Blepharoplasty (Lower Lid)

The eyelids heal very well, with minimal scarring. It is a privileged site for healing. The upper lid scar is hidden within the lid crease, which is very individual. As such, the reformation of the lid crease is tailored to the individual. The lower lid heals very well with an almost invisible line just under the lashes if skin has been removed. The lower lid has a scar less incision made inside the lid if skin does not need to be removed.

Scarring is reduced by accurately bringing the skin edges together at the end of the procedure under high magnification. It is also reduced by the type of stitch used, reducing the chance of inflammation brought on by self dissolving stitches.

Mr Das-Bhaumik will take a full and thorough history at your initial consulatation. The risks and benefits as well as the planned surgery is discussed in detail. Clinical photographs may be taken and suitable dates for the surgery will be discussed.

You will have ample opportunity to ask questions about the surgery and follow up. You will be asked to contact Mr Das-Bhaumik’s team if you wish to proceed and fasting instructions will be given to you if you are undergoing a procedure under sedation or general anaesthetic.

Patients are asked to refrain from taking any non-steroidal anti-inflammatory (NSAID) medication, such as ibuprofen and aspirin, for a week prior to surgery.

Please inform Mr Das-Bhaumik if you are on medication that thins the blood, e.g. aspirin, apixaban, clopidogrel, aspirin and warfarin as he will have to change the composition of local anaesthetic to compensate for these or reduce the medication if your GP deems it safe to do so. Please also refrain from alcohol consumption 2 days either side of surgery.

Mr Das-Bhaumik will see you on Cumberledge Wing of Moorfields Eye Hospital. You will be asked to sign a consent form. Again, any questions you have will be answered prior to surgery.

The following is advised:

• Bring in all your current medication and take them as usual unless otherwise advised.
• Wash the face to remove makeup to reduce your chance of an infection.
• Dress in comfortable clothes.
• Remove your contact lenses.
• Remove all metallic items including piercings and hair metallic hair extension clips if possible.

After meeting Mr Das-Bhaumik on the ward, a nurse will escort you to the theatre anaesthetic room. Mr Das-Bhaumik will put very specific marks on the eyelid skin to guide the surgery and instil soothing eyedrops to numb the eyes. The anaesthetist will then put a small cannula into your hand to give you sedation. Once sedated, a little gentle local anaesthetic is given to the lids. You will not feel any of this.

You will then be taken to the operating theatre. Mr Das-Bhaumik will clean and drape your head and put in protective opaque contact lenses.

The surgery is usually performed using a very fine radiofrequency needle and the procedure performed is very much tailored to need. Fine skin stitches (the width of human hair) are placed. The protective contact lenses are removed, then, antibiotic ointment, a soothing jelly gauze and soft eye pad are placed at the end of the procedure.

The procedure itself is very comfortable and patients are usually woken before the end of the procedure. Patients usually report the procedure to be relaxing and restful in a calm environment. Patients are also encouraged to choose the music played in theatre.

• A firm eye pad is put on after the procedure. This should stay on until you are instructed to remove the pad and will depend on the type and extent of surgery.
• Vision is initially blurred as ointment is put in the eye with a protective contact lens.
• You will be given eye drops and eye ointment for the wound before you are discharged.
• You will also be given saline and sterile gauze to help clean the lids once the pad is removed.
• A follow up appointment will be made for you.
• If stitches need to be removed, they are done at a follow up appointment, usually 10 – 14 days post surgery.
• Do not pick any crusts on the wound as this is healing. Just keep the wound moist with the antibiotic ointment.
• The stitches are designed to self unravel and some will fall out by themselves.
• Cool compresses to the eyelids reduce any swelling after the dressing has been removed.
• Eye makeup can be worn a couple of days after the removal of stitches.

Some swelling, bruising and a little blood in the wound is common. Blood in the wouln can occur for a couple of days, bruising and swelling is usually improved in a week and markedly improved at 2 weeks post surgery.

Mr Das-Bhaumik performs revision blepharoplasty (further surgery) for surgery originally performed elsewhere that has not gone completely to plan and patients seek his expertise to correct the eyelids.

Removing too much tissue
The lower lid can be pulled down and turned out if excessive skin and muscle is removed. This is unusual and can be avoided by ensuring that excessive eyelid skin and muscle is not removed. Measures can also be taken to tighten the lid at the time of surgery to prevent this from occurring. Hollowing of the lower lid can be prevented by being conservative with the amount of fat removed, and re-draping the fat rather than removing it.

Bruising and Bleeding (Haemorrhage)
Bruising to some extent is fairly common and fades as any bruise does.
There can be a little blood at the wound as healing takes place but this settles over a day or two post surgery.

Loss of vision
A bleed behind the eye is extremely rare and this can reduce vision or lead to vision loss. It is important to follow the preoperative instructions above. The surgery is performed in such a way that risks are minimised. Please see the paragraph on performing safe surgery below. The surgical technique and stitch type and placement add to safety.

Infection
Due to the excellent blood supply to the lids, infections are unusual and you will be given antibiotic ointment to use 2 times a day after surgery. A course of tablet antibiotics may be required in rare cases.