What happens on the day of functional upper eyelid surgery?
Functional upper eyelid surgery for hooded eyelids is called blepharoplasty, which is the surgical removal under local anaesthetic of excess skin in the upper eyelids, interfering with the vision or function of the eyes. This surgery is carried out under local anaesthetic as this gives the best possible opportunity to get an optimal result.
On the day of your surgery at Clinica London, the nurse will first of all see you for what is called the preoperative assessment. During that, she will measure your blood pressure, check your drugs and make sure you have not been on Aspirin and not taken any Nurofen and she will go over what is going to happen during the surgery.
She will start to introduce the consent form to you, and then the oculoplastic surgeon will come in and re-examine the excess skin of eyelids and go over the consent form with you. The consent form will have the risks and benefits of the surgery; it outlines the risks clearly in an information sheet given to you at your initial appointment and gone over again with the consent form so that you are aware of the associated risks and benefits.
After the preoperative assessment, the nurse will take you through to the Clinica London theatre where she will ask you to get up onto the soft operating couch, which is extremely comfortable, and initially, she will have you lying flat, and the nurse will put in drops which are anaesthetic drops onto the eye. She will then clean the face with a disinfecting solution which does not damage the skin or the eyes, and she will then put on the drape. The drape is paper, and it covers your chest and your hair allowing the whole of your face to be free (remember to clean the face before).
Then the surgeon will have been scrubbing, and she will come over and ask you to sit up. The nurse will help you to sit up as sometimes it is not very easy from the lying down position. Once you are in the sitting-up position, the oculoplastic surgeon will ask you to look straight ahead or a little bit upwards and will start to draw on the eyelids the desired level of the skin crease for the surgery and the amount of excess skin in the upper eyelid. Sitting position is important because often people have lateral hooding and where there is lateral hooding. It has to be clearly drawn on to know that it will be entirely removed because when you lie down the lateral hooding is not so apparent, and it could be partly missed, and you will get an unsatisfactory result unless you have sat for the drawing at the beginning of the surgery.
After the prepping and the marking and finishing these stages, you will be asked to lie flat again and to get comfortable, and then the oculoplastic surgeon will do the infiltrative local anaesthetic to numb the eyelids completely, but still, allow you to open them and close them. The local anaesthetics strings to begin with and then makes the eyelids completely numb and feel massive. If at anytime you feel that you are noticing the surgery, the surgeon could inject more local anaesthetic. Similarly, the topical anaesthetic eye drops are topped up regularly during the operation. The pen used for marking the eyelid is still present, and the surgeon will start the surgery. She uses a combination of what is called cold steel and cutting cautery. The cutting cautery is a little bit like a laser as it is very precise and accurate, ideal for delicate eyelid skin.