The Condition
Excess upper eyelid skin (dermatochalasis) results from age-related loss of skin elasticity and fat prolapse. Lower lid bags arise from herniation of orbital fat through a weakening orbital septum. These changes are almost universal with ageing and may be exacerbated by genetics, sun damage, fluid retention or thyroid disease. Upper lid hooding can occasionally impair peripheral vision, making surgery functionally indicated.
Surgical Options
Upper blepharoplasty: Removal of excess skin and, where required, herniated fat. The incision is concealed within the natural lid crease. Often performed under local anaesthetic as a day-case procedure. Mr Naparus is experienced in performing this procedure under local anaesthetic in a calm, comfortable manner.
Lower blepharoplasty: Removal or redistribution of orbital fat, with or without skin excision. Transconjunctival approach (no external scar) or subciliary approach depending on anatomy.
Combined upper and lower: Frequently performed together in a single session.
Who Is a Good Candidate?
Not everyone who notices ageing around the eyes is a good candidate for blepharoplasty — some patients are better served by non-surgical treatment, a brow lift, or no intervention at all, and this is discussed candidly at consultation.
Indications: Dermatochalasis causing aesthetic concern or visual field impairment; lower lid fat prolapse; periorbital ageing refractory to non-surgical treatment.
Contraindications: Dry eye syndrome (relative — must be assessed pre-op); thyroid eye disease in active phase; unrealistic expectations; significant lower scleral show (predisposes to ectropion).
A full ophthalmic assessment may be recommended prior to surgery in patients with pre-existing eye conditions.
The Procedure
Upper blepharoplasty can comfortably be performed under local anaesthetic as a day procedure at 84 Harley Street or Chelsea & Westminster Hospital Private Care. Mr Naparus is known for his calm, reassuring technique during local anaesthetic procedures, ensuring patients are comfortable throughout. The procedure typically takes 45–90 minutes. Incisions are placed in natural skin creases and closed with fine non-absorbable sutures removed at 5–7 days.
Aims & Expected Outcomes
Brighter, more open and rested appearance to the eyes. Resolution of visual field impairment where present. Natural results — the aim is always a refreshed, not operated, appearance. Results are long-lasting, typically 10–15 years for upper lids.
Risks & Complications
All surgery carries risk. Mr Naparus discusses these individually and in detail at your consultation. Evidence-based frequencies quoted where available.
Bleeding / Haematoma
1–3%. Usually managed conservatively; rarely requires return to theatre.
Infection
<1%. Prophylactic antibiotics used routinely.
Dry Eye / Altered Tearing
5–10% temporary; persistent dry eye uncommon if pre-op assessment thorough.
Lagophthalmos
Temporary incomplete eye closure; usually resolves. Permanent cases rare if conservative skin excision.
Asymmetry
Minor asymmetry common; significant asymmetry uncommon. Pre-existing asymmetry documented pre-op.
Ectropion (lower lid)
1–2%. Lower lid retraction. Usually resolves; may require further treatment.
Visible Scarring
Uncommon. Scars usually imperceptible within 3–6 months.
Injury to Eye
Extremely rare (<0.04%); serious vision-threatening complications exceedingly rare.
Aftercare & Recovery
- Shower and wash hair after 48 hours
- Cool compresses to reduce swelling for first 48 hours
- Sutures removed at 5–7 days (face)
- Make-up may be worn once wounds fully healed, typically 7–10 days
- Contact lenses: avoid for 2 weeks
- Screen use: reduce for first few days; low lighting initially
- Swimming/sauna: once wounds fully healed, typically 10–14 days
- Exercise (non-contact): return at 2 weeks; contact sports at 6 weeks
- Return to office work: typically 7–10 days; sooner for non-screen-based work
- Bruising and swelling: largely resolved by 2 weeks; subtle swelling up to 8 weeks
Mr Naparus uses the suture type most appropriate for each layer and location. Absorbable sutures (e.g. Vicryl Rapide, Monocryl) dissolve over days to weeks and typically require no removal. Non-absorbable sutures (e.g. Prolene, nylon) may be used for skin closure to achieve precise wound edges and are usually removed at 5–7 days on the face or 10–14 days elsewhere. You will be clearly advised which type has been used and what follow-up is required.
Dressings vary by procedure and wound site. Common options include:
Micropore tape — breathable paper tape applied along wound edges to reduce tension and improve scar appearance; used for several weeks post-healing.
Silicone tape/sheets — reduces scar thickness and redness; typically commenced 2–4 weeks postoperatively once wounds are fully closed.
Prineo — a mesh dressing/glue system used for longer incisions (e.g. abdominoplasty) that reinforces wound closure and is usually removed at 7–14 days.
Mepitel/non-adherent dressings — used where wounds need protection and moisture balance in the early postoperative period.
Alcohol increases bleeding risk during surgery and in the postoperative period by impairing platelet function and vasodilation. It interferes with anaesthetic agents, requiring higher doses and prolonging recovery. Alcohol also impairs wound healing by reducing collagen synthesis and immune function, and significantly increases infection risk. Mr Naparus advises complete abstinence for a minimum of two weeks before and two weeks after surgery.
Nicotine causes vasoconstriction, reducing blood supply to healing tissue and dramatically increasing the risk of wound breakdown, skin necrosis, poor scarring and infection. This applies equally to cigarettes, vaping, nicotine patches and gum. Mr Naparus requires patients to be nicotine-free for a minimum of six weeks before and six weeks after surgery. Evidence shows that smoking cessation improves outcomes significantly; in some procedures (e.g. facelift) smoking is an absolute contraindication if not ceased.