Eyes
Surgery around the eyes requires specialist skills, experience and knowledge.
At Refine Surgical all eye procedures are performed by a consultant eye surgeon with over 20 years of NHS experience. Aside from removing unwanted lesions, surgery can also address the excess skin that accumulates around the eyes over time.
Blepharoplasty
Blepharoplasty is a type of surgery to remove unwanted skin or fat from the eyelids. The aim is to improve hooded eyelids or eye bags resulting from excess skin, muscle and fat usually associated with ageing. As you age, your eyelids stretch, and the muscles supporting them weaken. As a result, loose skin and fat may gather above and below your eyelids. Besides making you look older, severely sagging skin around your eyes can reduce your peripheral vision, especially the upper and outer visual field.
The Procedure
Before undergoing surgery it is really important to have a fully comprehensive consultation and examination to look for associated medical conditions, check eyelid function and also examine the eye itself, due to the important relationship between the surface of the eye and the eyelid. It is also important to identify whether the issue is due to just loose skin, or there is some puffiness to address which usually represents a prolapse of orbital fat.
Assessment
Surgery can be performed under local anaesthetic and although the actual procedure takes around 45 minutes per side, arrival to discharge from the department is around 2-3 hours. Some patients are apprehensive about local anaesthetic, but if the anaesthetic fluid is warmed to body temperature and the injection performed slowly through a very fine (insulin) needle, then there is usually minimal discomfort and some patients have actually drifted off to sleep during the procedure!
Anaesthetic
Skin removal costs £2200. However, if dealing with the orbital fat the Surgeon must go a little deeper into the eye socket itself where the blood vessels, nerves and muscles are. This not only increases the amount of surgical time which increases the cost (upto £2850), but also the risk of complications. Serious complications are thankfully very rare but it is very important for the patient to have access to the surgical team 24 hours a day seven days a week for the first few days after surgery.
Surgery
After the procedure, patients are provided with a postop pack, which contains some sterile swabs and sterile fluid. This should be kept in the fridge and used to make a cold compress to be applied to the closed eye to manage the bruising and swelling. We recommend patients sleep slightly upright for the first night. Swelling and bruising can persist for up to a week, but usually after a few days a patient can go back to some light duties and we have even had patients return to work for meetings on day five! We find that absorbable sutures can sometimes cause inflammation as the body tries to dissolve them, so we use non-absorbable sutures, which are removed after one week. The scarring from surgery can be hidden in the natural folds of the eyelid which is much more effective for the upper lid which has a natural crease.
Aftercare
Results
We are very grateful to our patients for consenting to share their stories. The following images are from before and 4 months after upper eyelid surgery. Pre-operatively the excess skin has been marked for removal and post-operatively the surgical site is hidden in the natural lid fold. Aside from the skin encroaching on their peripheral vision especially when reading, applying mascara was also becoming a challenge due to restricted access to the eyelashes.
Blepharoplasty can be a transformative procedure, and high levels of satisfaction come from a more rested and youthful appearance and increased self-confidence. The procedure is typically very long lasting and in some patients the results of surgery can last a lifetime. For others, heavy eyelids may recur later on in life as the skin ages. Patients should be aware that all upper eyelids need a natural fold and some laxity of the skin is needed to be able to open and close the eye.
Lesions
Skin lesions around the eye require specialist input. An intricate understanding of the delicate structures, folds and layers of skin around the eye is needed to ensure that potential cancers are not misdiagnosed as benign lumps, and that when healing takes place the result is natural and does not interfere with the protective role of the eyelids.
Your Lead Surgeon
Mr Bhojwani is a Consultant Eye Surgeon who currently works within the NHS. Graduating from Manchester University in 1998 and training with world class surgeons from the University of Illinois in Chicago, he then underwent further sub-specialty training at Leeds, Birmingham and the Manchester Royal Eye Hospital, gaining his fellowship in Ophthalmology in 2010.
In his NHS consultant role, Mr Bhojwani has been the clinical lead for Ophthalmology across the North Lincolnshire region, developing services in peri-ocular skin cancers, glaucoma, cataract and macular degeneration. He is now the lead surgeon for community day case services at Refine Surgical in Retford.