Lower blepharoplasty is surgery on the lower eyelid to address the signs of ageing. These often present as:
- fine lines.
- loose or crépey skin
- bulges or bags under the eyes
- looseness of the lower eyelid away from the eye surface
- excess tearing
As with upper blepharoplasty, the signs of ageing on the lower eyelid result from alteration in the skin, muscle, fat and ligaments around the eyelid, plus the eye socket itself. Lower blepharoplasty can address many of these to some extent.
What can I expect?
During your consultation, Richard will carefully assess each component of your lower eyelid, in the context of the rest of your face and how you feel about your appearance.
Fine lines and crépey skin are best addressed with non-surgical means. Depending on the position and volume of fat, this may be repositioned or carefully removed to create a smoother, more rested appearance. As in many areas of facial aesthetic surgery, less is often more in lower blepharoplasty. Significant laxity or descent of the eyelid can be tightened by gathering or elevating it at the outer corner. Similarly, if the lower eyelid is sagging away from the eye, this may be repositioned closer.
The ideal result is an inconspicuous yet rested appearance.
What happens before surgery?
Lower blepharoplasty is most often performed in a hospital setting. Before your procedure, your Anaesthetic Specialist will discuss your anaesthetic plan, including any pain medications you may need during your post-operative recovery phase. The procedure is often carried out under general anaesthetic, although in some cases local anaesthetic with or without sedation is applicable. I will meet you again to make sure everything is taken care of, before drawing my surgical markings and any additional photographs as necessary.
What happens during surgery?
Regardless of the type of anaesthesia you receive, Richard will also inject local anaesthetic solution at the start of surgery. According to your surgical plan, Richard may access the eyelid fat deposits from the inside of the eyelid or the outer surface and release an adherent area in the tear trough (between lower lid and cheek). Only the minimal volume required is removed, similarly only the absolutely necessary amount of skin is removed. If required, the eyelid can be tightened at the outer edge. Often some subtle fat grafting is needed to complete the result. The skin is closed with sutures and light dressings and an ice pack applied.
What happens after surgery?
You will wake up from anaesthetic in the recovery room with an ice pack over your eyes to help minimise swelling and bruising. The eyelids are delicate, with thin skin, so some bruising and swelling is to be expected. Your vision may be a bit blurry due to ointments or fluid, which should resolve. Pain should be minimal if anything, but if you do experience pain, please ensure you discuss this with the recovery nurses.
Most patients can go home the same day, and once home, it’s important to keep your head elevated by setting up a comfortable chair or extra pillows in your bed to sleep for the first three or four days. Please feel free to move about the house as usual and do your normal activities of daily living. You may experience some dryness or feeling of irritation to the eye, and we will recommend some drops to help with this. Avoid strenuous activity or lifting for around four weeks, as this will prolong swelling.
We will see you in the rooms for removal of sutures a few days after surgery, but expect the majority of swelling to resolve after one or two weeks and result to settle over the coming few months. Lower eyelid swelling can be unpredictable, with some patients experiencing prolonged swelling.
When you’re comfortable, not taking any strong pain killers, have normal vision and can react to road conditions, you can resume driving. This often takes around a week or so.
Possible complications
The decision to undergo eyelid surgery is a very personal one, and should only be made after considering if the potential benefits can achieve your aims, and whether the risks are acceptable to you. The possible risks/ complications of upper blepharoplasty surgery include (but are not limited to):
- Cardiac problems, including heart attack or arrythmias.
- Venous thromboembolism (including deep vein thrombosis and pulmonary embolism, which may be fatal).
- Bleeding behind the eye requiring urgent return to the operating theatre, which may threaten vision.
- Surgical site infection.
- Wound breakdown, delayed healing or protruding sutures.
- Conspicuous scars, including hypertrophic, stretched or migrated scars.
- Numbness (temporary or permanent).
- Asymmetry, areas of tightness, pleating or contour irregularities.
- Dry eye (more likely in those who already experience dry eyes).
- Eye injury, which may require ophthalmologist input, including blindness (incredibly rare).
- Ectropion (pulling down of the eyelid) and scleral show (seeing too much white eye below the iris).
- Injury to the muscles that move the eye.
- Injury to tear ducts and associated structures
- Possible need for revisional surgery.
- You should understand that other people will probably notice you have had facial surgery, and this may draw attention.