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What is a blepharoplasty?

Blepharoplasty is the medical term for eyelid surgery. It describes a surgical procedure designed to remove excess tissue from the eyelid, create a fixed crease in the upper eyelid and produce a more open eye appearance when eyes are open. Excessive upper eyelid skin that is restricting vision can be removed to help create a greater visual field.

Blepharoplasty is usually performed as day surgery, under a general anaesthetic. The incisions are made where the natural crease should be in the upper lid and along the lash line in the lower lids. Excess fat and skin are removed.

If the lower lids have excess fat, but no redundant skin, the procedure may be done through an incision inside the lower lids. This leaves no visible scar as there is no external incision, and is known as a transconjunctival blepharoplasty. This is often associated with laser to the lower eyelids.

Some eyelid surgery procedures may attract an item number and therefore receive some money back from Medicare and your Health Fund. It is important to have a valid GP referral for all surgery. A rebate will only be available if the procedure satisfies the Medical criteria from Medicare.

Risks and Complications

Surgery is not an exact science. Incisions and scars are part of any surgery and the location and extent of the incisions will be discussed with you. Every effort is made by the surgeon to minimise scarring. Scars will fade over time, but they are permanent. They can also become hypertrophic or keloid. Scars vary from person to person and are related to each individual’s skin type, genetics and the ability of their skin to heal.

Every surgical procedure involves certain risks and complications (as per the ASPS brochure) including, but not limited to:

Asymmetry is evident physically in every person.  No two sides of the body are ever exactly symmetrical in shape, position or size and the surgeon will make every effort to achieve as close to symmetry as possible but some asymmetry is normal.

Delayed Healing, Infection and Suture Reactions can all be possible healing issues and may require antibiotics or in some cases surgical exploration.

Bleeding, Haematoma or Seroma Collections may resolve themselves but, in some cases may require further surgery.

Loss of Sensation and Numbness may also be experienced. In most cases this will improve over time on its own. In some cases this can be permanent.

Bruising and Swelling may also be a short term effect from surgery and will usually settle in one to two weeks.

Allergies to dressings, medical lotions, sutures or other materials can occur with some patients. You will be advised to cease the use of the dressing, lotion or material that is causing the reaction. In some cases anti-inflammatory medication may be prescribed.

Breathing Difficulties may be due to a general anaesthetic or breathing tube during the operation which has caused some swelling, noisy breathing or discomfort.

Blood Clots can also occur in some surgeries and may require urgent treatment and hospitalisation.

Pain thresholds vary from patient to patient. This may lead to different pain management and/or different recovery times to resume normal activities.

Achieving excellent results with minimal risk is a joint effort. It is important to disclosed to the surgeon and clinic and understand the following:

Full disclosure of your medical history including: allergies, personal, physical and mental history, previous surgeries, current medications and co-morbidities (including but not limited to, smoking, vaping, diabetes, prescription and illegal drug addictions, blood or heart disease, obesity or anorexia).

Co-morbidities may impact on outcome and healing post surgery.

Smoking, vaping, or taking recreational drugs must be ceased in the 6 weeks prior to some operations and during the healing phase. Failure to do so may increase the risk of complications, decrease your healing ability and affect your surgical outcome.

You should not take aspirin based prescription drugs 14 days prior to surgery and during the healing phase of the operation unless advised otherwise by the surgeon.

As per the Australian Health Practitioner Regulation Agency (AHPRA), all non-rebatable (cosmetic) procedures require a validated screening of Body Dysmorphia to be undertaken.

If Dr Layt is concerned about your mental state or physical state prior to the procedure, he may request evaluation by a psychologist, psychiatrist, general practitioner or other specialist. This referral is to assess your suitability, increased risks during surgery or any underlying physical or psychological problems which may affect your recovery or mental health.

In some cases this may require surgery to be postponed or cancelled by the doctor in his primary role to consider your care and personal well-being.

All surgery carries risks and it is important to understand these.

Every patient is an individual and therefore final surgical results will vary from patient to patient. Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified practitioner.

What can you expect after the operation?

After eyelid surgery you will often have black eyes which take a week or two to settle. You may notice that your eyes feel dryer than normal. This usually subsides in a matter of days to weeks. Until then, use artificial tears or ointment to comfort and protect the eye surface. You will have some sutures which need to be removed at 5 to 7 days.

Your eyes may feel sensitive to light for several days. You may find that your vision may blur for a week to 10 days due to the ointment and some swelling. These are common occurrences and should not alarm you.

The scars rapidly improve and will become almost invisible when they mature. Blepharoplasty is not typically a painful operation for most individuals, with oral medications easily controlling the pain.

What are the potential risks?

Although eyelid surgery is a widely performed procedure, all surgery involves a level of risk. When complications could potentially affect vision, it is especially important to be aware of the possible risks and take all precautions to avoid them. Pre and post-operative instructions, provided by Dr Craig Layt before the surgery, will thoroughly explain the best ways to minimise risk and expedite healing.

Specific Pre-Operative Instructions

WASHING: Wash the evening prior to surgery and the day of surgery paying particular attention to the area being operated on. This decreases the bacterial count and should decrease the risks of infection.

PRODUCTS: Do not apply moisturisers, make-up, perfume/deodorant, nail polish or hair products after washing. Remove all jewellery.

CLOTHING: Wear loose, comfortable clothing and footwear. A shirt with a button or zipper opening is ideal for removal.
HAIR: If you have long hair it should be tied up in a pony tail using a simple elastic band. This will keep it out of the way during surgery.

FASTING: You should have nothing to eat or drink for 6 hours before your operation. If you are required to take medication during this time please speak with your physician to check if this can be taken before the 6 hour fasting period or after your procedure.

SMOKING: Smoking and vaping increases the risks of complications significantly and should be ceased 6-8 weeks prior to surgery.

MEDICATION: If you are having the operation as a day case, you will be given a script for antibiotics and pain relief tablets that you will need to purchase from the chemist and bring with you on the day of your procedure. Do not take these prior to surgery. The nursing staff will advise you and your carer after your procedure on how to administer them.

Certain over the counter products and prescription medicines can cause complications before and after surgery. They can reduce the ability of your blood to clot and could increase your tendency to bleed during and after surgery. Do not take any medication containing or related to aspirin 2 weeks prior to your procedure. This includes NSAID’S, anti-Inflammatory medications, blood thinning medication.  Please see your doctor regarding if and when to cease medication. *This is not an all inclusive list*.

Also avoid Vitamin E supplements and red wine. Stop all herbal medications before surgery. The most common herbs used are Echinacea, Ephedra, Garlic, Ginseng, Ginkogo, Kava, St. John’s Wort, and Valerian. They may adversely effect anaesthetic drugs, prolong bleeding and impair healing after surgery. Please consult your physician before ceasing any medication.

ADMINISTRATION: Unfortunately, paperwork is a necessary evil. Each theatre complex has its own procedures. We have attempted to make it all easy by providing a simple series of steps to follow titled “THINGS TO DO FOR YOUR PROCEDURE” specific to the surgery centre you are attending. If you have any queries about this or anything else, don’t hesitate to contact us on (07) 5597 4100.

Specific Post-Operative Instructions

ICE: Cold compresses help minimise swelling and bruising. One of the best ways to do this at home is a small bag of frozen peas wrapped in a tea towel. Otherwise, the use of a bowl of ice cubes and several sponges at the bedside can soothe sore areas during the first day or so. It is more important to sleep than to have ice on the eyelids, so don’t ‘stay up’ in order to ice. When you do awaken, apply some ice for a few minutes before going back to sleep.

ARNICA (optional): You may take Arnica which is a homeopathic remedy to aid in reducing your bruising and swelling post-operatively.

OINTMENT: Cleanse eye with cooled boiled water and apply chlorsig eye ointment with cotton tips 4 times daily to suture lines.

EYE DROPS: Use the refresh plus eye drops as required to soothe irritated eyes.

POSITION: Keeping the head elevated will help reduce swelling. Sleeping with head elevated in a comfortable position for neck and body will also assist with swelling.

BLEEDING: If you bleed from one of the suture lines, apply pressure with gauze for 10 – 20 minutes, and it will almost certainly stop. If dried or clotted blood is stuck in the suture line, we advise gentle cleansing with clean water using a cotton bud or gauze.

SUTURES: One of Dr Layt’s nurses will remove the sutures at 5-7 days after surgery. The application of chlorsig eye ointment can then be applied during the day over the following few days until the tube is finished.

TED STOCKINGS: You may be required to wear TED stockings for compression to prevent DVT (blood clotting) post-operatively. If required these will be fitted at the hospital on your admission day. The nursing staff will advise you if you require these and on how long you need to wear these for.

PRODUCTS & BATHING: Take care when washing your hair and face or applying makeup/sunscreen/moisturiser not to get any product on the eyelids until the day after the sutures are removed.

ACTIVITIES: Most people feel nearly normal within a day or two after eyelid surgery (except for the eyelid itself). You can return to work as desired, provided your job does not involve any heavy lifting or straining. Do not do aerobic or heavy exercise for at least 3 weeks after surgery in order to avoid excessive swelling or bleeding.

MEDICATION: Take your pain relief and antibiotic medication as directed. Any medication you ceased prior to surgery must not be taken after your surgery until you are completely healed or as directed by your physician.

Eyelid surgery can be part of a full facial cosmetic makeover, including facelift, browlift, or other facial surgery procedures. Our plastic surgeon will talk with you about your ultimate goals and help you determine the best option for your needs.

Dr. Craig Layt

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If you are considering eyelid surgery and are wondering if you are a blepharoplasty candidate, contact our practice in Queensland to schedule a consultation with Dr Craig Layt at our Gold Coast practice or Ballina practice.  Any surgical or invasive procedure carries risks. Before proceeding, you should seek a second opinion from an appropriately qualified health practitioner.
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