EXCESS EYELID SKIN

CAUSES 

Dermatochalasis (excess eyelid skin) is usually caused by skin ageing: the fibres in the skin lose their elasticity and the skin becomes slacker.   Often, the collagen under the skin softens at the same time which can cause fatty fibres (which are normally found in the orbit) to be projected forwards.      

Dermatochalasis rarely occurs in young patients: problems of the thyroid gland (Graves’ disease), congenital illnesses and smoking are all factors that can predispose patients to dermatochalasis.         

TREATMENT: BLEPHAROPLASTY

Blepharoplasty (eyelid surgery) involves removing the excess skin.  

The amount of skin that needs to be removed will vary from one patient to another.   It is always important to find the right balance between cosmetic appearance and practicality: we do not want to remove too much skin otherwise there is a risk that patients will no longer be able to close their eyes properly.   It is also not advisable to remove too much skin if patients suffer from dry eye syndrome, because this can aggravate the problem.  

Before the operation

10 days before the operation

Anticoagulants

You must stop taking anticoagulants 10 days before the operation. However, before stopping, you must consult your doctor and check that he or she agrees that it is safe to do so. If you are taking MARCOUMAR, you will be offered a plan so that you can take an alternative drug as a replacement. Your doctor will be consulted about this to make sure that he or she agrees. If anticoagulant treatment prescribed for a general illness cannot be stopped, it is possible that the eyelid surgery will not be able to go ahead.

The day before the operation

• Go to the chemist and buy a cooling mask (ice pack).
• Make sure you have sunglasses or a protective hat.  
• Make sure you have some paracetamol (pain killers).

The day of the operation

You may eat as normal on the day of the operation. Take all your medication as usual (except for the anticoagulants).

Do not wear any mascara, make-up, earrings or necklaces. Wear comfortable clothes.   Do not wear your contact lenses.

Bring some recent (representative) photographs of yourself with you. You will be photographed before and after the operation so that you can judge the results for yourself.  

Tell the doctor or nurse if you are allergic to any medicines.

The operation will take approximately one hour.   It may take longer for some patients if underlying fat has to be removed.   If it has taken longer than expected to treat the patients before you, you will also have to allow for waiting time.

During the operation

First, the doctor will draw on your skin with a felt-tip pen so that he or she knows how much skin needs to be removed.   (The incisions will be made in the natural creases of your skin.)   Precision is extremely important at this stage in the procedure, and this is why a lot of time is spent on it.  

Next, your whole face will be disinfected with Isobetadine and sterile tissues will be placed around your face like a turban. Your nose and mouth will still be free, enabling you to breathe normally.  

During the operation you will not be able to touch your face. This is because it needs to be kept sterile.

The doctor will then give you subcutaneous (i.e., under the skin) injections (lidocaine 2% with adrenalin 1: 100,000). These injections are similar to the injections you have at the dentist. The anaesthetic will start to work immediately and the effect will last for about one hour.

During the operation you will have to sit up on a few occasions so that the doctor is able to judge the results more effectively.  

Small non-absorbable sutures will be used, as absorbable sutures can cause a reaction leading to unpleasant scarring.   While the sutures are being put in place, it is possible that the anaesthetic will start to wear off.   Consequently, you may feel some of the last sutures slightly.   We prefer not to give you any more anaesthetic as this would increase the risk of swelling and subcutaneous bleeding.  

At the end of the operation an antibiotic ointment will be applied to your eyelids. You will then get a cooling mask that you will have to leave on your eyes for half an hour. When you go home, it is important that you use the cooling mask every hour for 10 minutes.   Alternatively, you can use a packet of frozen peas because they will mould to your face easily. This cooling is very important as it helps to reduce the swelling, but it is only effective during the first 24 hours following the operation. If this causes pain, you can take some paracetamol (as this does not contain any anticoagulant substances).

The day after the operation

Chill your eyelids using ice every hour for 10 minutes. You will notice that the swelling gets worse up until the third day after the operation and that it will then start to get better.

The first week after the operation

It is possible that your skin will be blue for about a week. The swelling can last for up to three weeks.   Don't worry about any haematomas (blood clots under the skin), as they will gradually disappear.

While you still have the sutures, you must not get any water on your eyes. You are also advised not to wear any make-up.   Do not massage your eyelids in any way during the first three weeks.   Do not put any dressings on your eyelids.  

Removal of the sutures and check-up

The sutures will be removed 5 to 7 days after the operation.   Once they have been removed, you may use water on your eyelids again.   You will have another check-up 4 weeks after the operation.  

The first three months after the operation

Stay out of the sun as it can cause nasty scars. You can avoid it by using total sun block (factor 60) or by wearing a hat. Sunglasses will not offer you sufficient protection.

SIDE EFFECTS AND COMPLICATIONS

Just as with other operations, various complications and side effects may occur.  

Under-correction

If after several months it seems that there is still some excess eyelid skin, this can be removed.   Incisions will be made in the same place as previously.  

Scars

Scars are not only caused by surgical technique; they are also caused by the way in which the skin reacts to the operation.   Some people are naturally more prone to scars.   To help any scars heal, you are advised not to expose them to the sun.   Smoking also prevents the eyelid from healing as well as it otherwise would.  

Swelling of the eyelids and loss of skin sensitivity

Blepharoplasty leads to a temporary deterioration in lymphatic circulation to the eyelids, which causes more swelling at first.   Some nerve endings are cut during the operation, which can lead to hypersensitivity in the eye area.   The nerves repair themselves within a few months.  

Cysts

Small yellow cysts may form where the sutures are placed. In most cases, these are reabsorbed after a few months.  

Skin irritation caused by drying

Swelling of the eyelid can sometimes mean that patients cannot shut their eyes properly for a time. This can lead to dry eye syndrome.   This problem can be treated using artificial tears.  

Bulging eye caused by bleeding  

In rare cases, postoperative bleeding may cause tissues to be put under pressure.   This is an extremely serious complication and can even lead to blindness.   If you experience this problem, it is essential that you contact your doctor immediately.