Mr Morritt regularly undertakes blepharoplasty surgery at the Claremont and Thornbury private hospitals in Sheffield. Upper eyelid surgery (also known as upper blepharoplasty) is most frequently requested to remove excess skin from the upper eyelid. Sometimes there is bulging caused by collections of fat around the eye and these can also be reduced in size. Lower eyelid surgery is most frequently requested to improve the appearance of ‘eye bags’. As a Plastic surgeon, Mr Morritt frequently undertakes cosmetic eyelid procedures and reconstructive eyelid surgery.
Who requests upper blepharoplasty?
Patients requesting upper blepharoplasty surgery are generally concerned about excess skin on the upper eyelids. The amounts of excess skin can vary from those patients who have small amounts to those where there is so much excess skin that it rests on the eyelids and may obscure the vision. Some patients are concerned about bulging in the upper eyelid which is usually due to excess fat deposits. Patients will often report that their loose eyelid skin makes it difficult to apply makeup or gives them a sensation of eyelid heaviness. Others are unhappy because they can’t see their eyelid crease clearly. Patients are most frequently in the age range 40-70 years.
Upper blepharoplasty – procedure
Upper blepharoplasty is most frequently performed under local anaesthetic (patient is awake during surgery). For those who don’t like needles we offer the extra option of a sedation injection (the patient is still awake during surgery but very calm and relaxed). Upper blepharoplasty is sometimes performed under general anaesthetic for those who are particularly squeamish or if patient’s are having eyelid surgery at the same time as another procedure e.g. breast surgery or tummy tuck surgery.
The local anaesthetic is injected under the skin of the upper eyelid. The local anaesthetic contains adrenaline which is useful to reduce bleeding during surgery. Eyelid surgery commences once the skin is numb and involves removal of skin. In some patients a small amount of fat and/or eyelid muscle is removed if there is excess fat or muscle. Care is taken to ensure that all bleeding points are sealed (cautery). The skin is then closed with a fine stitch. Steristrips are used to hold the ends of the stitch in place. Ointment (chloramphenicol) is used on the central part of the incision as it is uncomfortable to have steristrips in this location. Cooling eye pads are then applied to reduce swelling.
Patients are observed in hospital for a few hours after surgery and go home the same day once they and the nursing staff are happy. The stitches are removed by the nursing staff 5-6 days after the procedure. Mr Morritt prefers to use stitches that are removed as he finds that this type of stitch gives the best cosmetic outcome and that self-dissolving sutures give less predictable results.
Video showing Mr Morritt’s upper blepharoplasty technique
Before/after photos upper blepharoplasty surgery
Case 1: Natural looking outcome from skin only upper blepharoplasty giving improved eyelid definition and making it easier for the patient to apply eye shadow.
Case 2: I removed a significant amount of excess skin from this lady’s upper eyelids (almost 2 cm of skin from each eyelid) giving a refreshed look and crisper definition to the eyelid crease. Appearances shown 5 weeks after surgery – scars expected to become paler with time.
Case 3. Thanks to my patient for giving permission to share this series of photos showing the healing process after upper blepharoplasty eyelid surgery. As you can see the swelling and bruising worsen for a few days after surgery before then resolving. At the one week stage (when the stitches have been taken out) much of the swelling has gone and the bruising is generally minimal.
Case 4. Photos showing the appearance before and 3 months after upper blepharoplasty surgery (eyelid lift). This lady in her 50’s had surgery because she was unhappy with the excess upper eyelid skin which felt heavy, made her look tired, and made it difficult for her to apply her eye makeup. The photo with the surgical markings shows how much skin was removed (2 cm in height). It was great to hear that the upper eyelid surgery improved the patient’s dry eye symptoms, in addition to improving her appearance.
Case 5. Photos showing appearance before and 7 weeks after upper eyelid skin excision (upper blepharoplasty). This lady in her 60’s was unhappy with the excess skin on the upper eyelid which made the eyelids feel heavy and prevented her from wearing eye makeup. Surgery performed under local anaesthetic (patient was awake during surgery but her eyelids were numb) has removed approximately 2cm of skin from each upper eyelid giving a more youthful look.
Case 6. Photos showing the appearances before and after upper eyelid skin removal (upper blepharoplasty) for this lady in her 50’s. This lady was unhappy with the excess upper eyelid skin which made it look like she didn’t have eyelids. Interestingly, this problem also affected her mum and aunt. 12mm of skin were removed here giving a more clearly defined upper eyelid crease and making it easier to apply makeup. Appearances shown 6 weeks after surgery.
FAQ’s on upper eyelid cosmetic surgery (upper blepharoplasty)
Does upper blepharoplasty hurt?
- there is some initial stinging when the local anaesthetic is injected and then patients should not experience any pain during surgery. After surgery once the local anaesthetic wears off there will be some soreness but this is usually well controlled with paracetamol and only lasts a few days
Will I feel anything during surgery?
- Most patients have upper blepharoplasty under local anaesthetic and are therefore awake during surgery. Patients will therefore feel surgery (but will not feel pain) and hear sounds during surgery.
How long does upper blepharoplasty take?
- I generally allow a total of 1hr 20mins for surgery. This includes time for allowing the local anaesthetic to get to maximum action after it has been injected (approximately 7 minutes after it has been injected), and for applying dressings etc. The surgical time is around 60mins on average which incorporates time for double checking eyelid symmetry and that bleeding has been controlled.
Will too much skin be taken away?
- This is a rare risk of eyelid surgery. Throughout my training I was taught ‘measure twice, cut once’ and follow this principle. The eyelids are marked before surgery and all markings for skin removal are checked at least twice before surgery begins. I explain to my patients that I prefer to be cautious about how much skin is removed to try and minimise the risk of this situation arising. It is quite normal after surgery for the eyelids not to close fully as there is swelling but this usually resolves within a few weeks.
When can I wear eye makeup after upper blepharoplasty?
- I would generally advise waiting a minimum of three weeks before applying eyeshadow and eyeliner to the upper eyelids after surgery. Mascara can be worn from two weeks after surgery.
When can I resume exercise after eyelid surgery?
- Patients are advised to avoid strenuous exercise for approximately 3 weeks after surgery (this means lifting and intense exercise). This is to reduce the risk of post operative bleeding.
Eyelid surgery (blepharoplasty) – risks
Bruising – bruising following the surgery is normal and generally resolves within a few weeks of the surgery. Sometimes patient’s will get ‘black eyes’ which can last up to three weeks after surgery. Generally all bruising has completely resolved within 6 weeks of surgery.
Bleeding – Bleeding following the surgery is uncommon but can cause excessive bruising or swelling. Bleeding requiring a return to theatre for the bleeding to be stopped is very rare. Patients with high blood pressure are at higher risk of bleeding following surgery.
Infection – this is very rare following eyelid surgery. Mr Morritt generally gives all of his patient’s antibiotic ointment to apply to the wound following surgery while the stitches are in in order to reduce the chance of wound infection.
Wound opening – this is uncommon and if it happens generally will only affect a small area of the wound. The opening usually forms a scab that ultimately heals after a few weeks and does not usually affect the final cosmetic result.
Dry eyes – this is relatively common in the first few weeks after surgery and is caused by swelling of the eyelids. As the swelling improves the eyes become less dry. Permanently dry eyes are rare and may require long term artificial tears.
Watery eyes – watering of the eyes is relatively common following the surgery. It is usually caused by swelling and generally resolves very quickly. It can rarely be permanent.
Skin colour changes – very rare and slightly more frequent in the lower eyelid. Generally resolves with time but may be permanent.
Scars – scarring following blepharoplasty is generally very inconspicuous as the incisions are planned to be well hidden and in some patients will be very difficult to see. Rarely poor scars can happen (thickened scaring). Scars take time to become pale and in some cases this may take up to 1 year.
Asymmetry – differences between the eyelids in terms of shape and/or position. Slight differences are common and are in fact normal for many patients before surgery. Significant differences are very unusual and can generally be corrected with minor revision surgery. Eyelids can also heal at direct rates.
Pain – chronic pain/discomfort are very rare following blepharoplasty. Sometimes people have a sensation of ‘pulling’ after surgery but this usually improves with time.
Overcorrection – due to too much skin being removed from the eyelid or excessive scarring and results in it not being possible to close the eye. Can be corrected with a skin graft procedure.
Undercorrection – sometimes not enough skin is removed. This can be remedied by removing more skin.
Double vision – a very rare complication of lower eyelid surgery. Usually temporary but can be permanent.
Loss of vision (blindness) – this a an extremely rare complication reported to affect approximately 1:50,000 patients
Ectropion – this is an uncommon complication of lower blepharoplasty (eye bag removal). The lower eyelid is pulled down exposing the inner pink part. It generally resolves once the swelling has settled but can otherwise be corrected surgically.
Unhappiness with the cosmetic result – Many patients requesting this surgery often demonstrate the desired effect by lifting their eyebrow. Upper blepharoplasty does not improve eyebrow descent or heaviness – this requires a different procedure called a brow lift (or sometimes can be improved with botox). Upper blepharoplasty does it remove wrinkles from the eyebrow area.
Recurrence of excess skin – with time and natural ageing some patients may develop more excess skin on the upper eyelids.
Eye injury – exceptionally rare potential complication from surgery.
Blepharoplasty – Video testimonial from one of Mr Morritt’s patients
Blepharoplasty (eyelid surgery) reviews – Mr Morritt, Sheffield