DO I NEED EYELIDS SURGERY? (Eyelids Sydney)

Normal ageing is usually first noticeable by changes in facial skin, downward shifting of the brow, and fullness of the eyelid skin.

This fullness leads to wrinkling and sagging of the eyelid (commonly called “bagginess”) which may become apparent under the lower eyelids and at the inner corners of the upper eyelids. The tendency for this to occur may be hereditary, and may become evident from an early age. More often, however, the fullness is developmental, and appears in the mid thirties, becoming even more marked in later years. Once the tendency for this to occur is apparent, the condition will progressively worsen.

The skin around the eyelid may become so stretched, as to impair sight. Once this has occurred, repair is much more difficult and the results may not be as good as with cases of earlier intervention. The rule of thumb with eyelid surgery is: the earlier the better! That is, as soon as any of the above conditions become evident, it is the time to take corrective action, in order to ensure optimum results.

WHAT SORT OF TREATMENT IS THERE?

The results of early treatment can be highly successful. There may be more wrinkling or fullness of the skin as years go by, but once fatty tissue “bags” are removed, in general, they do not return.
Correction may be performed along with a face-lift operation, or as an entirely separate procedure, when this area alone is primarily involved.

This operation involves the eyelid structure and the surrounding soft tissue only. There is no interference with the muscles or organs of the eye itself. Therefore, there should not be undue concern about the possibility of any visual impairment.

The repair of incisions is performed with very fine sutures (stitches).

In the upper lid, the excess skin and any overstretched muscle fibres, is removed, along with the protruding fatty tissue.

In the lower lid, the procedure may be performed in a similar way, from the outside, at which time usually some loose skin is removed. The incision line is very fine, takes the shape of a natural lid crease, and usually heals without any mark.

The procedure may also be performed from inside the lid, where the incision is made in the conjunctiva, with no marking on the outer aspect of the lid. This is called a “transconjunctival blepharoplasty”, and is often combined with laser resurfacing.

WHEN IS THE LASER USED IN THESE OPERATIONS?

In more recent years, the carbon dioxide (CO2) laser has been used increasingly in eyelid surgery. The main uses are:
• In the “transconjunctival” lower lid internal incision because the laser incision stops any bleeding as it cuts
• To help cut away the fat pockets in a “transconjunctival” lower lid operation
• To resurface the upper and lower eyelids after the fat has been removed. The use of laser resurfacing has a similar effect to cutting away the loose skin, and in addition, it smoothens out any wrinkle lines. (Refer to our sheet on laser resurfacing for any further information.)

HOW LONG DOES THE OPERATION TAKE?

The procedure itself takes about one to two hours. You may have only the one set of lids operated upon, or both the upper and the lower.
Normally the procedure is performed under local anaesthesia and only a few hours are needed in recovery in our Day Surgery Centre.

WHAT ARE THE RISKS?

Of course, as with any operation there are always risks, of which, we believe, every patient should be aware. However, the likelihood of these problems occurring is no greater than it is with any other operation.
• Scarring is rare, as the skin of the eyelid is the thinnest of any in the body. Hence it usually heals very well. If the lower eyelid is performed by the “transconjunctival method”, then there is no external incision.
• Infection is most unlikely, because the procedure is done under strict sterile conditions
• Excess bleeding is possible although great care is taken to seal all bleeding vessels. Very rarely, bleeding may occur in the orbit, and the blood presses against the optic nerve, causing loss of vision. This rare possibility is always checked for.
• Complications particular to laser resurfacing may occur if the skin of the eyelid is resurfaced. These include hyperpigmentation, hypopigmentation, milia, viral infections. For this reason, antiviral medications commence on the day of surgery, or the day before if you have suffered from cold sores
• The postoperative erythema (redness of the skin) may persist for up to three months when the Co2 laser is used for resurfacing. This may be camouflaged by the use of green concealer makeup. The erbium laser, which is more suitable for superficial wrinkles, has less down time in terms of recovery, and the erythema should only last for about a month.

WHAT HAPPENS AFTER SURGERY?

An icepack is placed over the eyelids to help reduce the swelling and bruising. The amount of bruising that you get is very variable. In some people, it is hardly noticeable; in others it is as having a black eye.

After discharge, you should go home to rest.

If sutures have been used to close the wound, these are removed after five days.
If you have the eyelid skin resurfaced, you will be give clear instructions for postoperative care.

HOW QUICKLY WILL I SEE THE RESULTS?

The eye area will be swollen and may be bruised for 7-10 days. This will gradually fade within one to four weeks. Then you will be your new self!

We do not recommend that you wear any face makeup for at least a week after your operation. Naturally, you can wear lipstick immediately. After the swelling has subsided you may apply eye makeup.

WHEN CAN I RETURN TO WORK?

This depends on the procedure that you have had.
• If you have had the procedure done from inside the lid (a “transconjunctival bleph”), you can almost return to work immediately, if there has been no bruising.
• If you have sutures placed in the wound, they will be removed after five days
• If you have had laser resurfacing, then you will need approximately two weeks before the skin has repaired itself enough to have makeup applied over it.

FURTHER INFORMATION ON EYELID SURGERY SYDNEY
• visit our comprehensive internet site www.lidsurgery.com.au
• we have made a video (on VHS or CD format) which may be viewed by those who wish a copy