Plastic Surgery | Dr. Enrique Etxeberria, Plastic Surgery in Bilbao


Plastic Surgery - Eyelids - Blepharoplasty


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Surgery of the eyelids (technically known as blepharoplasty) is a procedure used to extract fat, usually at the same time as removing excess skin and muscle from the upper and lower eyelids. Surgery can correct the separation of the upper eyelids and bagging below the eyes, features that can make you look older and more tired than you truly feel, in some cases even interfering with vision. However, this procedure does not remove wrinkles or so-called “crow’s feet”, neither does it eliminate the dark circles under the eyes or lift drooping eyebrows. Although it can help increase the fold in the upper eyelids of Asian people, it cannot remove evidence of ethnic or racial features. A blepharoplasty can be performed exclusively or simultaneously with other facial surgical procedures, perhaps facial stretching or a coronal rhytidectomy. If you are considering eyelid surgery, this leaflet will give you a basic understanding of the procedure in relation to when it might be of help, how it is performed and what results can be anticipated. The leaflet cannot answer all your questions as many things depend on the individual patient and the surgeon. Please ask your surgeon anything you do not understand.


A blepharoplasty can improve your appearance and self-confidence, it will not necessarily change your appearance in such a way that it remains ideal, nor can it make people treat you differently. Prior to deciding whether to have surgery, think carefully about your expectations and speak with your surgeon about them.
The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable and realistic in their expectations. The majority of candidates are aged 35 or more, however, if dropping eyelids are typical features in your family, you may decide to undergo eyelid surgery at an earlier age. There are certain conditions that increase the risks of a bleparoplasty, these include thyroid problems such as hyperthyroidism or Graves disease, problems of lack of moisture in the eye or insufficient tearing, high blood pressure or other circulatory disorders, cardiovascular diseases and diabetes. A detached retina or glaucoma is also a reason for being cautious; check with your ophthalmologist prior to having surgery.


When a qualified plastic surgeon performs eyelid surgery, complications are rare and usually minor. However, there is always the possibility of complications, including an infection or a reaction to the anaesthetic. You can reduce your risks by closely following the instructions of your surgeon both before and after surgery. The minor complications that occasionally occur after a blepharoplasty include double or blurred vision for a few days: temporary inflammation of the corner of the eyelids and a slight asymmetry in recovery or cicatrisation. Small white spots may appear after removing the stitches; your surgeon can easily extract these with a very fine needle. After surgery, some patients experience a degree of difficulty in closing their eyes when they sleep; in rare cases this condition can be permanent. Another very rare complication is ectropion, which is a downward stretching of the lower eyelids. In this case, additional surgery may be required.


La consulta inicial con su cirujano es muy importante. El cirujano necesita un historial médico completo suyo para verificar sus expedientes antes de la operación y estar listo para darle la información necesaria. Asegúrese de informar a su cirujano si usted es alérgico a cualquier cosa; si está tomando vitaminas, medicamentos (ya sea recetados o cualquier otro fármaco) también infórmele si usted fuma.

Durante esta consulta su cirujano o una enfermera le hará un exámen de la vista y evaluarán su capacidad de generar lágrimas. También debe proveer cualquier información relevante de su oftalmólogo o los resultados de su exámen de la vista más reciente. Si usa lentes comunes o de contacto, asegúrese de traerlos.

Usted y su cirujano deben hablar cuidadosamente sobre sus metas y expectativas de esta cirugía. Deberán discutir si es necesario tratar los cuatro párpados o solamente los superiores o inferiores y si es apropiado realizar procedimientos adicionales.

Su cirujano le explicará las técnicas y anestesia que utilizará, el tipo de instalación donde se realizará la cirugía y los riesgos y costos involucrados. No dude en hacer a su doctor cualquier pregunta que tenga, especialmente las que tienen que ver con sus expectativas y preocupaciones de los resultados.


The initial consultation with your surgeon is very important. The surgeon needs your full medical history in order to evaluate your risk factors prior to your operation and to be ready to provide you with all the necessary information. Be sure to tell your surgeon if you are allergic to anything; if you are taking vitamins, medication (either prescribed or any other drug), and also inform your surgeon if you smoke. During this consultation your surgeon or a nurse will examine your eyesight and evaluate your capacity to generate tears. You must also provide any relevant information from your ophthalmologist or the results from your most recent eye test. If you use contact lenses, make sure you bring them.
You and your surgeon must speak carefully about your goals and your expectations for this surgery. You must discuss whether it is necessary to treat all four eyelids or just the upper or lower ones and whether it is appropriate to perform additional procedures. Your surgeon will explain the techniques and the anaesthesia to be used, the type of facilities in which the surgery will be performed and the risks and costs involved. Don’t hesitate to ask your doctor any questions you may have, particularly those relating to your expectations and concerns about the results.


Eyelid surgery can be performed in a surgeon’s clinic, in a surgical centre for patients who are not admitted or in a hospital. Rarely is admission required.


Eyelid surgery is generally performed under local anaesthetic which numbs the area surrounding the eyes, together with oral or intravenous sedatives. You will be awake during the surgery but relaxed and desensitised to pain. (However, you may feel a pulling of the skin or occasional discomfort). Certain surgeons prefer general anaesthetic. In this case, you will be asleep for the duration of the operation.


A blepharoplasty generally takes one to three hours depending on the degree of the surgery. If all four eyelids are to be worked upon the surgeon will probably begin with the upper lids first and then the lower ones. In a typical procedure, the surgeon makes incisions which follow the natural lines of yoru eyelids: the folds in the upper lids and just beneath the eyelashes in the lower lids. The incisions may extend towards the crow’s feet or lines that form when you smile at the the outside edges of your eyes. Working through these incisions, your surgeon separates the skin from the internal fatty tissue and the muscle, extracting excessive fat and generally excising the dropping skin and muscle.
Subsequently, the incisions are closed with very fine sutures. If there is a bag of fat under the lower lids but extracting the skin is not required, the surgeon will probably perform a transconjunctival blepharoplasty. In this procedure, the incision is made inside the lower eyelid, without leaving any visible scar. This procedure is generally performed in younger patients who have thicker and more elastic skin.


After the surgery, your surgeon will probably lubricate your eyes with an ointment and apply a bandage. Your eyes will probably feel a bit taut and sore when the anaesthetic wears off, however your surgeon can prescribe medication for the pain and thereby reduce your discomfort. If you experience severe pain, call your surgeon immediately. Your surgeon will tell you to keep your head elevated for a couple of days and to use cold compresses to reduce the swelling and blood coagulation. (Coagulation varies from person to person; it generally peaks during the first week and generally lasts two weeks to one month). You will be shown how to clean your eyes, which can be a little sticky for around a week. Many doctors recommend drops, as your eyes may feel a little dry to begin with and you may feel that they sting or itch. During the first few weeks you may also experience excessive tearing, sensitivity to light and temporary changes in your vision, such as cloudy or double vision. Your surgeon will follow your progress closely during the first or second week. The stitches will be removed between two days to one week after surgery. Once these have been removed, the inflammation or discolouration around the eyes will gradually disappear, whereupon you will start to see and feel much better.


You will be able to read or watch television after two or three days. However, you will not be able to use contact lenses for approximately two weeks, and even then they may cause a certain degree of discomfort for a period of time. Most people feel ready to go out in public (and return to work) after a period of one week to ten days. Then, depending on your rate of recovery and instructions from your doctor, you can probably use make-up to cover the remaining blood coagulation. You will probably be sensitive to sunlight, wind and other irritants for various weeks, therefore, when you go out you should use sunglasses and apply a special sun protection cream designed for eyelids. Your surgeon will probably tell you to keep your activities to a minimum for three to five days and avoid more strenuous activities for at least three weeks. It is particularly important to avoid activities that increase blood pressure, including bending over, lifting things and rigorous sports. You will probably be told to avoid alcohol, as this can cause the retention of fluids.


Cicatrisation is a gradual process and the scars may remain slightly pink for six months or more after surgery. However, subsequently they will gradually disappear and adopt the appearance of a slim white line which is almost invisible. On the other hand, the positive results of eyelid surgery such as a more alert and youthful appearance, last for years. For many, the results are permanent.