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Mr Simon Madge, Herefordshire’s regional eyelid specialist and cosmetic surgeon, is only too aware of the incredible benefits of eyelid reshaping surgery, or ‘blepharoplasty’. In this procedure, the upper and / or lower eyelids are reshaped through the removal of excess tissue, such as skin, muscle and fat. Bags under the eyes can be removed, giving a more youthful and less tired appearance, and if required, the upper eyelids can also be lifted, giving a more alert, attractive expression.


The blepharoplasty procedure can be performed under either local or general anaesthetic, according to patients’ individual wishes, and can be combined with other surgery if necessary (e.g. eyebrow lifting, watery eye surgery). Patients are generally able to leave hospital the same day and are often back at work within a week. As the procedure is so well-established, costs are typically much less than one might expect.


Information on eyelid surgery is given below:





There are many different kinds of eyelid surgery, depending on your specific type of problem that we discussed in your consultation. One person’s operation is naturally different to another’s, so please do not assume that you will undergo the same procedure as a friend, even if, for example, you both have a watery eye.



Eyelid surgery is usually carried out under a local anaesthetic. With a local anaesthetic you will be awake during the operation and you may feel sensations in the area being operated, but you should feel nothing sharp or painful. You may be able to see some of what is happening, but you will be aware of the very bright operating theatre lights. In some cases, I will ask specifically ask you to open your eyes or look up / down, but otherwise feel free to keep your eyes closed unless otherwise directed, which will probably leave you most comfortable.



Aspirin / warfarin / clopidogrel drugs


If you are taking any of these drugs, I will have given you instructions about how to proceed at your consultation. If you start taking any of these medications between your consultation and surgery, or if this was not discussed at your consultation, it is vital that you contact my secretary prior to your operation going ahead. I will then advise you how to proceed. If you take non-steroidal anti-inflammatory drugs (e.g. ibuprofen, voltarol, etc.), it is preferable to avoid these prior to surgery, however, these are often necessary for other ailments and should not be stopped if you would otherwise be in pain.



Preoperative instructions


Please dress casually and comfortably. Avoid wearing jewellery and thoroughly clean your face prior to coming to hospital. No make-up or contact lenses please on the day of surgery. Please take your standard oral medication (except see above re. aspirin / warfarin / clopidogrel / ibuprofen etc.) on the morning of surgery.


If possible, stop smoking for at least 2 weeks prior to surgery and until wounds are fully healed and at least 2 weeks thereafter.





In order to help you relax during surgery, I can arrange for some music to be played while in theatre. If you would prefer to bring your own choice of CD with you, please do so.



Following surgery


After surgery, you can experience some swelling / bruising for 1-2 weeks. Typically the swelling is at its worst after about 48 hours, so please do not be alarmed if bruising worsens the day after surgery; this is normal and in some cases the discolouration spreads down your face from your cheeks to your chin. If so, it will soon fade.


You may still have a little oozing or bleeding from the site of surgery over the first few hours, which should resolve by itself. Following surgery, I prefer to apply a firm dressing to the surgical site until at least the following morning, typically secured with elastoplast tape. While some surgeons do not do this, I believe that the great reduction in swelling / bruising achieved with this technique is worth the temporary inconvenience that padding causes. Should you wish not to have your eye padded shut following surgery, please discuss this with me prior to surgery. In patients undergoing surgery on both left and right eyelids, I typically pad both eyes closed, one for around an hour after surgery and the other until the following morning.


If the patch becomes loose, apply more tape. Do not remove the patch. While the patch is on, do not get it wet. Shower from the neck down or take a bath.


Cool packs applied to the wound are very helpful at reducing the swelling and bruising. If you wish to, apply a cool pack (cold flannel / frozen peas wrapped in flannel / ice cubes in plastic bag wrapped in flannel) to the area for 10-15 minutes, 6 times per day for the first 2 days.


As the local anaesthetic wears off, you will experience tightness of the eyelids. Pain after surgery is typically minimal, however, if you experience significant discomfort please take mild pain relief as required (e.g. paracetamol). Paracetamol taken regularly works better than when taken occasionally.


Avoid strenuous exercise, bending or heavy lifting for a few days after surgery as this can precipitate bleeding. Sleep with 2-3 pillows in order to keep the head elevated – this will help to reduce swelling / bruising.


Antibiotic ointment should be applied to the wound three times a day, which prevents scab formation and may reduce the risk of infection. Wash hands thoroughly prior to applying ointment.


If crusting occurs, you may clean the wound with warm boiled water using cotton wool or cotton buds to remove crusts and pat dry. Do not use soap. Then apply a layer of antibiotic ointment.


You may shower and wash your hair, but try and avoid getting soap on the wounds. Dab them dry afterwards and apply ointment.



Stitches / sutures


Skin stitches typically need to be removed, although in certain cases I will use dissolvable stitches. If stitches are to be removed, I typically remove these 5-10 days following surgery at your follow-up appointment.





Healing is a gradual process and the scars may remain pink for up to 3 months, after which time it may become pale. The area around the wound may be numb for several weeks or even months. You may experience occasional sharp pain or itching of the wound; this is normal during healing. If a skin graft is used, the initial appearance of the graft will be very different to the final appearance, which may take many months to achieve.