Baggy upper lids
Age related changes can cause excess skin in the upper or
lower lids. Occasionally this can occur in much younger patients
as a result of recurrent upper lid swelling due to an allergy or
patients or thyroid abnormalities.
In its simplest form there is only abundant skin that needs to
be removed. In some individuals however there is excess of
muscle and fat that needs to be addressed.
Excess upper eyelid tissue can cause reduction of the upper
visual field and occasionally the fold of skin irritates the eye
as it sits on the eyelashes.
Patients with the above symptoms are entitled to NHS treatment.
Others seek a remedy for this to improve cosmesis which is not
undertaken on the NHS.
Eyebrow ptosis
In some individuals the baggy upper lids are as a result of
the decent of the eyebrows. It is usual in individuals above age
45 to have some degree of brow ptosis.
This is commonly age related although it can also occur in
facial nerve palsy. It is very important that the eyebrow is
lifted with or without removing the skin of the upper lid.
Your surgeon will have explained the likely cause of your
eyebrow ptosis or baggy eyelids. You will also be told if there
is an associated eyelid ptosis (droopy eyelid) which might have
to be addressed at the same time. (Please refer to eyelid ptosis
information).
Baggy lower lids
Excess or laxity of skin, muscle and fat can also occur in
the lower lids. It is very unlikely that this will result in any
functional deficit although surgery is undertaken outside the
NHS for cosmetic reasons. Patients with thyroid eye disease or a
very severe form of baggy lower lid can be considered for NHS
treatment.
How surgery is done:
Upper lid blepharoplasty
Excess skin or muscle or occasionally fat is removed from the
upper lid. Incision is usually in the skin crease and therefore
the scar is not visible, although some individuals with
particularly dark skin are prone to excessive scarring, however
this is very rare and can be remedied. It is preferable to
perform the operation under local anaesthesia.
Lower lid blepharoplasty
In some individuals fat is removed or repositioned back into
the socket and an amount of skin is also removed. An attempt is
made to lift the upper end of the cheek and stabilise it against
the bone of the outer corner of the eye and this guards against
puling down the lower lid.
Your surgeon might recommend this operation to be done under
general anaesthesia.
Eye brow lift
Your surgeon will recommend a particular technique that suits
your individual needs. There are different ways of lifting the
brow and none of the effects of all these procedures are
permanent or fully predictable. Most surgeons however will quote
a success rate of about 80%. The eyebrow does drop a little
after a few months after the operation, however surgery can be
repeated.
1. Direct brow lift
Here an eclipse of skin and underlying fat is removed from
above the brow. There might be temporary numbness of the
forehead. This usually resolves. The scar can be hidden by eye
brow hairs. The scar however is visible for few weeks and more
so in some individuals than others but usually quite
acceptable after few months.
2. Internal brow lift
There is no scar as the lift is done through the eyelid
incision. The eyebrow tissue is sutured higher up on the
forehead. You might feel some tenderness over the brow area
for few weeks
3. Endoscopic or non endoscopic small incision brow lift
He operation is performed under general anaesthesia. Few
small incision is made in the scalp about 2 cm behind the hair
line. The tissue of the forehead is lifted off the bone and
suspended higher up by removable or dissolvable screws. It is
helpful to use a small light source (endoscope) to improve the
visibility and increase the accuracy of the operation and
prevention of nerve and vasculature damage.
Temporary numbness of the forehead or some loss of
hair of incision site can occur. There is a small risk that
the nerve supplying the forehead muscle can be damaged. This
however is usually temporary.
If permanent,
one would not be able to raise the brow, though the primary
position of brow will be normal .
Rarely,
it is necessary for patient to return to theatre to
drain a blood clot, if bruising is excessive.
4. Large incision (Open forehead
lift )
The incision is much larger and placed behind the hair line
. The scar will be covered by hair but some degree of numbness
behind the incision line is permanent. The risk to Facial nerve is rare but can happen . Usually the
palsy is temporary.
In the event of permanent
facial nerve palsy the brow position will be normal but one
will not be able to raise the brow.
Some minor degree of
hairline around the incision line is also rare but can occur.
The operation is generally performed under general anaesthesia.
How to prepare for surgery
You will be asked to stop Aspirin for 3 weeks and Warfarin
for 2 days before the operation if you are taking any of these.
You must check with your GP to make sure it is safe for you to
do so.
It is
important to note that even if Aspirin is stopped 3 weeks prior
to surgery these individuals will have
more bruising.
You will also be asked to fast for about 6 hours. You can
drink water or tea but no milk up to 2 hours before the
operation. Even if your operation is under local anaesthesia, it
is advisable to have an empty stomach particularly as you might
require sedation. Wear comfortable clothes. You will be asked to
change into a theatre gown and also to remove your jewellery.
The alternative to
surgery is not to have surgery. Surgery can be done at any time
in the future should you change your mind.
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