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What happens during eyelid surgery?

For eyelid surgery such as ptosis and blepharoplasty, I use a Colorado needle or cutting cautery to incise the upper eyelid skin in the skin crease where the final scar will be both minimal and hidden.
The Colorado needle is a special cutting cautery which is like a laser although, in fact, one. It is a very fine cutting instrument which also coagulates tiny blood vessels at the same time. As it is very fine, I can do precise, careful incisions and reduce the amount of damage to adjoining tissues and “buzz” little blood vessels.
It does produce a small amount of smoke which sometimes can be smelt by the patient, but we try and aspirate the smoke so that they don’t inhale much. The Colorado needle allows the oculoplastic surgeon to remove the excess skin in the upper eyelids very precisely and accurately.
Once the excess skin has been deleted, I will decide whether any other deep tissue also has to be dispensed with to get the best result and this can mean removing a little bit of the underlying muscle, plus possibly the medial fat pad. If the lacrimal gland is a bit protuberant and prolapsed, that will be sutured back in first. It may be that the oculoplastic surgeon also has to correct a ptosis or drooping eyelid at the same time, in which case they will do that after removal of the upper lid skin by advancing a little delicate tendon belonging to the muscle that elevates the eyelid, to the rigid tarsal plate, with some stitches.
To check the progress of the surgery, the oculoplastic surgeon will ask you to look up and look down, and they will observe the way the eyelid skin falls, the shape of the upper eyelid and the height of it. They may sit you up again to have another look, having sat you up at the beginning of the surgery to mark the skin. They may want to check that as they go along and sit you up a second or even a third time. They then test to see that both sides look similar and natural looking and start to close up the incision.
After the upper eyelid skin has been reduced in eyelid lifting surgery and blepharoplasty, the very light eyelid skin is closed and made watertight.
I will use some fine sutures at the outside edges of the wound and possibly the inner side and then a TISSEEL fibrin adhesive, which is a type of glue which helps to seal the edges of the skin. However, TISSEEL fibrin sealant does more than that, as it is irrigated deeper in the eyelid underneath the skin where it helps to stop bleeding points, reduce bruising and give a quiet wound which heals well.
Because so few stitches are used in functional eyelid surgery, the incision sites are quite weak, to begin with, and so at the end of the surgery, the eyelids are covered with little transparent shields called Cartella shields. These are the shields that are often used after cataract surgery and may be familiar to people. They are placed on the eyes for a couple of hours while the patient rests after surgery in the recovery area at Clinica London.
The oculoplastic surgeon then goes back to check the eyelids, that there are no bleeding points, that there are no little openings in the incision and that everything is looking quiet. The patient can then go home either in their dark glasses or wearing the Cartella shields.
In the next blog post on Eyelid Surgery, I will tell you about what happens after the surgery when the patient is at home.

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