Frequently asked questions

Why do we have Blepharoplasties?

Eyes and eyelids are probably the most important features on our face and their attractiveness can be greatly reduced by excess skin, folds, colour changes, creases and eyebags. The removal of a few millimetres of skin can transform a face from looking tired and dull to bright and animated. The normal ageing process causes stretching of the eyelid skin giving rise to excess folds and wrinkles; and sagging of the fat around the eye gives bulges in the upper and lower lids known as eyebags. Heredity can be an important factor and patients get very fed up with comments from their friends that they look tired despite having had a good night’s sleep!.

What won’t the Blepharoplasty achieve?

Eyelid surgery will not eradicate all the creases or the crows feet lines because these are permanent cracks in the collagen of the dermis. Eyebags can be caused by thyroid diseases or kidney problems and these may not be eradicated by surgery. It is important that you realise that it is not possible to remove all the loose skin because some slack is needed to allow closure of the eyelid!

Am I a suitable candidate for surgery?

The best candidates are healthy, well motivated and psychologically stable and content. Some patients come too early because they are worried about the changes they see in older members of the family; and the only way to be sure is to come for a consultation. I will not suggest surgery unless you will get a significant benefit.

What are the positions of the incisions?

On the upper lids the incision is in the natural crease line that is present approximately one centimetre above the eyelashes and extends into the crows feet or laughter line area. On the lower eyelids the incision runs about 1 millimetre below the eyelashes. I mark these lines with a special pen in the Anaesthetic Room after taking your photos.

What does the operation involve?

After the incisions the excess skin is removed, the eyelids are gently opened and excess fat removed. I meticulously stop any bleeding points and very fine sutures are used to close the skin edges. Bleeding and bruising is to be avoided with eyelid surgery so don’t forget to stop things that thin your blood, aspirin and alcohol being the worst offenders (see General FAQ's)

What anaesthetic do I need?

The upper eyelids can be corrected with a local anaesthetic if you wish, but it is usual to have a general anaesthetic for both upper and lower.

How long does the operation take?

Upper blepharoplasty takes about 30 minutes and the lower 40 minutes.

What happens after surgery?

Bruising occurs following blepharoplasty so you will have a soothing cold compress over your eyelids. Swelling around the eyes is normal and sometimes occurs under the conjunctiva of the eye ball itself (known as chemosis) and although this may look alarming, like clear jelly attached to the eyeball, it is harmless and settles itself, usually within a week or two. It is usual to rest in hospital overnight and I will check you again before you go home.

What can go wrong?

There can be problems with any operation, namely - Bleeding, Infection, Nerve damage and Scars. There are also special problems with Blepharoplasty, namely removing too much (which means the lower eyelid pulls down) or not enough which means a minor revision procedure a few months later. Both these problems are rare and the first almost always resolves by itself. Bleeding can cause loss of vision (approximately 1 in 100,000) but I have never encountered this complication or any other surgeon who has. Infection is rare and temporary sensory nerve reduction is normal (the eyelids feel numb for several weeks). Transient watering of the eyes can occur and dry eyes can be made worse by surgery, so have some artificial tears ready. There can be temporary eyelash loss or the appearance of tiny whiteheads under the skin. Significant problems are rare and the consultation includes a full analysis of all these possibilities, their likelihood and what you can do to minimise the risks.

What can I do when I get home?

The most important post-operative message is to be very careful for the first week (at least), problems can occur if you do not rest properly and allow things to heal up inside. Do not lift anything heavier than a kettle and ‘keep your head above your heart’, that is, do not stoop unnecessarily and sleeping propped up on extra pillows reduces swelling. Two weeks is usually sufficient time off work but it is at least four weeks before you can start significant exercise. Most have very little post-operative pain and are tempted to overdo things, but you must resist this and be very careful.

What about the stitches?

The sutures are very fine monofilament nylon under the skin edges (so they will not be marked) and I have developed a ‘knot free’ technique which means removal is very simple and pain free. I remove them myself at the 5 day stage.

When can I go back to work?

This varies with occupations, but you should have at least two weeks clear of major commitments. If you overdo things you can pop a blood vessel and cause more bruising and swelling, which takes longer to subside.

When am I back to normal?

There is considerable variation in return to normal but most patients venture into the world with their make up on after two weeks, but be prepared to be flexible about this should you get more swelling than average. Eyelids take a minimum of four months to settle completely, sometimes it is six months or even longer. Most say they are back to normal at six weeks, but don’t forget, healing progresses slowly for months and you must be patient for the final result.

What are the scars like?

Average scars are red for a few months then fade to white or natural skin colour. The upper lid scars are hidden when the eyes are open and although the lines extending into the crowsfeet region are visible they nearly always fade well and rarely require a revision. The scars on the lower lids are in the eyeliner line and appear quite natural. While the scars are red you can of course cover them with concealer make-up.

Summary

Blepharoplasty is one of the most popular aesthetic surgery procedures and the vast majority of patients are delighted with their final result (although they may be rather alarmed by their appearance in the early stages). Blepharoplasty is long lasting and I have many patients who had their surgery more than ten years ago who are still very happy with their result.

I have two rules of Cosmetic Surgery

1. - If in doubt – don’t!

2.- Always talk to real experts.

In other words, be sure that you want to undergo surgery for your own reasons and talk to people who really know about the surgery, that is other patients or an experienced Plastic Surgeon. Many think they know all about Blepharoplastyplasty but in reality don’t and are likely to give you inaccurate and misleading information. This surgery changes many lives for the better but on rare occasions can have the opposite effect, so make sure you are an expert yourself before you decide. Everyone you know loves you whatever your eyes are like, it’s how you feel about yourself that matters!

How Many Blepharoplasties does Mr Levick perform?

In accordance with the National Healthcare Commission guidelines, the annual audit figures for the Priory Hospital show that in the last five years (2004-2008) Mr Levick has carried out 329 Blepharoplasties, that is an average of 66 per year.