cataract, oculoplastic, reconstructive, lacrimal and aesthetic surgery

Hugo Henderson MA MB BS FRCOphth

consultant ophthalmologist and oculoplastic surgeon

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Blepharoplasty

Droopy eye

Browlift

Botox

Aesthetic

Watery eye

Cataract surgery

 

Harley Street London eye surgeon

Frequently asked questions

Hugo Henderson surgeon at work

What is cosmetic eyelid and facial plastic surgery?

Cosmetic eyelid and facial plastic surgery is another term for cosmetic periocular (around the eyes) surgery. It embraces a number of procedures to correct hooded or baggy eyelids and improve the aesthetic appearance of the eyelids and surrounding area of the face, including the eyebrows, forehead and midface. There are also related aesthetic treatments.

What does Cosmetic Surgery include?
  • Upper eyelid blepharoplasty
  • Lower eyelid blepharoplasty
  • Endoscopic and non-endoscopic eyebrow and/or forehead lift
  • Mid face / cheek lift
  • BOTOX (botulinum toxin) for lines and brow ptosis
  • Fillers and other injections around the eyes and face

The two most common cosmetic surgery operations carried out by Oculoplastic Surgeons are:

  • 1. Blepharoplasty
  • 2. Brow lift

The most common aesthetic treatment carried out by Oculoplastic surgeons are:

  • 1. Botulinum toxin A (also known as BOTOX®, see Allergan and Dysport)
  • 2. Restylane® injections

What is an Oculoplastic Surgeon?

Oculoplastic surgeons are ophthalmologists (eye doctors) who have specialised in eyelid and facial plastic surgery. Oculoplastic surgeons are trained to do many different types of eyelid and facial surgery, ranging from simple eyelid malpositions to more complex reconstruction involving the eyelids and surrounding forehead, temporal and cheek areas. They understand the delicate anatomy and function of the eyelids and their surrounding structures. As well as the eyelids, they specialise in the lacrimal (tear) system, the orbit (bone cavity around the eye), adjacent periocular (around the eyes) and facial structures and the forehead and cheeks.

Oculoplastic surgeons are also known as ophthalmic plastic and reconstructive surgeons and oculo-facial surgeons.

  • Oculoplastic surgeons assess the surface health of the eyes and function of the eyelids prior to eyelid plastic surgery
  • As dedicated eyelid plastic surgeons, an oculoplastic surgeon routinely does surgeries in these areas, and recognises potential problems
  • Oculoplastic surgeons are trained to manage the complications or eyelid and facial plastic surgery which can involve the eye itself
  • Oculoplastic surgeons have a professional society which helps them maintain a high standard of care, called the British Oculoplastic Surgey Society.

Why are Oculoplastic Surgeons important around the eyes?

Oculoplastic surgeons are trained ophthalmologists (eye doctors) who understand how eyelid surgery can affect the comfort of the eye and the clarity of vision. They are accustomed to working around the eye and face.

What is blepharoplasty?

This is a surgical procedure to remove excess tissue – skin, muscle and sometimes fat, from the upper and/or lower eyelids. It is often done in conjunction with other treatment such as a brow lift and BOTOX. There are cosmetic and functional reasons for blepharoplasty surgery.

What is a brow lift?

This is a surgical procedure to raise the level of the drooping eyebrows and forehead, often done in association with upper eyelid blepharoplasty. The aim is to correct eyebrow ptosis. There are several different brow lift techniques, endoscopic or non-endoscopic, with or without fixation e.g. Endotine®.

What is BOTOX® treatment?

This is injection of botulinum toxin A (BOTOX is the name of one brand of botulinum toxin) into overacting muscles which cause deep activity lines on the face, especially the forehead and around the eyes, such as the vertical frown lones and the smiles lines. Common sites for injection are the glabella lines (vertical frown lines), forehead lines and smile lines aound the eyes (crow's feet). BOTOX causes reversible inactivation (chemodenervation) of the facial muscle causing these lines. Mulitiple small injections are made which have a peak effect one week after the injection then gradually wear off over three months approximately.

What is a filler?

A filler is an inert synthetic substance such as Restylane ® which is injected into the depressions or tear troughs below the eyes and the lines between the nose and the mouth (nasolabial folds). Fillers can be temporary, semi-permanent or permanent, depending on what material is injected. Restylane is temporary. The patients' own fat (autologous Coleman fat) can also be used to fill out depressed areas around the eyelids.

What happens at the consultation?

Mr Henderson will examine your eyelids and face and ask about your general health and any allergies and medications, especially aspirin and other over the counter tablets, and whether you smoke. You may be required to undergo a general health check by your general practitioner, including heart and blood tests. Your vision will be tested and the health of the eyelids, the tear film and the front of the eye checked, as well as a retinal examination. The whole face will be examined and the condition of the skin noted, and the position of the eyebrows and eyelids will be measured. Pre-operative photographs are taken as a baselinefor comparison with the results after surgery.

You will be advised whether just the eyelids or the eyebrows too need operating on and whether BOTOX (botulinum toxin) or other non-surgical treatment is recommended. You will be advised what tablets to stop before the surgery and given an information sheet about your operation and the post-surgery lid care.

What are the complications of blepharoplasty?

Serious complications are rare but may occur even in the hands of trained and experienced surgeons. Every effort is made to reduce the risk of complication - in the unlikely event of a complication which can affect your vision, oculoplastic surgeons are trained to manage this. You need to help by stopping aspirin, clopidrogel and non-steroidal anti-imflammatory tablets two weeks beforehand if you physician will allow it, in order to reduce the risks from bleeding.

  • Sunken appearance - a sunken-looking "cadaveric" eye appearance can occur if too much fatty tissue is removed
  • Asymmetry - a minimally uneven skin crease or lid height may be noticeable if there is asymmetrical swelling, more marked on one side than the other. If asymmetry is present after two weeks, it may persist and require later secondary surgery
  • Scar - rare as the incisions are hidden in the natural skin folds
  • Need for repeat surgery - patients should be warned of the need for further surgery if an optimum result is not achieved.
  • Eyelid and cheek swelling and bruising - May be noticeable for up to 6 weeks)
  • Blurred vision - For a few hours or overnight, due to surface ocular drying during the procedure, from effect of the local anaesthesia and ointment instilled. If this persists more than 24 hours, inform your oculoplastic surgeon
  • Watery eyes - Reflex tearing may occur for 24 – 48 hours due to mild ocular discomfort and surface dryness
  • Dry gritty eyes - This may occur for the initial two to three weeks after surgery due to reduced blinking. You will be prescribed artificial tears during the day (e.g. Hypromellose, Systane or Viscotears) and an ointment at night (e.g. Lacrilube or Simple Eye Ointment) to prevent this. Topical antibiotics such as Chloramphenicol are used for 1 week if surgery has been done from inside the eyelid.
  • Scratched surface of the eye - Minor injury to the eye surface can result in pain for 24 hours. If it persists or is severe, your oculoplastic surgeon must be informed.
  • Bruising behind the eye - Bleeding behind the eye is rare but can cause the eye to go blind. This is an Ophthalmic Emergency which Oculoplastic Surgeons are trained to prevent and manage. Oculoplastic surgeons are trained to prevent and manage this (repetition).
  • Wound infection - This is rare, but can result in failure of the procedure
  • Incomplete eyelid closure - For a day or two after surgery the eyelids will feel stiff and not entirely cover the surface of the eye when closed. It usually settles in days - associated discomfort is eased by lubricant drops and ointment.

What is the after care following eyelid surgery?

After surgery, your eyes are lubricated with ointment and a bandage applied. Your eyelids may feel tight and sore as the anesthesia wears off, but you can control any discomfort with the pain medication prescribed. If you feel any severe pain, call the hospital immediately.

You should keep your head elevated for several days, and use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a week or so. You will be prescribed eyedrops or ointment, since your eyelids may feel dry at first and your eyes may burn or itch. For the first few weeks you may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision.

Your progress will be followed very closely for the first week or two. The stitches will be removed a week after surgery. Once they're out, the swelling and discoloration around your eyes will gradually subside, and you'll start to look and feel much better.

You should be able to read or watch television after two or three days. However, you won't be able to wear contact lenses for about two weeks, and even then they may feel uncomfortable for a while.

Most people feel ready to go out in public (and back to work) in a week to 10 days. By then, depending on your rate of healing, you'll probably be able to wear makeup to hide the bruising that remains. You may be sensitive to sunlight, wind, and other irritants for several weeks, so you should wear sunglasses and a special sunblock made for eyelids when you go out.

How do I contact Mr. Henderson should I have a problem out of hours after surgery?

Mr Henderson is always happy to receive calls if a patient is having difficulties after surgery. Call the hospital at which the surgery was undertaken and they will give Mr Henderson your contact details.