The upper eyelids are usually operated on with the patient's eyelids anesthetised using local anaesthesia. Many patients prefer sedation or general anaesthsia, particularly for the lower eyelids.

2. Do I have to stay in hospital overnight after the operation?

This is according to the patients individual needs. It is easier to moniter post-operative course if the patient stays overnight after the surgery.

3. Do I have to stop my aspirin or warfarin before the operation date?

Yes, please do stop these. The aspirin should be stopped up to two weeks before your operation date. Warfarin is stopped two days before the operation date, in order to check the globe and socket, and the INR checked on the day of surgery. Aspirin is stipped two weeks before the operation to reduce per-operative swelling.

Please check that your physician agrees it is safe to stop warfarin.

4. What happens before surgery?

Preoperative assessment. You are assessed for surgery with an ophthalmic examination and general medical enquiry. You will be asked about allergies, medications including over the counter vitamins and aspirin, and about smoking. Photographs of the position of the eyelids are taken as a baseline. You may be asked to see a physician for blood tests and assessment if you aree in poor health and over 65 years of age.
You will be told whether or not to stop any medications, for example, aspirin-containing medicines or anticoagulants may need to be temporarily withdrawn or reduced. You are advised to stop smoking at least six to eight weeks prior to surgery.
Your eyes will be examined, the vision in each eye measured accurately, the pressure in the eye measured and the back of the eye (retina) is examined. The front surface of the eye and the eyelids are examined to exclude dry eyes, blepharitis, inturning lashes and allergy. Measurements of the eyelids and eyebrow position are made.
Photographs are taken with the patients consent as a record of the appearance before surgery. The medical insurance company may request to see these in order to authorise the surgery. They can be used to compare the post-operative result.

5. What happens after surgery?

The eyes are padded firmly for two hours to reduce swelling) then the vision measured.
Chilled eyelid packs (cold) are recommended to reduce lid and peri-ocular swelling.
If sutures are used, these may be absorbable or have to be removed.
You may go home if the surgery is in the morning and you live nearby, but if the surgery is performed in the afternoon or you live far away youy are advised to stay overnight.
You will be given lubricant eyedrops or ointment to put in the eyes for a few days after.

For more information, please visit the page "After eyelid surgery..."

6. Will I need eyelid or eyebrow droop (ptosis) surgery?

This will be assessed and discussed with each individual patient, as sometimes if the eyebrows are very droopy causing the skin to overhang the eyelashes, a brow lift operation is indicated instead of or as well as a blepharoplasty.

7. Are there any risks of blepharoplasty surgery?

You will be given a consent form to sign and the surgeon will discuss possible complications with you. Some complications are very rare and some more common. If you don't understand what the surgeon is saying, you should say so and ask any questions or about any worries you have about your proposed surgery. Once you are satisfied that you understand the aims of the surgery, what will happen and the possible risks of surgery, then you should sign the consent form.

8. What are the complications of blepharoplasty?

Serious complications are rare but may occur even in the hands of well experienced and trained oculplastic surgeons. Every effort is made to reduce the risk of complication, and oculoplastic surgeons are trained to manage these.

Eyelid and cheek swelling and bruising — may be noticeable for 3 weeks
Blurred vision — for a few hours or overnight, due to surface ocular drying during the procedure, from effect of the local anaesthesia and ointment instilled. If this persists more than 48 hours, inform your surgeon.
Watery eyes — reflex tearing is common for 24 — 48 hours due to mild ocular discomfort and surface dryness.
Dry gritty eyes — for two to three weeks due to reduced blinking. You will be prescribed artificial tears during the day (e.g. Hypromellose, Systane or Viscotears) and an ointment at night (e.g. Lacrilube or Simple Eye Ointment) to prevent this. Topical antibiotics such as Chloramphenicol are used for 1 week if surgery has been done from inside the eyelid.
Scratched surface of the eye — minor injury to the eye surface can result in pain for 24 hours. If it persists or is severe, the surgeon must be informed
Bruising — eyelid bruising or haematoma is common. Bleeding behind the eye is rare and a haematoma can cause loss of vision if not dealt with urgently. Oculoplastic surgeons are trained to prevent and manage this.
Acute glaucoma — raised pressure within the eye with nausea, vomiting and blurred painful red eye. Specific treatment must be given and review by an eye doctor is necessary. This is extremely rare.
Wound infection — this is rare
Incomplete eyelid closure — for a day or two the eyelids will feel stiff and not entirely cover the surface of the eye when closed. It usually settles in days — associated discomfort is eased by lubricant drops and ointment.
Sunken appearance — a sunken-looking "cadaveric" eye appearance can occur if too much fatty tissue is removed.
Asymmetry — a minimally uneven skin crease or lid height may be noticeable if there is asymmetrical swelling, more marked on one side than the other. If asymmetry is present after two weeks, it may persist and require later secondary surgery
Scar — rare as the incisions are hidden in the natural skin folds
Need for repeat surgery — patients should be warned of the need for further surgery if an optimum result is not achieved.

For further information about cosmetic eyelid plastic surgery, please contact an oculoplastic surgeon in you area.