Eye Bag Removal
The upper eyelid lift (technically called a blepharoplasty) is a procedure to correct heavy drooping upper lids - features that can make you look older and more tired than you feel. It is one of the safest and most reliable of all the cosmetic surgical procedures, with a very high satisfaction rate.
The best candidates are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.
A few medical conditions make blepharoplasty more risky. They include thyroid problems, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes.
When eyelid surgery is performed by a qualified oculoplastic surgeon, complications are infrequent and usually minor. Nevertheless, there is always a possibility of complications, and the risks you need to consider are the risk of infection, the risk of a large bruise known as a haematoma, the risk of the scar thickening to become more visible and a theoretical risk to your vision.
I usually perform upper lid lifts under local anesthesia--which numbs the area around your eyes, sometimes with intravenous sedation. You'll be awake during the surgery, but relaxed and insensitive to pain. (However, you may feel some tugging or occasional discomfort.)
After surgery, I lubricate your eyes with ointment and may apply a bandage. Your eyelids may feel tight and sore as the anesthesia wears off, but you can usually control any discomfort with paracetamol. If you feel any severe pain, call me immediately.
Post-operative I recommend you to keep your head elevated for several days, and use ice packs to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.)
The stitches will be removed a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.
Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and sunblock when you go out.
Keep your activities to a minimum for three to five days, and avoid more strenuous activities for about three weeks. It's especially important to avoid activities that raise your blood pressure, including bending, lifting, and rigorous sports. Minimise alcohol, since it causes fluid retention.
Healing is a gradual process, and your scars may remain slightly pink for six months or more after surgery. Eventually, though, they'll fade to a thin, nearly invisible white line. You will always be able to find your scars, but I aim for strangers to be unable to see them at 6 weeks, and your friends unable to see them by 6 months.
Blepharoplasty can enhance your appearance and your self-confidence, but it won't necessarily change your looks to match your ideal, or cause other people to treat you differently.
Lower Lid Blepharoplasty
The lower lid lift, or eyebag removal remains one of the most difficult cosmetic procedures. The reason is that the lower eyelid cannot be considered on its own but must be taken in consideration with the whole midface and indeed face. The lower eyelid rests against the eyeball and needs to be in perfect position to protect the eye and carry the tears with each blink into the tear ducts. Any attempt to remove too much skin from under the eye carries a great risk of the eyelid hanging away from the eye. This is made worse if there is any underlying lid laxity. This leads to a poor cosmetic and functional result, and a very unhappy patient!
In a similar fashion the orbital fat that surrounds the eyeball in its socket can bulge forward as we age, and the temptation is to remove this fat. Removing too much orbital fat however, can lead to a hollow appearing socket, with again a poor cosmetic result and unhappy patient!
The factors that age the lower lid and midface are volume loss as much as any fat prolapse and tissue descent.
The steps required to acheive good results from lower lid blepharoplasty therefore include:
Always replace lost volume with tear trough filler and cheek filler.
Always assess and tighten a lax lower eyelid.
Release the arcus marginalis to reset the tethering that tucks in and accentuates the lower lid bag.
Move rather than remove orbital fat, and be very conservative in removing orbital fat when essential.
Release the deeper tissues over the orbital margin and into the midface, to allow the deeper layers to be lifted by sutures to the orbital rim.
Be conservative in trimming excess skin, measure the excess with the patient opening their mouth wide.
Even with all these factors in place I warn my patients that if we can acheive a 99% result for the upper lid, the best to hope for with a lower lid is 70%.