Blepharoplasty

What is blepharoplasty?

Blepharoplasty is the name given to an operation that reshapes the area around the eyes, by removing excess skin, muscle, and/or fat from the upper and/or lower eyelids to restore a more youthful appearance.
The upper and lower eyelids are treated differently depending on what’s needed.
Upper blepharoplasty surgery can improve hooded or droopy eyelids.
Lower blepharoplasty surgery can reduce eye bags and wrinkles.
Blepharoplasty can be performed for cosmetic or functional reasons – some people have impaired vision caused by droopy upper eyelids.

Why do people have blepharoplasty?

The eyes are often the first thing people notice when they meet you – and also the first place where signs of ageing appear. It is not surprising that blepharoplasty is one of the most common cosmetic procedures in plastic surgery.

People who seek blepharoplasty may have:

Sagging upper eyelids that affects their vision.
Droopy upper eyelids that makes them look tired, sad or angry, even when they feel fine.
Wrinkles or crepey skin around the eyes.
Puffiness or bags under the eyes.

While it might seem like a straightforward operation, obtaining a good surgical result requires a deep understanding of facial anatomy, ageing, and surgical techniques.

Older techniques often took away too much tissue, which could make the eyes look hollow. Dr Law approaches blepharoplasty by looking to reduce the excess skin around the eyelids, but also to restore volume that has been lost around the eyes during the ageing process. By combining skin removal with volume restoration, the risk of a hollow or “overdone” look after surgery is greatly reduced.

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Surgery

Before your surgery, you’ll have a detailed consultation with Dr Law to discuss your goals, the procedure, and any risks. Clinical photos will be taken, and a second consultation will be arranged to answer further questions. It’s important to stop smoking at least six weeks before surgery to reduce risks. You may need blood tests and other health checks, and will receive instructions to prepare you for surgery.
Upper eyelid surgery can often be done in the office using local anaesthesia (numbing only the area).
Lower eyelid surgery is usually done under general anaesthesia or sedation in a hospital setting to ensure the best care, comfort, and safety.
The basic steps of upper eyelid blepharoplasty usually involves:
- A small cut is made in the natural eyelid fold and excess skin is removed.
- In some cases, a more complex method is used to restore the eyelid shape.
- Upper eyelid surgery may also be combined with a brow lift, which can sometimes be performed through the same cut for the upper eyelid surgery.
The basic steps of lower blepharoplasty usually involves:
- If there’s only fat, a hidden incision is made inside the lower eyelid.
- If skin also needs removal, a cut is made just under the lower eyelashes, which may extend into the crow’s feet.
- In general, fat is removed or repositioned from the eyebags, excess skin is trimmed, and the area is closed.
- If there is hollowing under your eyelid, you may be suitable for fat grafting to restore the contours of the eye area. Please see section on Facial Fat Grafting.
Dr Law will give you personalised instructions to follow after your surgery. Please also note that recovery can vary between individuals. But in general:
- Your eyes may be covered with pads and a special cream, which can blur your vision at first.
- You may have cold compresses applied and Dr Law will check on you before you go home.
- At home:
  - Rest with your head propped up on pillows.
  - Avoid smoking until wounds have healed.
  - Expect some swelling, bruising, and possibly watery or gritty eyes – this is normal.
  - You may need mild painkillers (like paracetamol).
  - You can wash your hair (with help) on day 2, leaning your head backwards.
- Makeup can usually be worn again after one week, once stitches are removed.
- Avoid strong sun or heat for six weeks to reduce swelling risk.

Risks & complications

All surgery carries risks and may include:
- Drug reactions.
- Allergic reactions.
- Infection.
- Bleeding and haematoma (blood clot).
Risks specific to blepharoplasty will be discussed with you during your consultation and will also be provided in your consent paperwork. These include:
- Bruising and swelling.
- Watery eyes.
- Dry eyes.
- Asymmetry.
- Difficulty closing eyes: This is very rare.
- Vision loss: This is extremely rare.
Choosing a specialist surgeon with proper anaesthetic support helps minimise these risks.