Eyelid Surgery (Blepharoplasty)

Informed Consent Document

Digital Version 1.1 | April 2026

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Introduction

How the surgery is performed

Blepharoplasty removes excess skin, muscle, and sometimes fat from the upper and/or lower eyelids. For upper eyelid surgery, an incision is made in the natural crease of the eyelid. For lower eyelid surgery, an incision may be made just below the lash line or on the inside of the eyelid. The excess skin and fat is removed and the incision closed with fine sutures.

What to expect after the procedure

Swelling and bruising around the eyes are expected and will gradually settle over one to two weeks. The eyes may feel dry or itchy, and lubricating eye drops may be needed for comfort. Cold compresses can help reduce swelling. The scars typically heal to become almost imperceptible.

Anaesthesia

Upper and lower eyelid surgery is performed under local anaesthesia as a day case procedure. Lower eyelid surgery may be performed under general anaesthesia if the surgery is more extensive or being performed as part of a combined procedure.

Why is eyelid surgery performed?

Blepharoplasty is performed to improve the appearance of the eyelids by removing excess skin that may cause hooding, reducing puffiness caused by fat deposits, and restoring a more alert, rested appearance. In some cases, excess upper eyelid skin can impair peripheral vision, and surgery may be performed for functional as well as cosmetic reasons.

Who is a suitable candidate?

The best candidates are those with realistic expectations who are in good general and eye health. Patients with thyroid eye disease, diabetic eye disease, dry eye syndromes, or those who have had recent botulinum toxin injections to the forehead area should discuss suitability with their Consultant.

Limitations

I understand that blepharoplasty does not treat crow's feet (wrinkles at the outer corners of the eyes), dark circles under the eyes, or drooping eyebrows. If brow ptosis (drooping eyebrows) is contributing to upper eyelid heaviness, a separate brow lift procedure may be recommended.

Risks and complications

As with all surgery, the decision to proceed should be based on a careful assessment of the benefits against the risks. Most patients do not experience significant complications, but it is essential to discuss all potential risks and outcomes with your Consultant before proceeding.

Alternative Treatments

Eyelid surgery is an elective surgical operation. Alternative surgery include:

Brow lift surgery when indicated
Non-surgical skin tightening treatments
Dermal fillers or fat transfer to address volume loss
Not undergoing surgery

Risks and potential complications are associated with alternative surgery.

Risks of Blepharoplasty Surgery

1. Bleeding – It is possible, though unusual, to experience bleeding during or after surgery. If postoperative bleeding occurs, it may require emergency treatment to drain accumulated blood (haematoma). Blood transfusion is rarely required. Increased activity too soon after surgery can increase the risk of bleeding. It is important to follow all postoperative instructions and avoid strenuous activity for the advised period. I have stopped taking aspirin, anti-inflammatory medications, and any herbal or dietary supplements that may increase the risk of bleeding, as advised by my Consultant.

2. Blindness – Blindness is extremely rare after blepharoplasty. However, it can be caused by internal bleeding around the eye during or after surgery. The occurrence of this is not predictable.

3. Infection – Infection is unusual after surgery. Should an infection occur, additional treatment including antibiotics, hospitalisation, or additional surgery may be necessary.

4. Scarring – All surgery results in scars. Although good wound healing is expected, scars may be wider, thicker, or more prominent than anticipated. Scar colour and texture may differ from surrounding skin, and scars may appear different on each side of the body. Hypertrophic or keloid scarring may occur, particularly in patients of Asian or Afro-Caribbean descent. Visible suture marks are possible. In some cases, further treatment such as steroid injections, silicone products, or surgical scar revision may be required.

5. Damage to Deeper Structures – There is the potential for injury to deeper structures including, nerves, blood vessels, eye muscles, and lungs (pneumothorax) during any surgical procedure. The potential for this to occur varies according to the type of blepharoplasty procedure performed. Injury to deeper structures may be temporary or permanent.

6. Dry Eye Problems – Permanent disorders involving decreased tear production can occur after blepharoplasty. The occurrence of this is rare and not entirely predictable. Individuals who normally have dry eyes may be advised to use special caution in considering blepharoplasty surgery.

7. Asymmetry – The human face is normally asymmetrical. There can be a variation from one side to the other in the results obtained from blepharoplasty surgery. Additional surgery may be necessary to attempt to revise asymmetry.

8. Pain – Some degree of pain and discomfort is expected after surgery, which is usually well controlled with prescribed painkillers. In rare cases, chronic pain may develop due to nerves becoming trapped in scar tissue or tissue stretching. Small nerve endings may become overactive during healing, producing areas of tenderness or heightened sensitivity, which typically resolves with massage and time. If pain persists, I will inform my Consultant.

9. Ectropion and Entropion – Ectropion (displacement of the lower eyelid away from the eyeball) or entropion (inward turning of the eyelid, causing the eyelashes to rub against the cornea) may occur after blepharoplasty. Either condition is a rare complication and may require further surgery to correct. Eyelid malposition, including asymmetric lid position, may also occur.

10. Corneal Exposure Problems – Some patients experience difficulties closing their eyelids after surgery and problems may occur in the cornea due to dryness. Should this rare complication occur, it may lead to keratitis (inflammation of the cornea), corneal ulceration, or corneal abrasion. These conditions require urgent treatment and, if untreated, could result in permanent damage to vision. Additional treatments or surgery may be necessary.

11. Allergic Reactions – In rare cases, local allergies to tape, suture materials and glues, blood products, topical preparations or injected agents have been reported. Serious systemic reactions including shock (anaphylaxis) may occur to drugs used during surgery and prescription medications. Allergic reactions may require additional treatment.

12. Eyelash Hair Loss – Hair loss may occur in the lower eyelash area where the skin was elevated during surgery. The occurrence of this is not predictable. Hair loss may be temporary or permanent.

13. Delayed Healing – Wound disruption or delayed wound healing is possible. Some areas of the skin may not heal normally and may take a long time to heal. Areas of skin may die. This may require frequent dressing changes or further surgery to remove the non-healed tissue. Smokers have a greater risk of skin loss and wound healing complications.

14. Change in Skin Sensation – It is common to experience diminished (or loss) of skin sensation in areas that have had surgery. Diminished (or complete loss of skin sensation) may not totally resolve after a blepharoplasty.

15. Skin Contour Irregularities – Contour irregularities and depressions may occur after blepharoplasty. Visible and palpable wrinkling of skin can occur. Residual skin irregularities at the ends of the incisions or "dog ears" are always a possibility and may require additional surgery. This may improve with time, or it can be surgically corrected.

16. Skin Discolouration/Swelling – Some bruising and swelling normally occurs following blepharoplasty. The skin in or near the surgical site can appear either lighter or darker than surrounding skin. Although uncommon, swelling and skin discolouration may persist for long periods of time and, in rare situations, may be permanent.

17. Skin Sensitivity – Itching, tenderness, or exaggerated responses to hot or cold temperatures may occur after surgery. Usually this resolves during healing, but in rare situations it may be chronic.

18. Sutures – Most surgical techniques use deep sutures. You may notice these sutures after your surgery. Sutures may spontaneously poke through the skin, become visible or produce irritation that requires removal.

19. Shock – In rare circumstances, your surgical procedure can cause severe trauma, particularly when multiple or extensive procedures are performed. Although serious complications are infrequent, infections or excessive fluid loss can lead to severe illness and even death. If surgical shock occurs, hospitalisation and additional treatment would be necessary.

20. Seroma – Fluid accumulations infrequently occur in between the skin and the underlying tissues. Should this problem occur, it may require additional procedures for drainage of fluid.

21. Unsatisfactory Result – Although good results are expected, there is no guarantee or warranty expressed or implied, on the results that may be obtained. You may be disappointed with the results of eyelid surgery. This would include risks such as asymmetry, unsatisfactory surgical scar location, unacceptable visible deformities, loss of function, poor healing, wound disruption, and loss of sensation. It may be necessary to perform additional surgery to improve your results. Additional surgical procedures such as a brow lift may be needed to correct eyebrow sagging which contributes to upper eyelid problems.

Additional Patient Information

Long Term Results – Subsequent alterations in eyelid appearance may occur as the result of aging, weight loss or gain, sun exposure, pregnancy, menopause, or other circumstances not related to blepharoplasty surgery. Blepharoplasty surgery does not arrest the aging process or produce permanent tightening of the eyelid region. Future surgery or other treatments may be necessary to maintain the results of a blepharoplasty.

Skin Disorders/Skin Cancer – A blepharoplasty is a surgical procedure to tighten the loose skin and deeper structures of the eyelid. Skin disorders and skin cancer may occur independently of eyelid surgery.

Medications – There are many adverse reactions that occur as the result of taking over the counter, herbal, and/or prescription medications. Be sure to check with your Consultant about any drug interactions that may exist with medications which you are already taking. If you have an adverse reaction, stop the drugs immediately and call your Consultant for further instruction. If the reaction is severe, go immediately to the nearest Accident & Emergency Department. When taking the prescribed pain medications after surgery, realise that they can affect your thought process and coordination. Do not drive, do not operate complex equipment, do not make any important decisions, and do not drink any alcohol while taking these medications. Be sure to take your prescribed medication only as directed.

Patients That Have Undergone Bariatric Surgery

I have informed my Consultant if I have undergone any form of bariatric surgery (such as gastric band, gastric bypass, or gastric sleeve). I understand that patients who have undergone bariatric surgery are at increased risk of surgical complications, including impaired wound healing, nutritional deficiencies (particularly in protein, iron, vitamin B12, folate, calcium, and vitamin D), and increased susceptibility to infection. I understand that these deficiencies can persist for years after bariatric surgery, even with supplementation.

I understand that it is recommended that my weight has been stable for a minimum of 6 to 12 months before undergoing elective surgery.

I understand that pre-operative blood tests may be required to assess my nutritional status and fitness for surgery.

Mental Health and Elective Surgery

I understand that all elective surgery carries inherent uncertainty and that results are influenced by individual biological factors beyond the Consultant's control. No guarantee of a specific outcome has been made or implied.

I am proceeding with realistic expectations focused on improvement rather than perfection. I understand that dissatisfaction with an outcome does not in itself indicate negligent or substandard care.

I have disclosed to my Consultant any current or past history of anxiety, depression, body dysmorphic disorder, or any other mental health condition. I accept that my psychological response to surgery, including any impact on my emotional wellbeing or ability to work, cannot be predicted regardless of the surgical outcome, and that surgery may temporarily or permanently exacerbate pre-existing psychological concerns.

I take personal responsibility for my emotional and psychological preparedness for surgery and its outcomes. I have been advised to seek independent counselling support before proceeding if I have any concerns about my ability to cope with a result that falls short of my expectations.

Cooling-Off Period

In accordance with GMC guidelines, Kinvara Private Hospital requires a minimum two-week cooling off period between your initial consultation and any cosmetic surgery procedure. By signing this consent form, you confirm that this cooling off period has been observed, or where it has not been possible, that you have chosen to proceed with your full understanding and acceptance.

Smoking or Vaping

I confirm that I have truthfully disclosed my smoking and nicotine use status to my Consultant. I understand that smoking and the use of nicotine products significantly impairs wound healing and increases the risk of surgical complications. I have been advised to refrain from smoking and all nicotine products for a minimum of six weeks before surgery and until my Consultant confirms it is safe to resume.

I understand that a urine or blood test may be carried out immediately before surgery to confirm the absence of nicotine, and that if nicotine is detected, my procedure may be postponed at the discretion of my Consultant.

Anaesthetic Risks

I understand that all forms of anaesthesia and sedation carry risks, including the possibility of complications, injury, heart attack, stroke, and in rare cases, death.

I understand that surgery carries a risk of blood clots, including Deep Vein Thrombosis (DVT) and Pulmonary Embolism (PE), and that preventative measures may include early mobilisation, compression devices, and anticoagulation therapy. Thrombosed veins may also develop around intravenous (IV) sites, which usually resolve without treatment. I have informed my Consultant of any relevant history, including blood clots, cancer, varicose veins, heart or lung conditions, recurrent miscarriage, obesity, recent long-haul travel, prolonged immobility, family history of clotting disorders, personal history of thrombophilia, or use of the oral contraceptive pill or hormone therapy. I have been advised by my Consultant whether to temporarily stop taking oral contraceptive pills, hormone replacement therapy, or any other oestrogen-containing medication before surgery, and I have followed this advice.

I understand that pulmonary complications such as chest infection, partial lung collapse, or fat embolism may occur, and that these risks are higher in smokers and those with pre-existing respiratory conditions. I understand that cardiac complications are a risk with any surgery and anaesthesia, even in patients without symptoms. If I experience shortness of breath, chest pains, or unusual heartbeats after surgery, I will seek immediate medical attention.

I understand that allergic reactions or adverse responses to anaesthetic agents, medications, or surgical materials may occur, ranging from mild skin irritation to severe anaphylaxis. I have provided my Consultant with a full list of all medications, supplements, and any known drug allergies.

I understand that where repositioning is required during surgery, there is a small risk of nerve injury or pressure-related skin damage.

I have informed my Consultant if I have been diagnosed with, or have symptoms suggestive of, obstructive sleep apnoea, including heavy snoring, witnessed breathing pauses during sleep, daytime drowsiness, or use of a CPAP machine. I understand that sleep apnoea increases the risks associated with general anaesthesia and that narcotic pain medications used after surgery may further compromise breathing during sleep.

I understand that ileus (temporary disruption of normal bowel function) may occur after surgery, particularly following general anaesthesia and the use of pain medications. Symptoms may include abdominal distention, nausea, and vomiting. In rare cases, aspiration of stomach contents into the lungs may occur, which can lead to pneumonia.

Patient Compliance

I understand that I must follow all Consultant instructions carefully, as this is essential for the success of my outcome. I understand that surgical incisions must not be subjected to excessive force, swelling, abrasion, or motion during the time of healing, and that personal and vocational activity needs to be restricted. I will not remove protective dressings or drains unless instructed by my Consultant.

I understand that successful postoperative function depends on both surgery and subsequent care, and that physical activity that increases my pulse or heart rate may cause bruising, swelling, fluid accumulation and the need for return to surgery. I understand that I must not drive a vehicle until advised by my Consultant that it is safe to do so, and that I must not drive while taking prescription pain medication. I have been advised to check with my car insurance provider regarding any restrictions on driving following surgery. I understand that I must attend all scheduled post-operative appointments as advised by my Consultant, and that failure to attend may compromise my outcome.

Financial Responsibilities

I understand that the cost of my procedure includes the fees for the surgery stated in my quote. I acknowledge that this quote does not cover any potential future costs for additional procedures that I may elect to have, or that may be required in order to revise, optimise, or complete my outcome.

I understand that should complications arise, additional costs may be incurred, and that any secondary surgery, further hospital admissions, or revision procedures will be charged separately and will be my financial responsibility.

I understand that complications arising from elective cosmetic surgery are generally not covered by private health insurance or the NHS, and that any treatment required for such complications will be my financial responsibility. I confirm that I have received and understood my quote prior to signing this consent form, and I accept responsibility for all associated costs, including any future treatments that may become necessary.

Consent for Eyelid Surgery (Blepharoplasty)

I hereby authorise my Consultant and such assistants to perform Eyelid Surgery (Blepharoplasty).

I recognise that during the course of the operation and medical treatment or anaesthesia, unforeseen conditions may necessitate different procedures than those above. I therefore authorise the Consultant and assistants to perform such other procedures that are in the exercise of his or her professional judgment necessary and desirable.
I consent to the administration of such anaesthetics considered necessary or advisable. I understand that all forms of anaesthesia involve risk and the possibility of complications, injury, and sometimes death.
I acknowledge that no guarantee or representation has been given by anyone as to the results that may be obtained.
I understand that it may not be possible to achieve optimal results from a single procedure, and that further surgical sessions may be needed to produce the desired final result. Any additional procedures will incur further costs.
I accept that the practice of medicine and surgery is not an exact science, and that while good results are expected, individual results may vary depending on factors such as my general health, healing capacity, and compliance with post-operative instructions.
I consent to be photographed or video recorded before, during, and after the operation(s) for medical, scientific, or educational purposes, provided my identity is not revealed. Detailed terms regarding the use of medical photographs are covered in the separate Medical Photography Consent Form.
I consent to the disposal of any tissue, medical devices or body parts which may be removed.
I understand that my Consultant is an independent medical practitioner and not an employee of Kinvara Private Hospital. My clinical agreement is directly with my Consultant, who is solely responsible for my surgical care and clinical decisions. Kinvara Private Hospital provides the facilities, nursing care, and administrative support.
I realise that not having the operation is an option.

It has been explained to me in a way that I understand:

The above surgery to be undertaken.
There may be alternative surgery.
There are risks to the surgery proposed.
I can confirm that I have read, understood, and have taken time to consider all the identified risks as described above. I have also had the opportunity to discuss any additional concerns and questions with my Consultant, and my Consultant has addressed my concerns to my satisfaction. Therefore I have decided to proceed with surgery with the full knowledge of the intended risk and benefits involved. I certify that I have fully informed my Consultant correctly and to the best of my knowledge my full medical history status.

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Patient Name

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Date

8 July 2026

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