skin and fat from ageing eyelids. The procedure is one of the most commonly requested procedures in cosmetic surgery. Usually all four eyelids are done at the same time; however, either the upper eyelids or lower eyelids can be done in isolation.
Following the procedure, your eyes will appear more youthful. Those troublesome bulges and the excess skin overhang typical of a tired appearance will be gone.
Before and after photographs
The New Zealand Medical Council has banned New Zealand doctors from using "Before and After" photographs in any form of public communication, including websites. The only permissible use of such photographs under the New Zealand Medical Council rules is during a medical consultation.
Dr Masters will show you examples of previous patient's "Before and After" photographs during your consultation.
Indications
The most common indication for having a blepharoplasty is dissatisfaction with the appearance of your eyelids. With time, the upper eyelids frequently develop excess skin which overhangs the eyelid proper (making eye makeup very difficult to apply) and a prominence near the nose. This, combined with the natural thinning of the skin which happens with time, tends to give the upper eyelids a very droopy and heavy appearance.
Unlike the upper lids where excess skin is usually the primary complaint, in the lower lids the most common indication for blepharoplasty is a bulging of the fat from around the eyeball causing the patient to have the appearance of heavy bags under the eyes. Not infrequently, there is also a degree of excess of skin which can be removed during the surgery.
Relevant Anatomy
Fat is packed into the bony eye socket around the eyeball, thereby protecting the eyeball from the hard walls. This fat is held in place by a septum which forms one of the layers behind the skin of the eyelid. This fat tends to grow with time (often independently from what the patient's weight is doing) and, at the same time, the supporting septum tends to weaken. The net result of these changes is that the fat herniates forward causing a bulge to appear in the eyelid.
Pre-operative Preparation
Mr Masters will provide you with precise instructions well in advance of your surgery to allow you a smooth and stress-free preparation for the procedure. Take the time to read your consent form thoroughly, along with any other written information Mr Masters has provided for you with regard to your surgery. This will allow you to have all of your questions answered prior to having the procedure, and ensure there are no unexpected surprises during the post-operative period. If you are the main domestic executive in your home, or you live alone, you should plan ahead with regard to housework and meal preparation. Do your grocery shopping, cleaning, etc the day before your surgery and plan to have meals that require minimal preparation and/or cooking time.
If you are a smoker, stop smoking at least one month pre-operatively. Do not take any aspirin or aspirin-containing products for at least one week prior to the surgery. If you are on any other medications, ensure that Mr Masters is aware of the medications (including homoeopathic remedies) so that any other medications, which require cessation during the pre-operative period, can be discontinued.
The Anaesthetic Used
The vast majority of blepharoplasties are done under local anaesthetic. This is Mr Masters’ preference for this procedure. Obviously, when combined with other procedures (eg facelift) the procedure can be done under general anaesthetic.
Where is the Surgery Performed
The majority of blepharoplasties are performed in Mr Masters procedure room. When the surgery is combined with other procedures (eg facelift) then the whole operating room is used.
The Surgery
In the upper eyelid, there can be a number of factors of concern to the patient. Commonly, these involve a bulge on the edge of the eyelid closest to the nose and excess skin on the outer aspect of the upper eyelid. The aim of the surgery on the upper eyelid is to leave the final fine scar sitting naturally in the upper eyelid fold so that when the eye is open, the scar is totally concealed. To do this your surgeon will mark the ideal position of your eyelid fold pre-operatively. Local anaesthetic has been injected to completely numb the operative area. When this is working, the incisions are made thereby removing the excess skin. The fat which is protruding forward from around the eye, causing the bulge near the nose, is then trimmed back appropriately. After ensuring there is no bleeding, the skin edges are then closed with fine sutures.
The procedure for the lower eyelids is similar but slightly different. The incision after the local anaesthetic is working, is typically made immediately below the eyelashes very near the margin of the lower eyelid. The skin is then raised up along with one of the eyelid muscles, revealing the fatty tissue that causes the lower eyelid bulge. Depending on the exact configuration of your fatty prominence, this fat is either trimmed away or, for some patients, repositioned to smooth the transition from the lower eyelid to the upper cheek. Your surgeon will then assess how much excess skin requires excision. After this is removed, the wound is closed with fine sutures.
For some people, the lower eyelid is troubled more by a prominent fatty bulge rather than excess skin. In this setting, the surgeon typically does not make a cut through the skin but, instead, pulls the eyelid forward and works from a concealed incision behind the eyelid to address the fatty bulge.
Post-operative Period and Recovery
As most patients have this relatively minor procedure performed under local anaesthetic (they are awake), they can usually go home the same day. Prior to going home, however, the surgeon will want the patient to be observed for a brief period of time to ensure that there is no bleeding present.
For the next 48 to 72 hours, most surgeons request that the patient do as little as possible. Ideally cooling packs are applied to the eyelids on a regular basis during this time. You will be requested to keep your head elevated and not to lay flat. There is often a degree of visual blurring for 48 hours after the operation and, as such, reading and watching the TV (or other activities which require the use of your eyes) are not encouraged. Any activity which raises your blood pressure or pulse should be avoided for at least 72 hours. This includes housework, exercise and lifting objects.
Your stitches will be removed at approximately 5 days following the surgery. At this stage, most patients are able to gently apply makeup to disguise any residual bruising which may be present. Although you will most likely still be slightly swollen, most patients are socially presentable at this stage with the assistance of a little makeup.
You will be aware of subtle changes occurring in your eyelids for a number of weeks, as the final result becomes apparent. Like all scars, blepharoplasty scars go through a series of stages whilst maturing. The final fine scars should be pale and inconspicuous, but may take a number of months to get to this stage.
Results
You can expect your eyes to appear more open, less tired and more youthful when fully recovered.
Complications
Before deciding to proceed with surgery, every patient needs to thoroughly consider the risks, as well as the benefits, of surgery. During your pre-operative consultation(s), Mr Masters will openly discuss the risks with you so that you can consider them. A full listing of all the potential complications and risks of this procedure is beyond the scope of this website. There are two broad groupings of surgical risks: those that pertain to surgery in general; and those specific to the procedure being performed.
Generalised surgical risks include:-
Bleeding - usually occurs within the first 24-48 hours of the procedure and may require a return to the operating room. A quiet, restful post-operative period will help to avoid this problem.
- Bruising - whenever possible, Mr Masters uses medications and techniques that help to avoid post-operative bruising. The appropriate use of Arnica may help to speed the resolution of bruising.
- Infection - surgical incisions, even though created in ideal circumstances, can become infected.
- When appropriate, antibiotics will be prescribed to lower this risk.
- Unfavourable scarring - every surgical incision results in a scar. It is Mr Masters’ role to maximise the quality of your scars and, whenever possible, to hide them in natural skin creases.
Complications specific to Blepharoplasty include:
- Dry eyes - a decrease in the production of the tear film of the eye, usually temporary and symptoms can be treated with artificial tears until resolved.
- Visual blurring - usually temporary and passes within a number of days.
- Lower eyelid contracture - the lower lid is pulled down and/or away from the eye itself. Whilst it is treatable, this a complication best treated by avoidance! With careful pre-operative screening and the application of appropriate techniques this should be a infrequent occurrence.
- Blindness - a very uncommon complication, 1 case in 40,000.
Approximate Costs
The cost of the procedure varies with a number of variables including the number of eyelids done, the patients medical history, the complexity of the case and the type of anaesthesia used. Dr Masters will prepare a written quote for you following your initial consultation and examination.
As a guideline, the total cost including the operative facility fee, consumable items used and surgeon’s fee for upper eyelids (local anaesthetic), usually starts from $4,500 and lower eyelids from $5,500. If all four eyelids are done at the same time under local anaesthetic, the cost starts from $8,000.
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