What causes eye bags?
Eye bags are part of the ageing process involving the face. They are produced by a loss of elasticity of the skin of the eyelids resulting in excess skin especially in the upper eyelids. Also weakness and stretching of the supporting tissues around the eye can result in protrusion (herniation) of the deep fat, which is normally located around the eyeball.
When do the changes appear?
Most commonly these changes become obvious in our forties and fifties. However there is no specific age, as we all age at different rates. In some individuals with a familial tendency these can start in their twenties. Smoking does hasten the ageing process as well.
Some individuals, particularly younger patients may show fat protrusion with little or no excess skin.
What does the surgery involve?
Surgery for the upper eyelids alone is usually performed as a daycase and takes about an hour whereas to do both upper and lower eyelids takes over two hours and generally requires an overnight stay in hospital.
The surgery can be done under a local anaesthetic or a general anaesthetic. I prefer to use a local anaesthetic if only the upper eyelids need done and a general anaesthetic if both lower and upper eyelids need done.
Incisions are hidden in natural crease lines in the eyelids. Excess skin is removed. Protruding fat re-draped and/or removed.
In some individuals it may be necessary to re-suspend the lower eyelid in its outer part (Canthopexy), if the eyelid is lax and tending to pull away from the eyeball.
I stitch the skin with non-dissolving sutures.
Individuals with just the fat protrusion can have this removed/re-draped with incisions on the inside of the eyelid through the conjunctiva.
In certain individuals, fat grafting into the cheek below the lower eyelid improves the aesthetic appearance.
What do you expect after the operation?
The sutures are removed 5-7days after the operation.
There would be some swelling and bruising. This is quite variable among individuals and persists longer in the lower eyelids. However most of the obvious swelling should be gone in 3-4 weeks.
In the first week particularly, it is important to generally take things easy and to avoid bending and straining as these can cause congestion in the face and increase the risk of swelling, bruising and bleeding.
There would be some discomfort and tightness in the early days. Pain is fortunately not common. Significant pain may be an indication that something is not right.
The scars are well positioned in natural crease lines. They remain red or pink for many months. Most will settle very well in the long term. Makeup can be used after 1-2 weeks.
What are the possible complications?
Any surgery carries a risk and possibility of complications. Significant problems are fortunately uncommon after blepharoplasty.
Significant bruising and swelling may persist for a longer period. Also swelling of the tear duct and swelling of the conjunctiva (chemosis) could result in excessive tearing. Some individuals may experience some irritation and dryness as well. The swelling may make it impossible to close the eyes in the first few days. Eye drops will then be helpful in both situations especially during sleep to keep the eyes moist. Occasionally this will require taping the eyes closed during sleep.
Bleeding may present as increased bruising or rarely blood collects in the eyelid (haematoma) and may need a return to theatre to evacuate.
Occasionally the lower eyelid pulls away from the eye with swelling (temporary ectropion) but this improves in 2-3 weeks. Rarely, too much skin could be taken away resulting in this being permanent. Corrective surgery may then be necessary.
Minor degrees of asymmetry can occur as no two sides of the face are same. However significant asymmetry and skin redundancies can be adjusted usually as a minor procedure under a local anaesthetic.
Blindness though fortunately extremely rare may occur from a severe sudden bleed.
Did you know!
Blepharoplasty is arguably the singular most important operation required to produce a youthful face. However, to give the best aesthetic results and facial balance, it is commonly combined with browlift and or face/neck lifts. It can also be combined with Botox and fillers post operatively.