EYELID SURGERY

More than any other facial feature your eyes reveal the most about how you feel. When your eyes are bright and alert, you appear energized, well-rested, and in control. However, if you have lower-eyelid puffiness, dark circles or drooping upper lids, other may assume that you are fatigued, angry or unhappy. If you believe that your eyes are making you look tired, as or older than you really feel, cosmetic eyelid surgery (also called blepharoplasty) may be right choice for you. Eyelid surgery can remove excess fat and drooping skin of the upper eyelids, minimize bags under the eyes and tighten the lower eyelid skin. The result is a more alert and rested appearance.

Is cosmetic eyelid surgery right for me?
Eyelid surgery is performed on men and women of all ages who want to improve their self-image. Most people have eyelid surgery to minimize the effect of aging. However, many people in their 20's or 30's may also benefit from the procedure.

You may be a good candidate for eyelid surgery if you have any of the following conditions:

• Excess skin that hides the natural fold of the upper eyelids
• Loose skin that hangs down from the upper eyelids
• Puffiness in the upper eyelids that creates a tired look
• Excess skin and fine wrinkles of the lower eyelids
• Puffy "bags" and, in some cases, dark circles.

Eyelid surgery needs to be approached with extra caution if you have any of the following medical conditions:

• Thyroid problems, such as hypothyroidism or Graves' disease
• Lower eyelids that droop significantly and reveal the white beneath the iris (the eye's colored portion)
• Eye problems, such as "dry eye", a detached retina or glaucoma
• High blood pressure or other circulatory disorders
• Cardiovascular disease
• Diabetes

What should I expect from the consultation?
A personal consultation is the first step for every patient considering a facelift. During this meeting, your surgeon will assess your physical and emotional health and discuss your specific cosmetic goals for surgery.

You should arrive at the consultation prepared to provide complete information about:

• Previous surgical procedures
• Past and present medical conditions
• Treatments you have received
• Medications you are taking, including herbal remedies or nutritional supplements.

As part of the consultation, your surgeon will assess the amount of excess fat and skin in your eyelid areas, the position of your eyebrows, and the condition of the muscles around your eyelids.

Your plastic surgeon may suggest other cosmetic treatments to meet your appearance goals. For example:

• A sagging brow can be tightened and smoothed with a forehead lift
• Crow's feet near the eyes can be minimized with a chemical peel or laser resurfacing
• Dark circles beneath the eyes that can't be helped by blepharoplasty can be treated with a bleaching medication, chemical peel or laser treatment.
• Lower-eyelid muscle tone can be improved with additional eyelid surgery

How is cosmetic eyelid surgery performed?
The specific method used for your eyelid surgery will be determined by your features and your surgeons preferences.

Upper eyelids

Typically, the incision begins within the natural crease of the eye's inside corner and extends slightly beyond the outside corner into the crows feet or laugh lines. Through this incision, excess skin and fatty tissue are removed. The incision lines follows the natural contour of the upper eyelid, and is camouflaged when healed.

Lower eyelids

Usually the incision is concealed just below the lower lashes. Through this incision, excess skin, muscle and fat are removed. Your surgeon may also make special adjustments. For example, the fat beneath the eye can be redistributed to eliminate puffiness or bulges. In some patients, the underlying muscle will be tightened.

Your surgeon may decide that the best approach for removing fat from the lower eyelid is with a transconjunctival blepharoplasty. In this procedure, an incision is placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. Laser resurfacing or chemical peel is something used in conjunction with this procedure to minimize fine wrinkles near the eyes.

What can I do to prepare for my surgery?
When the date for your surgical procedure has been set, your plastic surgeon will provide you with specific instructions for the days immediately before and after your surgery. A number of points may be covered, including:

• Avoiding certain medication that may complicate surgery or recovery
• Stopping smoking for a period of time before and after surgery
• Arranging for help or special care following surgery

How will I be cared for on the day of my surgery?
Cosmetic eyelid surgery may be performed in a hospital, an outpatient surgery center or an office-based surgical suite.
Frequently, local anesthesia and intravenous sedation are used for patients undergoing eyelid surgery. However, for some patients general may be best choice. With either type, you'll remain very comfortable throughout the procedure. Your plastic surgeon will monitor your physical status throughout the operation and during your recovery.

How will I look and feel right after surgery?
When surgery is complete, you'll be taken to a recovery area. You may experience any of the following:

Blurred vision - this temporary condition is caused by the ointment that may have been applied to lubricate and protect the eyes

Tightness around the eyes - this sensation will diminish once the swelling goes down

Discomfort - some discomfort is common after any type of operation. It can be controlled with pain medication prescribed by your physician

Bruising and swelling - the amount and duration of swelling and bruising varies greatly among individuals.

Although everyone heals at a different rate, you can expect that your recovery will follow this general time line:

The first day

• In the early stage of healing, it's important to rest with your head elevated.
• Cold compress on the eyes reduce swelling.

Within the first week

• Bruising and swelling will reach its peak, and then subside.
• Healing may be accompanied by mildly blurred vision, excess tearing or dryness, light sensitivity or itching.
• You can begin to use makeup to conceal any discoloration.
• Stitches will dissolve or be removed.
• You may resume most of your normal (nonstrenous) activities.

After several weeks

• Most of the swelling will subside and you'll begin to see the final result.
• Any vision-related symptoms will disappear.
• You may resume vigorous exercise, including bending and lifting.
• You may resume wearing contact lenses.

What should I know about my results?
If you're like most people who have the procedure, you'll be very pleased with your refreshed and alert appearance. You may find that you feel more confident in business and social situations. Friends and colleagues may tell you that you appear happier or more rested, without realizing that you had eyelid surgery.

Most traces of surgery will disappear after several weeks. However, the skin around your eyes must be treated with extra care for several months. When you go out during the day, you should wear sun block on your eyelids and darkly tinted sunglasses to protect your eyes from wind and sun irritation.

How long will I continue to see my plastic surgeon?
After the initial period, you will return to your plastic surgeon's office for a postoperative follow-up visit so that your healing and progress can be evaluated. In the following months, your surgeon may ask you to return for periodic checkups. It's important to keep these appointments so that your surgeon can assess your long-term results and address any questions or concern you may have.