Aesthetic Surgery of the Eyelid (= Blepharoplasty)

1. What are the aims of the surgery?

The purpose of aesthetic surgery of the eyelids is to surgically reconstruct or remove excess adipose tissue, skin and muscles that cause sagging of the eyelids. This operation is not performed to correct wrinkles under or lateral to the eyes, dark circles around the eyes or depressed eyebrows called. This operation is not to correct the drooping of the upper eyelid, also called ptosis. For the later problem, it is necessary to intervene in the eye muscles (the same can be done during surgery). At the same time, if the sagging skin is large enough to restrict the visual field, this problem is also solved by this surgery.

2. What is the expected appearance after surgery?

Swelling, asymmetrical bruising, temporarily increased tear secretion, dry eye syndrome caused by swelling of the eyelids or conjunctiva which may need using artificial tear drops, itching and blurred vision, tightness on the upper and lower eyelids, a thin scar on the upper and lower eyelids, a little more pronounced sclera, possible small asymmetries in the eyelid and incision site. Due to some maneuvers during the surgery, the eyelids may be slightly raised temporarily.

3. What should be done before surgery?

a. 2 weeks before surgery:

• Please avoid the use of aspirin, ibuprufen or vitamin E. If you take a drug at the pharmacy or doctor, it is very important to remind that you will have surgery. Many painkillers and drugs against common-cold may contain these preparations. Paracetmol or acetaminophen can be used when painkillers are needed.

• Please stay  away from all nicotine-containing products such as cigarettes, pipes and cigars. Nicotine can affect healthy blood circulation and ultimately success in surgery. It also puts you at a higher risk group if you are taking anesthesia.

b. 1 week before surgery:

• Blood tests, Electrocardiography, chest x-ray and eye examination should be performed if necessary. These tests should be brought or sent to the office before surgery.

• If pregnancy is probable, the operation is postponed.

• Please stop drinking alcohol.

c. One day before surgery:

• If you are not sure about the exact time and place of the surgery, please call the secretary of the nurse of the clinic from +90-232-4631163.

• Do not eat and drink after night (including water and gum). If your operation is after a lunch, be fully fasting as behind the operation from a light breakfast made at an early hours as early morning such as 07.00. If this rule is not followed, the operation may be postponed. If you are using medications such as blood pressure and blood glucose regulating drugs that are used regularly, they can be taken very early in the morning with a sip of water.

d. Day of operation:

• Go to the reception of the hospital where the operation will be performed at the given time. They will guide you in your room and fulfill the formalities.

• You can take a shower in the morning. However, do not use make-up, hair spray or gel, do not use nail polish.

• Avoid clothing worn over the head. Wear comfortable clothing, such as sweatshirts or pajamas. Just before you go to the operating room, you will be dressed OR clothes.

• Do not wear jewelry such as rings or necklaces and do not bring invaluable items with you.

• If you are carrying mouth prosthesis, they should be removed for general or even local anesthesia.

4. Is it done under local anesthesia?

It can be performed under local or general anesthesia according to the patient’s preference. It is useful to do with general anesthesia in excited persons or when combined with other surgeries. However, if it is only the eyelid surgery it can easily be done under local anesthesia, in most of the times supported by IV anesthesia. 

5. What are the first steps related to surgery?

Upper eyelid:

The excess skin on the upper eyelids is carefully measured and marked. The incision site is also marked on the lower eyelid. Local anesthetic is administered to the upper and lower eyelids to numb and reduce bleeding. After waiting for 15-20 minutes, the upper eyelid is cut from the previously marked lines and the excess skin is removed. Depending on the situation, a limited amount of muscle strip can be removed as well. The eye compartment (= orbital septum) is then reached. If there is a herniated fatty tissue in the medial compartment, it is usually removed. Bleeding control is performed using cautery. The skin is closed with stitches. The same procedure is done on the other eyelid.

Lower eyelid:

The lower eyelid is cut from the previously marked lines. After passing through the muscle fibers, the orbital septum of the lower eye is reached. If there is a herniated fatty tissue in the lateral, middle and medial compartments, they can be removed, or repositioned. Bleeding control is performed using cautery. After very limited excess skin removal, the skin is closed by stitches. The same procedure is done on the other eyelid.

If skin and muscle removal is not the case in young patients and only fat hernia is to be addressed, the incision can be done in the conjunctiva and the operation can be done transconjunctival. 

In order to minimize postoperative edema and discoloration, cold application is performed on the eyes for at least 3 days. Sutures are taken in 4-5 days if there are any, because absorbable sutures can also be used in some cases. 

6. What are the instructions to follow after eyelid surgery?

• Sleep on your back or sideways with the head elevated.

• Eyelid surgery usually causes minimal post-operative pain. Please call us immediately if you have persistent and obvious pain.

• If you would like, you can apply cold compresses on your eyes 6 times a day for 20-30 minutes each time for 3-4 days.

• Do not use aspirin or non-steroidal anti-inflammatory drugs against pain. Other painkillers such as paracetamol or acetaminophen can be used easily.

• You can use your eyes as much as you want for reading and watching TV.

• Apply the ointment to the surgical site twice a day. However, please apply in small amounts on the incision sites. 

• Do not use your contact lenses for at least two weeks. 

• Do not use any known make-up such as eyeliner or eye contour for 10-14 days unless instructed to do so by us. A gentle make-up application against bruising on the lower eyelid is acceptable. Please do not pull eyelids.

• Any redness in the eye is a form of bruising and will disappear during early healing.

• Do not exercise for at least 3 weeks.

• The removal of the sutures after the operation depends on the type of skin and the quality of the suture material applied to the operation. Please follow the instructions given by us.

7. What are the possible complications after eyelid surgery?

Your surgery will be performed in the most secure way to achieve the best possible surgical result. Most likely, there will be wound healing without major problems after surgery.

You have the right to be informed of the risk of unsuccessful outcome due to surgery and that complications may arise due to known or previously unknown causes. Since individuals vary in skin structure, tissue, blood circulation, wound healing and reactions to anesthetic drugs, no guarantee can be given in terms of results or possible complications.

The following complications have been reported in the medical literature. These very rare situations are listed here for information purposes only, not to scare you. In this way, it is aimed to give you more information about this surgery.

  • Wound separation: It is the separation of the wound edges at the level of the incision line after the sutures have been removed.
  • Infection: Very rare, but may occur.
  • Epiphora: Excessive tears due to the formation of tears or obstruction of the tear duct.
  • Corneal damage: It is caused by direct trauma or insufficiency of eyelid closure. It is usually preventable, but as with other eye problems, eye diseases may require examination.
  • Telangiectasia (Visible superficial small blood vessels): The number and length of pre-existing lesions may increase.
  • Scarring: Keloid scars (puffy wound healing from the skin) are very rare, but wound healing may leave a visible scar. Usually the incision lines are inconspicuous.
  • Pigmentation: Rarely darkening of the skin due to bruising in patients who have darker skin may rarely maintain its presence for a long time, which may exceed the normal healing process.
  • Inclusion cysts: Small white cysts within or near the incision line.
  • Postoperative wrinkles
  • Hematoma: Blood collection behind the eyeball or skin.
  • Eyelid asymmetry: Reveals a pre-existing asymmetry.
  • Lagophthalmos: Difficulty closing eyelids. It is usually frequent and temporary after surgery for 1-2 weeks, but very rarely it can be permanent.
  • Dilution of eyelashes: Very rare.
  • Ptosis: Low upper eyelid.
  • Image change: Usually temporary. Very rarely can be permanent.
  • Enophthalmos: The retraction of the eyeballs into the orbit can be seen especially in people with deep-seated eyeballs.
  • Keratoconjunctivitis sicca: dry eyes.
  • Ectropion or scleral show: The eyelid can be pulling down after the surgery
  • Skin necrosis: Very rare. It usually heals without the need to add a skin patch, but sometimes a skin patch may very rarely be needed.
  • Secondary blepharoplasty: Occasionally, a second eyelid cosmetic surgery may be required due to overcorrection or undercorrection.

If a complication or an undesirable problem occurs after surgery, a retouching can be performed 6 or 12 months after the operation.