Aesthetic eyelid surgery is routinely performed on adults of all ages. Some people have eyelid surgery to correct problems that are a result of aging, while others have inherited traits that require correction. In addition, eyelid surgery is performed on young children who are unable to open their eyes adequately (eyelid ptosis).
Eyelid surgery helps to rejuvenate the face by taking away the tired and baggy look. Although you don’t feel tired all the time you may be told that you look tired. The freshened appearance that a blepharoplasty may bring to your face is quite remarkable.  

Medical conditions may result in eyelid problems and we should discuss these at length.  High blood pressure, thyroid problems or diabetes are among the medical conditions that may increase the risks associated with eyelid surgery.

Other important information required includes:

    Previous ophthalmologic abnormalities and previous consults
    Eye irritants and allergies
    Recurrent bouts of conjunctivitis (possible eye exposure during the night, or exposure to irritants in the environment)
    Dry eyes (important)
    Use of contact lenses or if you have cataracts
    Facial nerve disorders
    History of other diseases such as Graves disease, diabetes mellitus, glaucoma, thyroid disease, renal disease, cardiovascular isease and liver disease
    Bleeding tendencies and the use of certain medication that can increase bleeding such as aspirin
    Previous eyelid trauma or surgery
    Medications taken including topical eye-drops and ointments

In some cases it is important to have an ophthalmological consultation prior to surgery.

INDICATIONS
 
Any one or combination of the following conditions may indicate that you are a good candidate for eyelid surgery:

    excess skin obscuring the natural fold of the upper eyelids
    loose skin hanging down from the upper eyelids, perhaps impairing vision
    a puffy appearance to the upper eyelids, making the eyes look tired
    excess skin and fine wrinkles of the lower eyelids

Aesthetic eyelid surgery can usually correct these problems, though other treatments may also need to be considered. For example, if the upper eyelid condition is accompanied by sagging of the eyebrows, then a forehead lift may be recommended. Smoothing of crow's feet may require chemical peeling or Botox injection. Fillers may also compliment the procedure

PROCEDURE

Not everyone will need the same procedure and get the same results as there are many individual factors involved. 

BlepharoplastyFor the upper eyelid, an incision is made within the upper eyelid crease which extends beyond the outside corner of the eye into the laugh lines (crows feet). Through this incision, excess skin and fat are removed. This will rejuvenate the look of the upper eyelid. The incision is then sutured and the sutures will need to be removed after several days.

For lower eyelid surgery, often an incision is hidden just below the lower lashes. Through this incision, excess skin, muscle and fat are removed or redistributed. Often times, a slight hitch of the lower eyelid muscle is required to address muscle laxity.
After the surgery you will be monitored for a few hours and possibly go home the same day of surgery but it is not uncommon to stay overnight for additional monitoring if required. Your vision will be blurry as a result of the ointments that are placed into your eyes for comfort. There may be some oozing of blood through the incisions which is expected and normal after this procedure.
Swelling and bruising of the eyes will occur a few hours after surgery and will worsen over the next 48 hours. The swelling will start improving on the third day after surgery in most cases. The amount of time it takes for recovery varies greatly among different individuals.
In the first day or two you should rest quietly with your head elevated. You should apply cold compresses to your eyelids with cotton wool soaked in ice water. Do not place ice directly onto your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications.
The eyes may feel tight initially but this improves with time. Bruising and swelling typically disappears within seven to ten days. After the first week you will be permitted to use makeup, if desired, to conceal any discoloration.
Your eyes may be sensitive to light, and you may experience tearing or dryness of the eyes. These symptoms are not uncommon and they resolve in several days after the surgery.
You will be able to resume most of your normal duties and activities within ten days or less. Contact lenses should be avoided for at least 10 days after the surgery.
 Aesthetic eyelid surgery has the effect of making you look more rested, refreshed and alert. Incisions will fade over a number of weeks until they become barely visible. Because the scars are generally not visible and the results are very refreshing, eyelid surgery is very popular and rewarding. You may also benefit from additional minor procedures such as Botox and Restylane fillers to optimise the procedure.


DISADVANTAGES / COMPLICATIONS

Fortunately, significant complications from aesthetic eyelid surgery are infrequent. Every year, many thousands of people undergo successful eyelid surgery, experience no major problems and are pleased with the results. It is however important that every surgical procedure has risks.

Some of the potential complications that may be discussed with you include:

    Haematoma (an accumulation of blood under the skin that may require removal),
    Infection
    Reactions to anaesthesia.
    Feeling of dryness or irritation in the eyes which may progress to dry eye syndrome that requires treatment
    Possibility of a temporary decrease in sensation of the eyelid skin or impaired eyelid function that sometimes may need to be corrected by additional surgery
    Loss of vision and blindness is the most dreaded complication (occurs in 0.04% of cases)
    Retrobulbar haematoma
    Corneal injury (scratch on the eye membrane which could become opaque and obscure vision)
    Diplopia (double vision but is usually temporary)
    Temporary diplopia can occur secondary to oedema and haematoma
    Permanent sterabismus can result from injury to the extraocular muscles or nerves
    Inferior oblique most frequently injured
    Treated conservatively until no further improvement occurs. Refractory cases can be referred for appropriate strabismus surgery.
    Wound dehiscence
    Epiphora (excessive tearing which usually goes away in a few weeks)
    Lower lid hyperpigmentation
    Hollow lower eyelids
    Eyelid ptosis (inability to open upper eyelids properly and may require further surgery)
    Prolonged swelling
    Ectropion (eversion of the eyelid margin)

These complications are very rare but it is important for you to be completely informed about your operation. The results of aesthetic eyelid surgery are long-lasting, but they may be affected by your heredity and lifestyle factors. It is however a very rewarding procedure and the rejuvenation that it brings to the eyes makes you look less tired and younger.
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