FAQs
The area around the eyes are the first to show changes of ageing. A properly performed Blepharoplasty should rejuvenate your face and make it look more alert. This operation can also be performed for people with excessive skin on the upper eyelids blocking peripheral vision
Nothing lasts forever. However, by rejuvenating the part of the face most prone to ageing, it should take many years for the loose sagging skin to reform and the fat pockets to reaccumulate.
Every surgical procedure leads to scars. The incisions in Blepharoplasty are in the normal creases and folds of the upper and lower eyelids. With time the scars become very thin and hardly visible. If surgery is performed to treat baggy lower eyelids, the incision can sometimes be done from inside the eyelid with no external scarring.
Blepharoplasty is not intended to deal with these problems. Other cosmetic procedures may be able to help. Please discuss this with your oculoplastic surgeon.
We are all slightly asymmetrical – if you reflect one side of your face to the other side you would look very different. We tend to have our own concept of what is or is not unacceptable asymmetry in one’s own appearance. So the main risk of any surgery to the eyelids is the risk of unacceptable asymmetry.
Short-term bruising and swelling after surgery is normal and the eyelids may feel quite tight in the immediate post-operative period. The eyes may also feel uncomfortable and dry. Usually this is alleviated by using soothing drops (artificial tears) in the early postoperative period.
Please see Complications of eyelid surgery
The surgery is normally performed on a day patient basis under local anesthesia and light intravenous sedation for relaxation.
The maximum bruising and swelling should settle after two weeks, although it may take a full month or more to achieve complete recovery. Consult your surgeon.
Where there is a case for undertaking surgery to treat visual impairment, some insurance companies will reimburse all or part of upper eyelid surgery. Procedures for cosmetic improvements are generally not covered. However patients should check these details with their insurance companies or agents.
Botulinum toxin, often known as “Botox,” works by temporarily relaxing muscles. It does this by blocking nerve signals that tell muscles to contract. Normally, nerves release a chemical called acetylcholine, which makes muscles move. Botulinum toxin stops this chemical from being released, so the muscles stay relaxed.
Nothing happens for 48 -72 hours but afterwards Botox may:
Reduce Wrinkles & Fine Lines around the eyes by preventing muscle contractions, Botox softens frown lines, forehead wrinkles, and crow’s feet around the eyes.
Lift the Brows – Strategic injections can sometimes give a subtle brow lift, making the eyes look more open and refreshed.
It can also treats medical conditions like muscle spasms so decreases excessive blinking, twitching, and discomfort and restores normal facial function and appearance.
The results generally last 3–6 months so regular treatments help maintain both functional relief and cosmetic improvement.
Some bruising can occur. Every injection is different . Nothing happens for 48 -72 hours. Sometimes the Botox can spread to the muscles that move the eyes leading to temporary double vision or the muscle that opens the eye causing drooping. All the side effects improve rapidly over a few weeks as the effects of the Botox fade. Mostly the good effects last much longer than any side effects.
Usually no time is needed off work although you can experience some bruising that you can hide with make up unless you develop one of the complications of the treatment.
Normally if the treatment is used to improve your appearance (cosmetic use) this will not be covered by insurance. However sometimes treatment for facial spasms watering eye or inability to close your eye may be covered by your insurance.
DCR surgery involves bypassing the narrowing or blockage in the tear drainage by joining the lining of the tear sac to the lining of the nose to decrease the level of watering in your eye(s). However, it is still normal that you will have watering some of the time even with successful surgery.
You can decide not to have any treatment if you are happy to put up with your symptoms or try nasal sprays and eyedrops. Sometimes your doctor will recommend that you have DCR because of upcoming eye surgery or because you have had recurrent infections. The surgery is usually carried out with you asleep (under general anaesthetic).
Usually after the surgery your nose will be blocked and there are small tubes put into the corner of the eye to keep the newly created passages open. These are normally removed a few weeks to months after surgery. You should notice watering gradually improve as you recover from the operation.
The operation may be performed in two ways: External approach: the operation is performed through a 1-1.5 cm skin incision on the side of the nose. The scar is usually minimal or invisible. Endonasal approach: depending on the size of the interior of the nose it may be performed from inside the nose with no external skin incisions. Tubes are usually put in to keep the new surgical passage open as it heals.
It is common to have a bloody discharge from the nose. Bad nose bleeds can occur in 1 in 50 patients. Sometimes the tubes can cause problems as such irritation and occasionally this can dislodge if this happens the tubes will need to be repositioned.
Internal blockage can occur if a scar forms inside the nose causing the eye to remain watery.
Usually, DCR surgery will take about one hour per side and usually you do not need to stay overnight.
This depends on the nature of your work. You should not plan to travel for two weeks following surgery. You should not do heavy physical work for 2 weeks after surgery as these activities can cause bleeding from your nose.
Usually most medical insurance companies will cover the procedure but you will need to check with your insurance companies about the level of cover.
Thyroid eye disease (TED). is an auto-immune disease Your immune system is like a bodyguard—it protects you from harmful invaders like bacteria and viruses. But in an autoimmune disease, the immune system gets confused and mistakenly attacks the body’s own healthy cells, thinking they are threats. TED is usually linked to an over-active thyroid due to Graves’ disease which is also an autoimmune disease. Up to half of patients with Graves hyperthyroidism can be affected by TED. Sometimes this condition can happen when your thyroid levels are underactive or even normal.
TED is commonly associated with bulging forward eyes (exophthalmos) and eyelid retraction ( raised upper eyelid). TED can cause physical discomfort including eye pain, grittiness, excessive watering and light sensitivity. TED also causes significant inflammation inside the eye socket (orbit) leading to swelling of the muscles that move the eyes and increase in fat deposits. As the orbit is a confined space this can cause the eye to be displaced forwards as well as caused double vision as the eyes don’t move together in sync leading to double vision. These changes often cause profound psychological distress.
It is important that your thyroid and eye doctors work together to discuss the best treatment for you, taking into account both thyroid function and eye health. It is really important to control the overactive thyroid and stop smoking. There is scientific taking Selenium supplements for 6 months may benefit. Using soothing eyedrops may also help. However, if you have moderate or severe disease your doctors may discuss starting immunosuppression treatment or entering into a clinical trial of new TED treatments.
Successful TED treatment should be able to quickly reverse visual problems and disfigurement, have a good safety profile and improve patient’s quality of life. Unfortunately, no treatment that fulfils all the above criteria is currently available outside the USA.
In Europe and most of the world patients with moderate to severe TED are offered either intravenous or oral steroids and other treatments to suppress the immune system. These treatments are reasonably safe if monitored closely, and effective in preventing vision loss and relieving pain and swelling, and sometimes improve double vision. However, these treatments do not usually reverse the exophthalmos (shrink the eyeballs backwards into the eye sockets).
Significant exophthalmos is usually treated by orbital decompression surgery (breaking open the eye socket walls to enlarge the orbital cavity to allow the eye to settle backwards). Most doctors do not recommend this major surgery to improve the exophthalmos until the orbital inflammation has settled and the hyperthyroidism has been effectively and permanently treated.
There has been exciting new treatment developments. Tepezza ™ has been approved for use in TED in the USA since 2020 and has been very successful in reversing disfigurement and inflammation without need for orbital decompression surgery.
Many drug companies are now developing new treatments for TED. Some of these new drugs work in a very similar way as Tepezza and some others by other mechanisms thanks to new scientific breakthroughs. TED Patients can now get access to these new treatments by taking part in clinical trials.