Eyelid Surgery, which is also known as a blepharoplasty, eliminates bags and excess skin around the upper and lower eyelids. The eyes are often the most expressive feature of a person's face and quickly define the facial expression and overall mood. Unfortunately, the eyelid areas are often the first area to show signs of aging with lower lid "bags" and wrinkles along both lids; they can be noticeable as early as the mid to late thirties. Subtle improvements can have a dramatic improvement on the image you portray, such as by helping you to appear less tired and more alert. Some people have fullness to the lower eyelids that are an inherited characteristic and are eliminated in a similar surgical fashion.

Understanding the Procedure

Blepharoplasties are usually performed under local anesthesia with IV sedation. The eyelid skin can be completely anesthetized with small amounts of local anesthetic. The upper eyelid incision is usually within the natural crease of the eyelid and redundant skin carefully trimmed (Figure 1). On rare occasions, excess fat around the upper eyelids exists and requires excision.

The lower eyelid incision is typically located immediately below the eyelash for maximum concealment (Figure 1). The excess skin to the lower eyelid is also trimmed in this way. Often there is excessive fat to the lower eyelids that are responsible for the "bags" and can be directly excised in order to improve the contour of this area. In some people, the problem is primary the bulging fat of the lower eyelids and not excessive wrinkling or redundant skin. Under these circumstances, the surgeon may be able to make the incision along the inside of the eyelid in order to gain direct access to this fat (Figure 2). When performed this way, there is no skin incision made.

Both of the incisions are closed with small sutures that will dissolve by themselves. The incisions typically look somewhat red for the first couple of weeks although they are easily concealed with makeup.

What to Expect After the Surgery

Bruising and swelling frequently occur after surgery and can be minimized with diligent use of ice packs and head elevation. It is important to keep a moisturizing ointment directly on the incision in order to keep it clean. These incisions can get wet after 36-48 hours as water, soap and shampoo trickle over them. The incisions should not be directly scrubbed or irritated. You will need to see the surgeon a couple of times during the first week in order to have the incision carefully cleaned and inspected.

Frequently Asked Questions

Is there any potential danger to my vision with this type of procedure?
Any surgery in and around the eyes can potentially jeopardize vision. It is extremely unusual for any permanent change, however, the swelling in this area can cause temporary changes in refraction. For this reason, it is recommended to delay having any prescription measurements made immediately after eyelid surgery. In addition, some of the ointment around the eye can cause some blurriness to your vision.

What are the possible complications?
Small changes in your eyelid shape can occur after excess skin and fat are removed. The lower eyelids, in particular, are subject to retraction inferiorly and can cause some rounding of the eyelid margin. Small changes of the lash line can also occur where the lid margin is rolled outward.