As you get older, the fine skin around your eyes can begin to droop and sag, making you look more tired and older than you feel. Eyelid surgery ("blepharoplasty") is a simple procedure that involves removing excess skin and tightening the muscles of the upper and/or lower lids to give you a more youthful, refreshed look. In some cases, your health plan may cover part of the cost of this procedure if the loose skin of your upper eyelids is actually blocking your vision.
If the hooding and excess upper eyelid skin is accompanied by drooping eyebrows, then a browlift may be recommended. If you have deep crow's feet, then procedures such as Botox, chemical peels, or laser resurfacing can minimize lines. Fat injections (fat grafting) are also often used to correct hollowness around the bony rim beneath the eye.
Upper eyelid surgery can:
Lower eyelid surgery can:
If you have drooping and wrinkled upper eyelids and/or puffy lower eyelid bags, you could benefit from eyelid surgery. In addition, if your eyelid skin is drooping to the extent that it affects your peripheral vision, upper-eyelid surgery can remove this excess skin and improve your sight.
To be a good candidate, you should be emotionally mature, understand your motivations for having this procedure, and have realistic expectations about what the surgery can achieve. Smoking, diabetes, high blood pressure, and thyroid problems are some of the conditions that can increase the risks during eyelid surgery. Also, if you have a lot of allergies that affect your eyes or you suffer from "dry eye" or any other eye problems, your recovery may be more prolonged.
Local or general anaesthetic
Day surgery. 1-1.5 hours for the surgery.
Recovery is 15 minutes to up to 2 hours if sedation is required.
Can resume light activity the next day. Return to work within 1-3 weeks.
Eyelid surgery is usually done with local anesthetic when you are awake but can be performed with you asleep under general anesthetic. Your surgeon will discuss the advantages of each. It is short (approx. 45 minutes for upper eyelids, 1 hour for lower eyelids) and you will be able to go home within hours of the surgery.
For upper eyelid surgery, excess skin and fat is removed through small incisions that will be hidden along the eyelid crease. If you have a lot of hooding and extra skin in the crow's feet region beside the eye, the incisions may have to be extended into this region to correct this and give you a crisp contour. Eyelids generally heal quickly, and the scars tend to fade and be camouflaged nicely with time.
For lower eyelid surgery, there are two main approaches:
The most common is the external incision. With this approach, excess skin is removed, the support to the lower eyelid is tightened, and the fat is either removed or repositioned to correct any bulges or puffiness under the eyes. Lower eyelid surgery may also include a canthopexy, which helps correct droop and loss of muscle tone to the lower lid.
You may have a preoperative visit with a nurse to review the details of what to expect during your surgery and recovery. You will be asked to stop taking all over-the-counter pain or fever medicines (except Tylenol) and blood thinners for two weeks prior to your procedure. Many herbal medicines can also cause bleeding and so need to be stopped before surgery, such as ginkgo biloba, St. John's Wort, and high doses of fish oil, flax seed oil, or vitamin E.
It is common to experience swelling to the eyelids and a feeling of numbness in the first few days. Most patients require painkillers for a couple of days to relieve any discomfort. Some patients have their swelling resolve in just one week whereas others have mild swelling that persists for several weeks. Bruising normally disappears in 2-3 weeks and you may use makeup within the first week to hide discoloration.
You can resume light activity the next day but heavy lifting should be avoided for a few weeks. Thus, if you have young children, you may want extra help during this time. Depending on how strenuous your job is, you may be able to return to work within 1-3 weeks.
Recovery from lower eyelid surgery is often much longer than from upper eyelids, and patients tend to have more prolonged swelling, tearing, and redness to the eyes. This is usually gone by 6 weeks. Any scarring is confined to natural creases on the eyelids or hidden by the lashes, and the end results are long-lasting. Your scars will take 6 months to 1 year to soften and fade.
As with any surgery, there are risks. These include the normal surgical risks of infection, scarring, delayed wound healing, bruising, or bleeding. Complications specific to this surgery are asymmetry, numb skin, changes in vision (VERY rare), dry/teary eyes, eyelid droop, inability to close eyes completely (lagophthalmos), changes in eye shape, and prolonged redness or swelling. However, all risks in this procedure are rare. They will all be discussed further during your consultation.