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Eyelid surgery (blepharoplasty)

What is eyelid surgery?

Eyelid surgery, or blepharoplasty, is a cosmetic eye surgery that can make the area around your eyes appear younger and rejuvenated, making you look rested and alert. It can involve restructuring the upper eyelids, lower eyelids or both. If you suffer from droopy eyelids, double eyelids or eye bags, eyelid surgery can help. Eyelid surgery can be done alone or with another procedure such as a facelift or a brow lift.

Surgery on the upper eyelid might remove fat that makes the eyelid appear puffy, or can remove loose skin that might be affecting vision. Surgery on the lower eyelid can correct droopiness, and can remove bags and wrinkles. It won't remove crow's feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows.

The best candidates for eyelid surgery are men and women who are physically healthy, psychologically stable, and realistic in their expectations. Most are 35 or older, but if droopy, baggy eyelids run in your family, you may decide to have eyelid surgery at a younger age.

Click here for pictures before and after eyelid surgery procedures.

What does eyelid surgery involve?

Before your surgery, you will be asked to provide any relevant information from your ophthalmologist or the record of your most recent eye exam. If you wear glasses or contact lenses, be sure to bring them to your procedure. 

Surgery usually takes one to three hours, depending on the extent of the surgery. In a typical procedure, Dr. Appel makes incisions following the natural lines of your eyelids; in the creases of your upper lids, and just below the lashes in the lower lids. The incisions may extend into the crow's feet or laugh lines at the outer corners of your eyes. Sometimes, incisions can be made inside your lower eyelids, leaving no visible scars.

Working through these incisions, Dr. Appel separates the skin from underlying fatty tissue and muscle, removes excess fat, and often trims sagging skin and muscle. The incisions are then closed with very fine sutures.

What to expect after eyelid surgery

Right after eyelid surgery, you can expect to be tired from the anesthesia. Your eyes might be lubricated with ointment or bandaged. You can also expect swelling, tightness and bruising.

Dr. Appel will instruct you to keep your head elevated for several days and to use cold compresses to reduce swelling and bruising. (Bruising varies from person to person: it reaches its peak during the first week, and generally lasts anywhere from two weeks to a month.) You'll be shown how to clean your eyes, which may be gummy for a week or so. Eye drops are recommended after surgery, since your eyelids may feel dry. You may also experience excessive tearing, sensitivity to light, and temporary changes in your eyesight, such as blurring or double vision, for the first few weeks.

You will be able to read or watch television a couple days after surgery. You must keep contacts out for at least two weeks. Most people are ready to go back to work after 10 days; makeup can normally be used to hide any bruising that remains. You should wear sunglasses and special sunscreen made for eyelids for at least a few weeks. You will need to keep activity to a minimum for three to five days and avoid strenuous activity and alcohol for about three weeks.

Stitches will be removed two days to a week after surgery. While final results will appear quickly, the scars will keep fading and refining for months. The effects of eyelid surgery are long-lasting, but natural aging might reverse some of the effects.  

Eyelid surgery side effects and risks

Most of the risks of eyelid surgery are similar to those of all surgeries, and are mainly related to bleeding, infection and unfavorable scarring. There is also a slight risk that your vision will be temporarily blurred. You might also experience dry eyes or difficulty closing your eyes.

A few medical conditions make blepharoplasty more risky. They include thyroid problems such as hypothyroidism and Graves' disease, dry eye or lack of sufficient tears, high blood pressure or other circulatory disorders, cardiovascular disease, and diabetes. A detached retina or glaucoma is also reason for caution; check with your ophthalmologist before you have surgery. 

Following surgery, some patients may have difficulty closing their eyes when they sleep; in rare cases this condition may be permanent. Another very rare complication is ectropion, a pulling down of the lower lids. In this case, further surgery may be required.

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