Eyelid Surgery (Blepharoplasty)

The aim of eyelid reduction surgery is to improve facial appearance and reduce the signs of ageing. Whilst it is an individualised procedure, specific issues which may be addressed include:

• Excess skin and wrinkles of the eyelid

• Excess fatty deposits that appear as puffiness in the eyelids

• Bags under the eyes

• Droopiness of the lower eyelids, showing white below the iris (coloured portion of the eye)

At your consult, Mr. Bunker will discuss your goals and expectations and perform a targeted examination prior to discussing a surgical plan if appropriate. Blepharoplasty can be performed alone or along with other facial rejuvenation procedures such as facelift or browlift. Eyelid reduction surgery may be appropriate for you if:

• You have significant skin redundancy in the eyelids

• You have realistic expectations of what surgery can achieve

• You understand that eyelid reduction surgery cannot remove dark circles under the eyes, lift sagging eyebrows or eliminate crow’s feet. These require different interventions.

• You do not have any significant ocular conditions

• You do not smoke or have a history of poor wound healing, bleeding, or medical conditions which significantly increase your risk of surgery or anaesthesia.

Some eyelid surgery can be done in the rooms under local anaesthetic whilst other cases are best done with sedation or under a general anaesthetic in a hospital setting. Modern anaesthetics are safe and effective but carry some risks, which you will discuss with your anaesthetist.

Blepharoplasty as a standalone procedure is usually performed as day surgery. Prior to discharge home you will have a period of observation to ensure there are no early complications such as bleeding and that your pain is well-controlled.

All surgery has risks. There are general risks which apply to all operations as well as specific risks for individual procedures. General risks and complications of surgery may include:

• Bleeding

• Infection that may require treatment with antibiotics or further surgery in some cases

• Allergic reaction (to sutures, dressings or antiseptic solutions)

• The formation of a large blood clot (haematoma) or fluid (seroma) beneath the skin that may require drainage

• Pain, bruising and swelling around the operated sites

• Keloids and hypertrophic scars that are raised, red and thickened scars over the healed incisions. These may be itchy, annoying and unsightly but are not a threat to health

• Poor or slow healing

• Wound breakdown

• Short-term nausea following general anaesthesia and other risks related to anaesthesia

Specific risks and complications associated with eyelid surgery include:

• Asymmetry of the eyelids

• Noticeable scarring

• Itchiness, watering or dryness of the eyes

• Swelling of the tissue over the white part of the eye (scelera). This is referred to as chemosis and may require medications to settle

• Removal of too much skin which can interfere with the ability of the eyelid to close, exposing the cornea to injury

• Drooping of the lower eyelid (ectropion) which will usually recover with massage and taping but occasionally requires further surgery

• Temporary changes in vision. In rare cases, changes in vision may be long lasting or permanent

• In extremely rare cases, eyelid reduction surgery can lead to blindness.

Your surgery will take place in an accredited hospital facility.

• Due to the recent cosmetic surgery reforms, all patients in Australia undergoing cosmetic surgery are required to undertaken a Body Dysmorphic Disorder Questionnaire.

• You will be asked to complete a full medical history. You must list all medications you take including dietary supplements such as fish oil which increase your risk of bleeding. It is also important to disclose any ocular conditions or the use of prescription glasses or eyedrops.

• Check with your surgeon about your medications as some may need to be stopped. Any additional tests required pre-operatively will be arranged by Mr. Bunker or your anaesthetist.

• If you decide to have eyelid surgery, you will need to sign a consent form. Make sure you read the consent form carefully before signing. If you have any questions, please ask them prior to surgery.

• Avoid any strenuous activity or exercise in the week before your surgery

• Make sure you arrange for a relative or friend to drive you to and from the hospital or clinic and that you have arranged appropriate help at home including someone to stay with you for the first 24 hours. Think about the setup at home where you will recover – you may want extra pillows, fluids and a toilet nearby and it is useful to have a telephone within reach.

• Ensuring you have sunglasses available is also useful as you may be sensitive to light for a few days postoperatively.

• If you wear contact lenses, you will need to consider obtaining eyeglasses as you will be unable to place contacts for 2 weeks postoperatively.

• Consider work arrangements. Most patients will remain off work for 1 -2 weeks after surgery. A medical certificate can be supplied to your preoperatively if required

• Take Vitamin C supplements 1 gram daily starting at least 2 weeks before your surgery, unless you are allergic or unable to tolerate

• You will receive detailed preoperative and postoperative instructions. Follow them carefully.

• Arrange for a relative or friend to drive you home after the surgery. Someone should also stay with you for at least the first day after the operation and preferably for a few days.

• You will receive medications for home (usually pain relief and antibiotics) as well as detailed postoperative instructions which include how to care for your surgical site, signs which warrant concern, contact information and follow-up instructions.

• You can usually drink fluids and eat a light meal two or three hours after surgery.

• Some bruising and swelling is normal and may take up to a few weeks to disappear.

• Dressings are to remain intact until your postoperative review unless otherwise advised.

• You may be required to clean your eyes as the incisions sometimes become crusty. You may also need to use lubricating drops.

• Your eyes may be sensitive to light for a few days requiring you to wear sunglasses.

• Do not wear contact lenses for at least 2 weeks.

• Avoid heavy lifting, strenuous exercise, swimming and strenuous sports for 4 weeks.

If you experience any of the following symptoms, notify us immediately:

• Heavy bleeding from the incisions

• Significant swelling around the eye or pain

• Changes in vision

• Fever (>38°C) or chills

• Worsening redness around the incision sites

Some visible scars are inevitable, however Mr. Bunker will aim to place these in natural creases where possible and they usually become inconspicuous with time.

Revisional surgery may be necessary to correct minor irregularities.

Cost is always a consideration in elective surgery and may include:

• Surgical fee

• Hospital or surgical facility costs

• Anaesthesia fees

• Prescriptions for medication

• Medical tests

A quote for the surgical fee is provided to you prior to surgery. This also contains instructions on how to obtain quotes for associated fees as listed above. If you have further question please contact the Practice Manager.

Terms You Should Know:

• General anaesthesia: Drugs and/or gases used during an operation to relieve pain and alter consciousness. When you are under general anaesthesia you are ‘asleep’.

• Intravenous sedation: Sedatives administered by injection into a vein to achieve relaxation. Also referred to as ‘twighlight’ anaesthesia.

• Local anaesthesia: A drug injected directly to the site of an incision during an operation to relieve pain. Also referred to as ‘numbed with needles’.

• Blepharoplasty: A surgical procedure to address excess skin (+/- fat) of the eyelids.

• Ectropion: A pulling down of the lower eyelid as a result of tension, scarring, or weak eyelid support mechanisms.

• Chemosis: inflammation of the covering (conjunctiva) over the sclera.

• Sclera: The white part of the eye.