Eye-lid bags are a combination of excessive skin on the lid with or without bulging fat from under the eye-lid. This can make the eye look older, tired or ‘puffy. The changes may affect only upper or lower eyelids or both of them.

The eye-lid bags can be composed of both skin and fat. This varies from patient to patient. In older patients it is usually extra skin with variable amounts of fat while in younger patients it tends to be mostly prominent fat that is the problem. The standard blepharoplasty is removal of this extra skin and then removal or re-distribution of bulging fat. The incisions are just below the lid margin on the lower lid and in the lid crease on the upper lid. In some younger patients the incision can be made inside the lid to remove fat only (Trans-conjunctival blepharoplasty).

Incisions

The incisions on the eye-lids heal extremely well and can be very difficult to see. This is particularly true in the upper lid.

Length of surgery

Operation takes 60 minutes for the upper eyelids and 90 minutes for the lower lids. The procedure is done under local anaesthesia..

Nights in hospital

Can be a day case or one night stay.

Dressings and stitches

You will have one long stitch for each eyelid treated. This stitch is easily removed at the day 5 visit.

Postoperative instructions and recovery

Day 1 You should be taking it very easy! Either relax in the hospital or at home.
Day 2-5 You can be up and about but your eyes will be swollen and have stitches that are visible. Sunglasses may be useful.
5-14 Your stitches will be removed and most of the swelling and bruising will settle over this time. You will be feeling much better from here onwards. You can start exercising gently and build it up over the next 10 days. 
Week 3 onwards you will be nearly back to normal.

Final outcome

Although your result will be noticeable early it will continue to improve over the first three months.

Follow up

Wound check and removal stitches at day 5.
Time off work and socializing

Allow 1-2 weeks. People vary in recovery. Most patients are very comfortable at one week and it is only the bruising and swelling that may make you feel uncomfortable about going to work. Most bruising has gone by the third week.

Time to exercise

Walking a distance at 3 days, swimming by 10-14 days (if fully healed). Strenuous exercise (aerobics etc) should be avoided for 4 weeks.

Complications

This is a routine operation that is a great success for the vast majority of patients. However, it is very important you understand what can go wrong as well as right with an operation. With blepharoplasty the potential problems are listed.

Ectropion: This is very uncommon. It is where the eye-lid gets pulled down and does not rest on the eyeball. It occurs in the lower lid if it is weak or the skin closed too tight. Great care is taken in the lower lid to avoid this and checks will be made to ensure you are not at risk. If you are, then variations in the technique will be discussed with you at consultation.

Small degrees of asymmetry: The same operation will be performed both sides. There is a small risk of minor irregularities in the skin surface on one side and not the other.

Scars: Patients can vary in the quality of scars they produce.

Wound breakdown: Although very uncommon this can result in delay in wound healing and scar quality.

Bleeding: A blood clot can collect under the skin needing you to go back to theatre for its rem oval.

Infection: Also very uncommon but if occurs you will need a course of antibiotics.

Eye injury: Injury to the eye itself is protected against but can occasionally occur. The most common of these is a small abrasion to the cornea (front of eye-ball) which although painful heals without detriment in a few days.