Cosmetic Laser Surgeon Dr Daniel Fleming explains what upper eyelid surgery can and cannot do.

When people start telling you that you look tired - even when you aren’t - there’s a fair chance it’s your eyes. Droopy upper lids, or bags under the eyes, are often the first signs of aging. Blepharoplasty (cosmetic eyelid surgery) is one of the commonest forms of cosmetic surgery procedures and can make a striking difference to a person’s appearance when performed on the right patient.

The Consultation

If you ask for improvement in heavy, drooping or sagging upper lids, it is crucial for your surgeon to establish if upper blepharoplasty is the correct procedure to fix the problem. In some patients “heavy lids” are, in fact, due to sagging of the eyebrows. Lowered eyebrows push the skin immediately below them into the upper eyelid giving a heavy look. As eyelid surgery does not raise the eyebrows, it will not correct this problem - a browlift is needed. Of course, many patients with sagging eyebrows also have excess eyelid skin and these patients need both a browlift and an upper blepharoplasty to get the best results. You can check this yourself. Look in the mirror. If you feel your eyebrows are a little low, use your fingers to push them up to a height you think looks desirable. This will probably be only 1-1.5 cm. Look what happens to the upper eyelid. If it appears as you wish, then you probably only need a brow lift. If there is still sagging in the eyelid you need a browlift and an upper blepharoplasty. If you think the level of your eyebrows is just fine - and raising them makes you look surprised or unnatural - the upper blepharoplasty alone is probably for you.

Make sure you get the risks and benefits of the operation explained to you. There will be a scar in the upper eyelid crease but this tends to heal very well and is rarely a problem.

The Operation

Upper blepharoplasty is normally carried out under local anaesthetic with sedation. Your cosmetic surgeon will mark out the area to be excised and then inject local anaesthetic with adrenalin. The adrenalin dramatically reduces the amount of bleeding by temporarily clamping down the blood vessels. The excision can be made with a scalpel or Carbon Dioxide laser.

The final result will probably be the same, but recovery times have shown to be a day or two quicker when laser is used. This is because it seals blood vessels as it cuts, further reducing bleeding and bruising. From the outside in, the layers removed are skin, muscle and fat. Because only excess tissue is removed, the eyelids should function normally after surgery. The skin is then sewn together, usually with quick-dissolving stitches. If non-dissolving stitches are used, they are usually removed at about 5 days.

Recovery

Immediately after the operation, you will probably have ice packs applied to reduce swelling. You should be fit to leave about one hour later. You will need someone with you to drive and generally look after you for the first 24 hours. Antibiotics, painkillers and sometimes eye drops are prescribed. Typically, there is very little pain afterwards and it is unusual to need painkillers for more than 24 hours. Some patients don’t need painkillers at all. You should expect some bruising and swelling in the days after surgery. You should avoid strenuous activity and bending down for the first week after surgery. Expect to be fit for social circulation and back to work in a week. There will still be some swelling at this stage but it will not be too dramatic. In most patients the swelling is gone and the final result apparent about six weeks after surgery.

Costs

Upper blepharoplasty usually costs from £2,000, lower-blepharoplasty from £2,250 and uppers and lowers from £4,000 inclusive of theatre costs.

Who should perform it?

The answer is simple: someone experienced in upper blepharoplasty. Choose a doctor who has performed this procedure many times before and with high quality results. Ask how many times he or she has done this procedure and ask to see photographs of the doctor’s results. If possible, speak to previous patients.

Laser blepharoplasty is a procedure performed by specialists at Franklynn Cosmetic Laser Centre.