Eyelid Surgery (Blepharoplasty) Cost and Procedure Guide

What can eyelid surgery achieve?

The area around our eyes is one of the first places on the face to show the signs of ageing. As a result of this, patients may find that the skin here becomes loose, wrinkled and puffy. Consequently, over time this may leave patients with a permanently tired appearance. Some patients may find an inherited tendency to develop changes around the eyes, such as eye bags, earlier on in adult life. If this is something that affects patients, then eyelid surgery can help reverse these changes around the eyes. The procedure aims to:

• Reduce the excess skin and fat on the upper or lower eyelids
• Improve vision if excess skin on the upper eyelid is impeding it
• Give the eyes a more youthful and awake appearance
• Make patients less conscious of age-related changes around the eyes
• Boost self-esteem.

However, eyelid surgery is unable to resolve all problems. It cannot resolve:

• Wrinkles around the eyes
• Dark shadows under the eyes
• Folds of skin and fat extending into the cheek (called festoons).

If patients find that they are struggling with any of the above, then a brow lift, facelift or botox and fillers may be a more appropriate option.

How much does eyelid surgery cost?

Eyelid Surgery will usually cost between £3000 and £6000. The exact price can only be determined following a consultation with a surgeon. During the consultation, a patient and surgeon discuss what exactly can be achieved from the procedure and how the procedure can be personally tailored around the wants and needs of the patient.

Some of the factors decided upon during the consultation may accrue slightly higher costs than others. They include:

• Which hospital or clinic is chosen for the procedure
• Surgeon experience
• Anaesthetist experience
• Surgical techniques or combination surgeries
• The time required in surgery for each patient’s case

After the consultation, the price for the procedure is set; that price will not include any hidden fees or add-ons. It will cover:

• Highly rated CQC hospital costs
• Surgeon costs
• Anaesthetist costs
• Overnight stays (if required)
• Aftercare and follow-up appointments

Who are the best candidates for eyelid surgery?

Blepharoplasty, commonly known as eyelid surgery, is a popular cosmetic procedure for men and women. The eyes are one of the first places on the face to show the signs of ageing. As we age, the skin around the eyes can start to lose its elasticity, and the muscles begin to slacken. This slackening of the muscles causes the fat around the eyes to become more prominent, therefore, making the eyes look puffy. This can create the appearance of eye bags. Some people find that this bagginess of the eyelids affects their self-esteem and makes them feel unhappy. Eyelid surgery aims to remove this excess skin and fat, making the eyes appear more youthful. Individuals suffering from these problems may be suitable for eyelid surgery candidates.

As the purpose of eyelid surgery is to remove excess skin and fat from the upper and lower eyelids, suitable eyelid surgery candidates include those who are unhappy with:

• Any loose or baggy skin around the eyelids
• Their vision due to excess skin drooping over the eyes
• Eyebags or puffiness around the eyes

Before going ahead with the procedure, it is important to make sure that patients:

• Feel mentally and emotionally ready for surgery
• Are a healthy individual
• Do not smoke or use nicotine for at least six weeks before and after surgery
• Have no serious eye conditions

Surgeons will fully assess and examine the face during the consultation. This will allow them to decide which procedure will best meet the patient's desired outcome.

How is eyelid surgery performed?

An eyelid surgery procedure usually takes between 60 and 120 minutes to complete. It is usually done as a day case, which means patients will be able to go home the same day. The surgeon may perform the surgery using either a general anaesthetic or a local anaesthetic with the use of sedation. Once patients have chosen their ideal surgeon, they will have a free consultation with them. During this consultation, the surgeon will give details about the procedure. They will also discuss all expectations from the surgery. Finally, they will give instructions on what to eat, drink and what medications to take on the day of the surgery.

Consent

Patients will need to sign a consent form either in the pre-operative assessment or on the day of surgery. In order to sign this, patients will need to be fully informed about all aspects of the eyelid surgery procedure. Therefore, the surgeon and anaesthetist will discuss the surgery and its potential risks and complications. It is important that patients ask any questions that they may have. Next, the surgeon will examine and draw some lines on the treatment area.

Anaesthesia

On the day of surgery, patients will meet the anaesthetist and be taken to the operating theatre. The anaesthetist will then deliver an anaesthetic. This may be a general anaesthetic where the patient goes to sleep and wakes up after the surgery. This may leave them feeling groggy for a couple of hours post-op but will wear off. Alternatively, a local anaesthetic that numbs the treatment area with some sedation, so patients feel relaxed, may be used.

Incisions

Once asleep, the surgeon will clean and drape the treatment area. This is to ensure the treatment area is sterile and to reduce the risk of infection. According to the patient's desires, the surgeon will correct the upper or lower eyelids or combine the two. The location of the incision will depend on which part of the eyelid the patient is unhappy with. Therefore, the surgeon may use two different incisions in this procedure.

Upper blepharoplasty

This involves making an incision along the natural crease of the upper eyelid. The scar from this technique will be very discreet and lie in the fold of the eyelid.

Lower blepharoplasty

This technique involves making an incision below the line of the lower eyelashes. This is called transcutaneous blepharoplasty. This gives full access to the lower eyelid.

Alternatively, the surgeon can also make a small incision on the inside of the lower eyelid. This technique removes fatty deposits only from the lower eyelid and is known as a transconjunctival blepharoplasty. Although this technique will not leave a visible scar, it may not be suitable for every patient.

Depending on the incision, the surgeon is able to:

• Remove or reposition excess fat
• Remove excess skin
• Tighten or remove loose and slacking muscle

The incision site may vary according to personal desires and what the patient wishes to achieve from their eyelid surgery procedure.

Closing of incisions

Following the procedure, the surgeon will apply steri-strips or sutures to support the eyelid. They may give eye pads to put on after to help reduce swelling. These will only be kept on for a short amount of time, typically an hour.

Return to the ward

Once the surgery is complete, patients will return to the ward. They will need to stay there for a few hours or overnight. This is to allow the effects of the anaesthetic to wear off, ensuring the patient is safe to return home.

What to expect from an eyelid surgery consultation?

Firstly, patients will meet with their chosen surgeon. This initial consultation should last between fifteen minutes to an hour. In this meeting, the patient and surgeon will discuss expectations, personal goals, and the operation itself. Furthermore, in the eyelid surgery consultation, the surgeon will ask the patient about the following:

• Current and past medical conditions
• Any medications (prescribed, over-the-counter and herbal remedies)
• Any allergies
• Alcohol intake
• Smoke or use recreational drugs
• Any eye conditions or problems

It is important patients share all the above information with the surgeon as it may affect their approach. In the consultation, patients should also be as honest about their expectations and desires as possible. The more the surgeon knows about a patient's wishes, the more likely they will be to give the result the patient wants.

After they have taken a medical history, the surgeon will examine the eyes. They will assess how much excess skin and fat there is around the eyelids and decide on the best surgical approach. The surgeon will also take confidential photos for all medical records with permission.

Questions to ask during an eyelid surgery consultation?

It is important to use this initial consultation to ask any questions about the procedure. Some questions patients may like to ask the surgeon include:

• Do you think what I expect to achieve from surgery is realistic?
• What can I do to help with my recovery? How long will it take to recover fully?
• Will I have any scarring? If so, where will the scars be?
• What can I do to achieve the best results?
• Do you have any photos of eyelid surgeries you have performed in the past?
• How long can I expect the results to last?

If patients think of any more questions, it’s good to write these down and take them along to the consultation so as not to forget them. Finally, after the meeting with the surgeon, patients will be given a two-week cooling-off period. This is the time to think about everything. Then if the patient wishes to go ahead with surgery, they can book in their surgery.

What are the main eyelid surgery risks and complications?

All kinds of surgical procedures carry the potential for complications to occur. Therefore, before patients decide to go ahead with surgery, they should educate themselves on the main eyelid surgery risks. Although complications arising from surgery are rare, there is a small chance that they may occur. The potential risks and complications include:

Blurred vision

Blurred vision is common after surgery and may occur due to dry, watery eyes or swelling of the eyelids. If this were to occur, it is often temporary and should resolve in around a month.

Double vision

This is a rare complication after blepharoplasty. This happens when the muscles that move the eye are injured. Alternatively, it may also happen when the fat surrounding the muscle become scarred. This is often temporary, but there is a risk that it may become permanent. If the double vision becomes permanent, patients may need to have further surgery to correct it.

Loss of vision

A total loss of vision after eyelid surgery is a very rare complication. It may occur if a large amount of bleeding around the eye creates enough pressure to cut off the blood or nerve supply to the eye. This would present with intense pain, double vision and sudden bulging forward of the eye. If patients experience these symptoms, it is critical that they seek medical attention as it may require further surgery.

Suture cysts

Following surgery, tiny white bumps (known as milia) may form along the incision line. These usually resolve within a couple of weeks. Patients may also develop small fluid-filled sacs called cysts. These also can resolve by themselves, but if these small cysts bother the patient, the surgeon can remove them in a quick, simple procedure.

Infection

There is a risk that wounds may become infected after the procedure. However, infections are often minor and not very serious. If patients develop an infection, they may notice the following symptoms:

1. A temperature over 38° C
2. Increasing redness or swelling around the wound
3. Yellow and foul-smelling pus oozing from the wound
4. An increase in pain and discomfort that painkillers cannot control.

Most infections are mild and will resolve after a short course of antibiotics. It is, however, to get infections treated quickly as they can spread and become more serious.

Scarring

As the surgeon needs to make an incision during the blepharoplasty, the procedure will always leave a scar. The scars, however, tend to be minimal and well-hidden. The extent of the scar will depend on the technique the surgeon uses and the ability of the skin to heal. Some patients experience some more severe forms of scarring, such as hypertrophic or keloid scars. It is important to let the surgeon know if patients have had any of these types of scars in the past.

Bleeding

Bleeding during the procedure may result in bruising around the eye. Rarely, there can be a large amount of bleeding, which may affect vision. This would require immediate medical attention and may need another operation.

Removal of too much skin

Sometimes the surgeon may remove too much skin in the operation. This may result in:

1. Lagophthalmos – the inability to close the eyes completely
2. Ectropion – the lower eyelid drooping away from the eye and turning outwards
3. Eyelid retraction – the lower eyelid being pulled down

Patients can help avoid complications such as these by choosing a highly qualified and skilled BAAPS/BAPRAS surgeon.

Aesthetic

There is always a risk that patients are unhappy with the final result of surgery and the look of the eyelids. Therefore, it is advised that all patients choose their surgeons very carefully. Being honest about all expectations and desires from the surgery will help achieve the results the patient wants.

General surgical complications

All the different kinds of surgical procedures carry some common general risks. Everyone involved in the patient's care will do all they can to reduce the risk of any of this occurring. These general risks can include:

• Nausea and vomiting
• Reaction to your anaesthetic
• Blood clots in the legs and lungs
• Post-operative pain.

If patients have had an operation in the past and been affected by any of the above, it is vital that they tell the surgeon. This way, they can take extra measures to prevent them from happening again. Carefully following the surgeon’s aftercare advice will also help reduce the chance of any eyelid surgery risks and complications occurring.

How to prepare for eyelid surgery?

Before patients go in for surgery, there are some things they can prepare at home. Preparing well will make it easier to recover once they get home after the procedure. Below are some eyelid surgery preparation tips that our patients have found to be useful.

Cleaning

Some people find it useful to clean the house, take out the bins and do the washing before coming into hospital. This ensures the recovery time can be relaxing without having housework to do.

Shopping

It may be a good idea to do a food shop before the operation. Patients could even batch cook some food for the freezer, so they don’t have to worry about cooking.

Children and pets

To aid in recovery, patients may find it useful to ask family and friends to look after young children and pets for the first few days. This will allow patients to get all the rest they need after having the procedure.

Driving

Patients will be unable to drive after eyelid surgery. This is due to the anaesthetic agents that they use in the procedure. It is therefore important that patients arrange transport to take them home from the hospital. Furthermore, patients will be unable to drive until their vision is back to normal, so it may be useful to plan daily activities around this and arrange help as necessary.

Eating and drinking

In order to help recovery and maintain results, patients should eat a healthy diet. Try to eat foods that are high in protein and low in sodium and fats. This should include lots of fruits and vegetables. Try to drink plenty of water and stay away from drinks with caffeine in them.

Eyewear after Surgery

Following surgery, patients will be unable to wear contact lenses for a while. Therefore, patients should make sure they have a pair of glasses with the correct prescription after the procedure.

Furthermore, the surgeon will recommend that patients wear sunglasses for a few days after the procedure. This is to protect the eyes from wind, rain, and sun. Wearing sunglasses will also conveniently hide the swelling and bruising that occurs after surgery.

Sleeping

After surgery, some people find it more comfortable to sleep with a few extra pillows than normal. Therefore, it may be useful to get some extra pillows ready for this. It may also help to sleep in a slightly inclined position. This will reduce the swelling that may occur after the operation and protect the eyes from damage.

Following these eyelid surgery preparation tips can help patients feel more ready for surgery, and it will allow them to have the relaxing recovery time that they need.

What to expect after eyelid surgery?

By knowing a bit about eyelid surgery aftercare, patients may feel a bit more at ease before going in for the procedure. During the consultation with the surgeon, they will explain the eyelid surgery aftercare process. This will include information about when they can go back to driving, work, and exercise.

Waking up after surgery

How patients will feel after surgery will depend on the anaesthetic agent used during the surgery. If they use a general anaesthetic, patients will wake up slowly and feel a little groggy at first. Patients may find that the drugs they use in the operation may affect concentration and memory for the first couple of days. But this will resolve over time. If patients have a local anaesthetic, the treatment area may feel a little numb for a few hours. Furthermore, as the medication begins to wear off, they may find they experience some tingling or burning sensations around the eyes. If this is uncomfortable, patients can ask for some pain medication.

The first 24 hours

It is important that patients have adult supervision in the first 24 hours after surgery. Patients may feel dizzy or have problems with their vision straight after the surgery, and it is important to have support in case of this.

Returning to work

After having eyelid surgery, patients will need to take about a week off work. Most people return to work in seven to ten days after the surgery. If a patient's occupation involves driving, it is important that they do not return before their vision is back to normal.

Driving

Patients will not be able to drive themselves home after the surgery. This is due to the eyes being slightly swollen from the procedure and the medications used may cloud judgement. Patients must, therefore, ask a friend or family member to collect them from the hospital.

Returning to exercise

It is important that patients do not partake in strenuous exercise in the first week following surgery. This is because aerobic activity can increase the swelling around the treatment site. Patients should also avoid swimming for at least the first week.

Care of the treatment area

Patients will feel some pain and discomfort around the eyes after having eyelid surgery, including some swelling and bruising in the area. This should all resolve within a few days. Over-the-counter painkillers such as paracetamol can help with the pain. Patients may also find that their eyes are sensitive, difficult to shut or watery after surgery. This should settle down within a few weeks.

To aid in the recovery, it is essential that patients clean the eye area with clean water. The surgeon may also recommend some ointments or eye drops to use as well. Patients should avoid rubbing their eyes after the procedure as this may disrupt the stitches on the eyelids. It is important to keep in mind that patients will not be able to wear contact lenses for a couple of weeks after surgery, so they should get some prescription glasses to wear during this time.

Final results

Although patients can see the effects of eyelid surgery immediately, it may take up to six weeks to appreciate the full cosmetic result. As the incisions are made in the natural creases of the eye, the scars are often very faint after blepharoplasty. Once the scars heal, the eyes should have a more youthful and awake appearance.

It is crucial that patients follow their surgeon’s eyelid surgery aftercare advice so that they can achieve the best results in the safest way possible.

BAAPS/BAPRAS surgeons will see you for an initial consultation without a referral from your GP. If you then plan to continue with the surgery, your surgeon will ask for your permission to contact your GP practice so they can obtain your medical records.

There are some medical conditions that may need to be signed off by your GP before eyelid surgery, your Patient Care Adviser will let you know if this applies to you.

Smoking can greatly increase the risk of complications occurring after surgery. Therefore, most surgeons recommend that you are smoke and nicotine-free for at least six weeks before and after the procedure. Furthermore, some drugs and herbal remedies can affect the way your body heals. This is why it is important to tell your surgeon the full list of drugs and medications that you take.

As blepharoplasty is generally considered to be a cosmetic procedure, it does not qualify for NHS funding. However, if the reason that you want the surgery is due to excess skin on your eyelids, which is affecting your vision you may wish to speak to your GP to see if this could qualify you for NHS funding.

Most surgeons advise that you do not wear any eye makeup until your eyelids have fully healed following your eyelid surgery. Generally, this will be around six weeks. Your surgeon will give you specific advice on when you can resume wearing makeup.

We recommend that you wear dark glasses for the first week following your eyelid procedure. This will help protect your eyes from the sun and wind and also prevent you from touching your eyes. Dark glasses are also a good way to keep your procedure discreet if you do not wish to discuss it. They will also hide the bruising and swelling of your eyelids.

All of the information found on our website is sourced from highly reputable experts, government-approved authorities and is widely used by healthcare professionals.

• https://www.nhs.uk/conditions/cosmetic-procedures/eyelid-surgery/ NHS
• https://baaps.org.uk/patients/procedures/9/eyelid_surgery_blepharoplasty British Association Of Aesthetic Plastic Surgeons
• Understand.com Understand

Our content is written by our Medical Quality Managers and Patient Care Advisers, all of who have medical backgrounds and training. Prior to publishing, all the information is reviewed by a surgeon specialised within the relevant field.