the eyes have it: Upper and lower blepharoplasty
Have you looked in the mirror recently and worried about the tired and sad look of your eyes? Maybe you noticed the heaviness or hooding of your sagging upper lids. Or perhaps it was the puffiness and wrinkling of your lower lids. Besides making you feel older, the look may have reminded you of an older relative. These changes occur in everyone beginning in their 40’s, and in some patients even in their 20’s when there is a familial background.

Certainly not everyone is a candidate for blepharoplasty. But if you are willing to undergo a relatively painless operative procedure, and allow 10-14 days away from social or professional commitments, your eyelid worries could be resolved.

The procedure is called blepharoplasty, which means, “eyelid re-shaping”. The excessive upper eyelid skin, often up to ½ an inch, can be removed and the puffiness due to fat at the inner eye reduced. In the lower eyelid, several surgical approaches are possible, depending upon your signs of ageing and desired goals. Virtually invisible incisions are made just under the eyelashes, or sometimes behind the eyelid. This allows the fatty bags to be sculpted to smoothen out the puffiness above and fill in furrows below the eyelids. The crepy, wrinkly excess skin can also be trimmed. This creates a more youthful lower eyelid. In some cases additional procedures such as mid-face lifting or filling of the “tear trough” deformity below the eyelid may be recommended. There are many options available for this, including the hyaluronic acid fillers, such as Juvederm and Restylane, and fat.

Good candidates for eyelid surgery are those with healthy eyes – good vision, normal tear function, good eyelid tone and function and no eye diseases. There should be a one-year separation between refractive eye surgery and blepharoplasty to minimize the chances of “dry eye syndrome.” People with high blood pressure, diabetes, immune diseases or smokers are at a higher risk for postoperative problems, as they are with all surgeries. General good health, rather than age itself, is the most important medical factor. It is also important to have realistic expectations. You cannot have the eyes you had in your 20’s, or those selected from a fashion magazine. However, you can achieve a less tired, more refreshed and youthful look, which makes you look 5-7 years younger. Most importantly, you feel that your outer appearance reflects your vitality and spirit. Usually within a few weeks you forget your older look and enjoy a sense of comfort and satisfaction. Friends really don’t notice anything changed about your eyes, just you “look well”, are “working out”, or look “less tired” – subtle but real changes associated with youthfulness.

Blepharoplasty is performed as a day surgery, under either local or general anaesthetic – you can talk to your surgeon about which is best for you. Bruising and swelling begin overnight and maximize at 3 days. Cool compresses and eye ointments promote healing, and rarely is there any pain. Small stitches, if used, are removed about day 4.

You can look like “raccoon eyes” for several days, but can be up and about right away. Most people, with perhaps some foundation, are able to return to normal activities in 10-14 days. Fading of the pink incision lines and firmness of the eyelids can take several months to resolve completely.

As for all cosmetic surgery, your first decision is whether you are motivated enough to change your appearance to consider a surgical procedure or some other non-invasive treatment. Next, see your cosmetic surgeon to clearly define your expectations, and consider carefully the reasons for his or her recommendations. Then select which treatment may be best for you, and plan your life so that you can proceed without worry to experience your eyelid rejuvenation.

As Sir Frances Bacon, “The eyes are the portal of entry to the soul”. Blepharoplasty can help your soul to shine through.

Peter A. Adamson, M.D.,F.R.C.S.C., F.A.C.S.