Eyelid surgery, or blepharoplasty, is a surgical procedure to improve the appearance of the eyelids. Surgery can be performed on the upper lids, lower lids, or both. Whether you want to improve your appearance or are experiencing functional problems with your eyelids, eyelid surgery can rejuvenate the area surrounding your eyes. The decision to have plastic surgery is extremely personal and you will have to weigh the potential benefits in achieving your goals with the risks and potential complications of eyelid surgery. Only you can make that decision for yourself.

Eyelid surgery can treat loose or sagging skin that creates folds or disturbs the natural contour of the upper eyelid, sometimes impairing vision, fatty deposits that appear as puffiness in the eyelids, bags under the eyes, drooping lower eyelids that reveal white below the iris, excess skin and fine wrinkles of the lower eyelid. Eyelid surgery should be performed in an accredited office-based surgical facility, a licensed ambulatory surgical center, or a hospital. Be sure to arrange for a friend or family member to drive you to and from surgery and to stay with you the first night following surgery.

Good candidates for eyelid surgery include healthy individuals with no medical conditions that can impair healing, nonsmokers, individuals with a positive outlook and realistic goals, and individuals without serious eye conditions.

The eyelids are just part of the face. The appearance of a drooping upper lid may also be due to relaxation of the forehead skin and eyebrow. Sometimes stretching out of the upper eyelid muscle may cause a drooping eyelid. This is called eyelid ptosis and requires a different surgical treatment. Your plastic surgeon will evaluate your facial anatomy thoroughly and will discuss what procedures might best remedy your concerns.

During your eyelid surgery recovery, lubricating ointment and cold compresses may be applied and in some cases your eyes may be loosely covered with gauze. You will be given specific instructions that may include how to care for your eyes, medications to apply or take orally to aid healing and reduce the potential for infection, specific concerns to look for at the surgical site or in your overall health and when to follow-up with your plastic surgeon.

Initial healing may include some swelling, bruising, irritation, dry eyes, and discomfort that can be controlled with medication, cold compresses, and ointment. Irritation at the incision sites is also possible. Be sure to ask your plastic surgeon specific questions about what you can expect during your individual recovery period.

Here are some good questions you can ask:

  • Where will I be taken after my surgery is complete?
  • What medication will I be given or prescribed after surgery?
  • Will I have dressings/bandages after surgery?
  • When will they be removed?
  • Are stitches removed? When?
  • When can I resume normal activity and exercise?
  • When do I return for follow-up care?

Possible eyelid surgery risks include:

  • Anesthesia risks
  • Swelling and bruising
  • Bleeding from the incision lines
  • Dryness to the eyes
  • Sensitivity to sun or other bright light
  • Difficulty closing your eyes
  • Ectropion, an outward rolling of the lower eyelid
  • Infection
  • Lid lag, a pulling down of the lower eyelid, may occur and is often temporary
  • Temporary or even permanent change in vision, and very rare chance of blindness
  • Changes in skin sensation or numbness of the eyelashes
  • Pain, which may persist
  • Possible need for revision surgery
  • Unfavorable scarring

These risks and others will be fully discussed prior to your consent. It is important that you address all your questions directly with your plastic surgeon.

In preparing for eyelid surgery, you may be asked to:

  • Get lab testing or a medical evaluation
  • Take certain medications or adjust your current medications
  • Stop smoking
  • Avoid taking aspirin, anti-inflammatory drugs, and herbal supplements as they can increase bleeding and bruising

Eyelid surgery procedure includes the following steps:

Step 1 – Anesthesia

Medications are administered for your comfort during the surgical procedure. The choices include intravenous sedation or general anesthesia. Your doctor will recommend the best choice for you.

Step 2 – The incision

The incision lines for eyelid surgery are designed so the resultant scars will be well concealed within the natural structures of the eyelid region. The upper eyelid can be corrected through an incision within the natural crease on the eyelid. This allows for removal or repositioning of fat deposits, tightening of muscles and removal of excess skin.

Conditions of the lower eyelid may be corrected with an incision just below the lower lash line. Through this incision, excess skin in the lower eyelid is removed. Again, the excess fat can be repositioned or removed. A transconjunctival incision, created on the inside of the lower eyelid, is an alternate technique to correct lower eyelid conditions and redistribute or remove excess fat. With this technique, no skin is removed.

Step 3 – Closing the incisions

Eyelid incisions typically are closed with sutures or skin glue. Sutures are removed within one week.  Your surgeon may also suggest use of a laser or chemical peel to reduce discoloration of the lower eyelids.

Step 4 – See the results

The results of eyelid surgery will appear gradually as swelling and bruising subside to reveal a smooth, better-defined eyelid and surrounding region, and a more alert and rejuvenated appearance.

After surgery, you must practice diligent sun protection and use darkly tinted sunglasses until the healing process is fully complete.

 

Terms to Know

Blepharoplasty-Eyelid surgery to improve the appearance of eyelids.
General anesthesia-Drugs and/or gases used during an operation to relieve pain and alter consciousness.
Hematoma-A collection of blood under the skin whose pressure may impair vision.
Intravenous sedation-Sedatives administered via an intravenous line to help you relax.
Local anesthesia-A drug injected directly to the site of an incision during an operation to relieve pain.
Skin resurfacing-Treatment to improve the texture, clarity, and overall appearance of your skin.
Sutures-Stitches used by surgeons to hold skin and tissue together.
Transconjunctival incision -Incision hidden inside the lower eyelid within the reddish conjunctival tissue.