Eyelid Surgery (Blepharoplasty)
Blepharoplasty, or an eyelid tuck operation, is a commonly performed operation to improve the aesthetics of the eyelid area giving a more youthful, awake appearance! It can involve the upper eyelids, the lower eyelids (bags), or both, and can be done as a single procedure, or combined with other facial rejuvenation techniques, like facelifts, neck liposuction etc.
ANATOMY
Both upper and lower eyelids consist of 3 layers: Skin on the outside, muscle in the middle, and fatty tissue on the inside. Surgery is tailored to the specific needs of the individual, and would typically involve modifying some or all of these layers.
UPPER EYELIDS
Often the ‘first sign of ageing’, upper eyelid surgery is simple to perform, and the results are generally good to excellent. The major problem in most people presenting for this surgery is skin excess, which hangs onto the lid margin, and gives a tired appearance.
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The surgery is done under local anaesthetic with oral sedation, and a strip of skin is removed from the upper eyelid. This leaves a thin, fine scar in the upper eyelid crease, which fades over a few months to become barely perceptible. Often, some fatty tissue is removed at the same time, but little or no muscle (middle layer) is removed. The incision is closed with stitches which are removed at 5 days to a week post op. Bruising and swelling are variable, but usually minor – most important is to avoid aspirin or medication containing aspirin for about 2 weeks prior to the surgery – see under advice.
LOWER EYELIDS
These are somewhat more tricky surgically, since most of the cheek fat is suspended just below the lower eyelids, and hence has a tendency to pull the lower eyelid down after surgery. Patients usually complain about eyelid bags, which bulge under the eye, and are often hereditary. The main problem in the lower eyelid is usually fat excess, or apparent fat excess, occasionally with some skin excess.
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The “conventional” way of performing surgery on lower eyelids is to cut through the skin, through the muscle, and then remove some fat, and often a bit of skin and muscle too. More recently, there has been a shift in thinking in this regard – surgeons (like myself) believe that the middle layer (muscle) should not be injured or operated in most cases, and hence we do a transconjunctival approach to the fatty pockets. In essence, what this means, is that the fatty tissue is removed using a direct approach with a small incision on the inside of the eyelid (leaving no external scar). In younger patients (and often in older ones too!) this is all that is necessary, as the skin on the front of the eye often retracts once the fat is removed. In patients in whom there appears to be a true skin excess in the lower eyelids, this can be dealt with either by a concomitant light acid peel (to tighten the skin and minimise the ‘crepey’ lines) or surgically by using a ‘skin pinch’ – a small amount of excess skin is removed at the time of surgery (in front of the muscle). Hence – fat is taken from behind the muscle, and skin may be taken from in front of the muscle, but the muscle itself is not injured / operated upon. More often than not, fat micro-grafts are then placed along the eyelid-cheek junction to blend this area, and fill the tear trough. These grafts may also be used to plump out the cheekbone area to better support the lower lid.
Because the lower blepharoplasty involves surgery very close to the eyeball itself, I prefer to do this under a light general anaesthetic to ensure patient safety. In addition, a special corneal protector is used to shield the eyeball.
How to prepare Eyelid Surgery
Getting ready for your Eyelid Surgery (Blepharoplasty) is a vital step toward achieving a refreshed and more youthful eye appearance. Our aim is to ensure you feel completely prepared, confident, and comfortable on the day of your procedure in Cape Town.
Here’s what you need to know and do before your surgery:
- Comprehensive Medical Review:
We will conduct a thorough review of your medical history, including any eye conditions or vision issues. You may need to undergo specific pre-operative tests or clearances from your general practitioner or ophthalmologist. - Medication & Supplement Guidance:
You’ll receive clear instructions on which medications, especially blood thinners like aspirin, ibuprofen, and certain herbal supplements (e.g., Vitamin E, fish oil), to avoid in the weeks leading up to your surgery to minimize bruising. - Quit Smoking:
If you smoke, it’s crucial to stop several weeks before your surgery. Smoking significantly compromises circulation and healing, increasing the risk of complications. - Arrange Post-Surgery Support:
Plan for a trusted friend or family member to drive you home after your procedure and assist you during the initial 24-48 hours of your recovery. - Prepare Your Recovery Space:
Set up a comfortable area at home where you can rest with your head elevated. Have plenty of ice packs or cold compresses ready, along with any prescribed eye drops or ointments. - Fasting Instructions:
You will receive precise instructions on when to stop eating and drinking before your surgery. Adhering to these guidelines is essential for your safety during anaesthesia. - Avoid Eye Makeup & Contact Lenses:
On the day of surgery, arrive with a clean face, free of makeup, and do not wear contact lenses.
Following these detailed preparations will help ensure a safe and comfortable experience, laying the groundwork for your beautiful, revitalized results.
What to expect during your eylid surgery recovery journey
The recovery period after your Eyelid Surgery (Blepharoplasty) is crucial for achieving optimal results, and our team in Cape Town is here to guide you every step of the way. While individual healing varies, here’s a general overview of what to expect:
- Immediate Post-Surgery:
You will likely experience some swelling, bruising, and possibly a feeling of tightness or mild discomfort around your eyes. Cold compresses will be applied immediately and are vital for reducing these symptoms in the first 48 hours. Your vision may be temporarily blurry from ointments. - First Week:
Swelling and bruising will be most noticeable during the first few days, gradually subsiding over the week. You’ll need to keep your head elevated, even while sleeping. We will provide specific instructions for cleaning your incisions and applying any prescribed eye drops or ointments. Stitches are usually removed within 5-7 days. - Managing Discomfort:
Any discomfort is typically mild and can be managed effectively with over-the-counter pain relievers or light prescription medication if needed. - Activity Restrictions:
Avoid strenuous activities, heavy lifting, bending over, and anything that increases blood pressure to your head for at least 2-4 weeks. Light walking is generally encouraged to promote circulation. - Eye Care:
Protect your eyes from sun and wind with sunglasses, and avoid rubbing your eyes. You may experience temporary dryness or increased tearing; we’ll advise on appropriate eye drops. - Returning to Routine:
Most patients feel comfortable returning to light, non-strenuous work within a week to 10 days, depending on their comfort and the visibility of residual bruising. Makeup can often be worn to conceal bruising after the first week. - Long-Term Healing:
While initial recovery is relatively quick, subtle swelling can linger for several weeks to months. Scars, strategically placed, will continue to fade and soften over many months, eventually becoming very discreet.
We are committed to supporting you throughout your entire recovery, ensuring a smooth path to fully enjoying your brighter, more refreshed eye appearance.
Reveal Brighter, More Youthful Eyes With Blepharoplasty
Are tired-looking eyes dimming your sparkle? Imagine a refreshed, more alert appearance that truly reflects how you feel. Dr. Paul Skoll offers natural-looking eyelid rejuvenation, addressing sagging lids and under-eye bags with precision and artistry. Schedule your confidential consultation to discuss your vision for brighter eyes.
A few commonly asked questions
What is eyelid surgery (blepharoplasty), and how can it rejuvenate my appearance?
Eyelid surgery, or blepharoplasty, is a cosmetic procedure designed to remove excess skin, fat, and muscle from the upper and/or lower eyelids. It effectively addresses sagging eyelids, puffiness, and under-eye bags that can make you look tired, older, or even obstruct your vision. By carefully reshaping the eyelid area, blepharoplasty creates a more refreshed, alert, and youthful appearance, making your eyes look brighter and more open.
Am I a suitable candidate for blepharoplasty?
You might be a suitable candidate if you have excess skin on your upper eyelids that creates a hooded appearance or interferes with your vision, or if you have puffy bags and dark circles under your eyes. Ideal candidates are generally in good health, non-smokers, and have realistic expectations about the outcome. During your consultation in Cape Town, we will assess your specific concerns, eye health, and medical history to determine if blepharoplasty is right for you.
What specific concerns can upper blepharoplasty address?
Upper blepharoplasty primarily addresses sagging or drooping upper eyelids, which can result from loose skin and excess fat. This can lead to a tired or sad expression, and in some cases, the skin can hang over the eyelashes, partially obstructing your field of vision. The procedure removes this excess tissue to create a smoother, more defined eyelid crease and a more open, refreshed eye appearance.
What specific concerns can lower blepharoplasty address?
Lower blepharoplasty targets the concerns of the lower eyelids, most commonly under-eye bags, puffiness, and fine wrinkles. These issues often arise from fatty deposits that bulge forward, creating shadows and a fatigued look. The surgery can remove or reposition this fat, tighten loose skin, and smooth the contours beneath the eyes for a more rested and youthful appearance.
Can upper and lower blepharoplasty be performed together?
Yes, it is very common for upper and lower blepharoplasty to be performed simultaneously. This comprehensive approach allows for a harmonious rejuvenation of the entire eye area, providing balanced and natural-looking results. Combining the procedures can also mean a single recovery period, which many patients find convenient.
What can I expect during the consultation process for blepharoplasty?
Your initial consultation is an in-depth and personalized experience. We will carefully listen to your aesthetic goals, review your medical and ophthalmic history, and perform a thorough examination of your eyelids and surrounding facial structures. We will then discuss the most suitable surgical techniques for your unique needs, explain the procedure, potential risks, and recovery, answering all your questions to ensure you feel fully informed and comfortable.
What kind of anaesthesia is used for eyelid surgery?
Eyelid surgery can typically be performed under local anaesthesia with sedation (where you are relaxed and comfortable but awake) or general anaesthesia (where you are completely asleep). The choice depends on the extent of your procedure and your personal preference, which will be discussed with our qualified anaesthesiologist to ensure your utmost safety and comfort throughout the surgery.
What is the recovery period like after blepharoplasty?
The initial recovery period typically involves some swelling, bruising around the eyes, and mild discomfort, which usually peaks within the first few days. Cold compresses are highly effective in managing these symptoms. Most visible bruising resolves within 1-2 weeks, and swelling largely subsides within a few weeks, though subtle swelling can linger for longer. You will be able to read and watch TV within a few days.
Will there be visible scarring after eyelid surgery?
Incisions for blepharoplasty are strategically placed to be as inconspicuous as possible. For upper blepharoplasty, incisions are hidden within the natural crease of the eyelid. For lower blepharoplasty, incisions are often made just below the lash line or, for fat removal only, on the inside of the eyelid (transconjunctival approach), leaving no visible external scar. While all surgery results in scars, these typically fade remarkably well over time, becoming very difficult to detect.
How long do the results of blepharoplasty last?
The results of eyelid surgery are generally long-lasting and often considered permanent for the removed fat and skin. While the natural aging process will continue, blepharoplasty effectively “resets the clock” on the appearance of your eyes, and most patients enjoy their refreshed look for many years, often a decade or more.
How much does eyelid surgery cost in Cape Town?
The cost of eyelid surgery in Cape Town varies depending on whether you are having upper, lower, or combined blepharoplasty, the complexity of the procedure, anaesthesia fees, and facility charges. Following your detailed consultation, we will provide you with a transparent and comprehensive quote that outlines all associated costs, allowing you to make an informed decision about your investment in a more refreshed appearance.
How should I prepare for my eyelid surgery?
Detailed pre-operative instructions will be provided. Generally, preparation involves avoiding certain medications (especially blood thinners) and herbal supplements for a specified period, refraining from smoking, arranging for transportation home after surgery, and ensuring you have cold compresses and a comfortable, elevated resting space ready for your recovery. It’s also important to moisturize the skin around your eyes and stay hydrated.
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