Eyelid surgery (blepharoplasty) is a popular cosmetic plastic surgery to remove excess skin, fat or muscle from the upper and lower eyelids. Blepharoplasty improves baggy skin under the eyes, sinking upper eyelids or drooping eyelashes that impair vision. The surgery can also treat a medical condition called ptosis (drooping eyelid), which is caused by poor muscle tone or nerve damage. Ptosis causes the eyelids to hang very low and block vision. Blepharoplasty treats drooping eyelids, but not drooping eyebrows or wrinkles. Blepharoplasty is often performed with another cosmetic surgery such as a brow lift or facelift to improve droopy eyebrows, crow's feet and facial sagging.

Why Blepharoplasty?

As we age, excess skin forms in the eye area, and the skin loses elasticity. Fatty tissue can accumulate under the skin. Your eyes will "look older" because these aging processes leave the eyes appearing tired, wrinkled or puffy. Even with good skincare and eyecare, wrinkles, puffiness and drooping eyelids will catch up to you. Genetic factors and body chemistry can cause these aging effects in younger people. Plastic surgery may restore a youthful and refreshed appearance to your eyes.

Is Blepharoplasty Right for Me?

The best candidates for blepharoplasty are physically healthy, emotionally stable and well-informed about the procedure. Ideal candidates are typically at least 35, though genetic factors may indicate treatment for younger people. Candidates may be excluded if they have any of the following conditions: dry eyes, high blood pressure, hypothyroidism, cardiovascular disease, diabetes, glaucoma, or Graves' disease. Your anatomy, including bone and supporting structure, may also affect your candidacy.

The Blepharoplasty Procedure

Your surgeon will make incisions along the line creases of the upper eyelid and possibly along the outer lower rim of the eye's skin. When removing fatty tissue, but not skin, the surgeon may perform a transconjunctival blepharoplasty with an incision inside the lower rim of the eye's skin. These incisions often reach the outer corners of the eyes. The surgeon then divides the fatty tissue and muscle from the skin so that excess skin, fat or muscle can be removed.

Blepharoplasty is often performed under local anesthesia — while you are sedated, numbed and awake — in an outpatient surgery center, surgeon's office or hospital. General anesthesia (meaning, while you are asleep) may be used. Be sure to discuss the appropriate type of anesthesia with your doctor and the anesthesia provider.

Depending on the extent of the procedure, time in surgery may be up to three hours. Patients return home typically within hours of the surgery.

After Blepharoplasty Surgery

Your eyes will likely be lubricated and covered with bandages after surgery. Oral medications will help with pain and discomfort. Report any unmanageable pain to your doctor immediately. The doctor will also prescribe an antibiotic to prevent infection.

You will receive a list of instructions to follow for several days, including:

• the proper way to clean your eyes
• use of cold compresses
• use of lubricating eye drops
• head elevation
• no makeup
• no alcohol
• no television
• no contact lenses

Stitches are removed about a week after surgery. Bruising and swelling will continue to decrease after stitches are removed. Sunglasses and protective sun block are required for several weeks.

Normal activities can resume after about 10 days, though strenuous activities such as lifting, bending and exercise can resume after about three weeks.

The Eyes Have It

Ever wonder how others rate your age and vitality? It's all in your eyes, according to a recent study out of the University of Tennessee Health Science Center in Memphis. The study findings, appearing in the February issue of Ophthalmology, may help you choose appropriate cosmetic surgery procedures, an important determination given today's tough economic climate.

Using eye-tracking methods, researchers analyzed where 47 young adults most often fixed their gaze when asked to evaluate signs of age or fatigue among older people. Although the "eye area" represents a mere 21 percent of the total face, study participants spent almost half of their time looking at this part of the face while assessing age. By comparison, the nose garnered about 19.2 percent, followed by the forehead (13.3 percent) and the area between eyebrows (10.6 percent).

In assessments of fatigue, study participants spent 44.7 percent of the time looking at the eyes, followed by the nose (18 percent), forehead (13.7 percent) and the area between eyebrows (12.3 percent). Researchers noted that the "mouth area" might attract more attention if videos were used (rather than static images) and subjects were talking.

These findings may help explain why eyelid surgery (blepharoplasty) ranked as one of the top five cosmetic surgery procedures performed in the United States in 2007. According to the American Society for Aesthetic Plastic Surgery, it was also the most popular surgical procedure among people aged 51 to 64 in 2007. The findings also speak to the popularity of Botox to erase the wrinkles around the eye such as crow's feet.

Complications and Risks of Blepharoplasty

Following surgery, you may experience tearing, itchy, burning eyes, dry eyes, light sensitivity and blurred or double vision, which can persist for several days. Lubricating eye drops. can relieve these complications. There will also be some swelling around the eyes. Scarring is another possible complication.

Sometimes patients have difficulty closing their eyes when asleep; though rare, this complication can be permanent. The lower lids may appear to be pulled down; this rare condition, called ectropion, may require additional surgery. The eyes may also look somewhat asymmetrical.

As with any surgery, there is a risk of infection or reaction to the anesthesia. You can avoid most complications by choosing the right plastic surgeon and following pre- and postoperative instructions. With proper precautions by the surgical team, complications are typically minimized or prevented