• 6 May 2019
  • Dr Masood Ansari

The skin and muscles around your eyes are very delicate, which makes them tend to become loose and sag from the pull of gravity as you age. This tendency may make you look older than you are and could impair your vision. As your upper and lower eyelids start to droop, you will start to look sleepy or exhausted when you feel fine. Eyelid surgery is officially called blepharoplasty and its purpose is to tighten the loose muscles and skin around your eyes. It may restore your natural alert expression helping you look more rested and youthful.

The American Society for Aesthetic Plastic Surgery (ASAPS) says there is the misconception that a facelift is the most popular cosmetic procedure. Eyelid surgery, both upper and lower, actually outranks the facelift as one of the top five most common cosmetic surgery procedures in the U.S. It has a 94.2 percent patient satisfaction rating.

If you haven’t already, don’t waste your time and money on creams to treat puffy eyes. These creams range from over-the-counter remedies that are relatively inexpensive to very expensive prescription medications. The bottom line is no cream can treat the root cause of under eye bags because they are caused by fat packets pushing through the weakened muscles. No cream or gel can treat the underlying structure of the eyelid. The best you can expect of any cream is to make the skin look smoother. You need eyelid surgery to remove or reposition the fat and tighten the muscles.

The six most common reasons people get eyelid surgery are:

  • Sagging excess skin that covers the natural fold of the upper eyelids
  • Drooping skin that hangs over the eyelid and impairs vision
  • A swollen or puffy appearance in the upper and lower eyelids that makes you look like you haven’t had enough sleep
  • Fine wrinkles and crepe-like skin under the lower eyelids
  • Bags that cause dark circles under the eyes in a depression along the bony edge of the lower eyelids. These are not the dark circles from lack of sleep, stress or skin pigmentation.
  • Sagging of the lower eyelids so that white shows beneath the iris

What Is Eyelid Surgery?

Blepharoplasty may be performed on the upper eyelids, lower eyelids, or both. Most people have both done at the same time. The upper eyelid skin begins to stretch and become heavy for your eyelid to hold up. This inhibits the eyelid from becoming fully open and gives a tired, drooping impression. In some cases, the drooping is such a slow process that you don’t even realize your field of vision has diminished. You may unknowingly start tilting your head back a bit to see better. In some cases, the heavy upper eyelid can start to pull down the eyebrows, which may contribute to an angry appearance.

For upper eyelid surgery, the incision is made in the natural crease of the eyelid. When your eyes are open, the incision area cannot be seen. The facial skin heals quickly and even when your eyes are shut, the incision will be difficult to see. Over time the scar can completely fade away.

The procedure involves removing excess fat, muscle and skin from the upper eyelid through an incision that is made along the natural fold of the eyelid. When the skin stretches and sags, fat may accumulate in the area causing a puffy appearance, under eye bags and sagging eyebrows. If you are having surgery on both eyelids, we generally start with the upper eyelid. If the eyelid is obstructing your vision, we may recommend a blepharoplasty with a procedure called ptosis that will give the eyebrow muscles additional support.

When the lower eyelid droops, you may develop a sad, tired expression. If you would like to wear contact lenses, you probably won’t be able to because your lower eyelid will not hold them in place. For most lower eyelid surgeries, the incision is usually made just below the lash line. The excess muscle and sagging skin are removed through the incision and in some cases, the fat is redistributed to the under eye area so it looks smooth and not sunken.

Eyelid surgery is one of the most risk-free cosmetic procedures available. Any complications are minimized if you follow our surgeon’s instructions before, during and after the procedure. The results will look like your natural eyes only younger. Our surgeon is able to perform bladeless blepharoplasty, which means the incisions are made with an energy-based device. This method results in less bruising and swelling, as well as a shorter recovery time for the patient.  

Who Is a Good Candidate for Eyelid Surgery?

Just by looking in the mirror, you may think you need help with the appearance of your eyes. They look unusually tired and droopy. The best way to know if you are a good candidate for any type of eyelid surgery is to meet our eye specialist and have your eyes examined. At this time you can point out your concern and learn more about upper or lower eyelid surgery. Our specialist will check the strength of your lower eyelid muscles and the surrounding structures of the upper eyelids and cheeks.

While sagging and drooping eyelids are one of the more obvious cosmetic problems, you still need to examine your motivation for the surgery. Your lifestyle may be seriously inhibited with your eyelid problems and it is obvious you need help. If the problem is not very severe, make sure you are choosing the surgery because you want it and not because of pressure from someone else.

Most patients are more than 35 years old, but there are reasons why a younger person may be a good candidate. One reason may be vision problems. Other reasons may be a genetic trait of drooping eyelids. If you are younger than 30 and would like to get eyelid surgery, you should consult with our specialist so you can learn all the things you need to consider before opting for cosmetic surgery.

Some pre-existing conditions may prevent someone from being a good candidate are:

  • Hyperthyroidism, which means your thyroid gland is overactive and produces too much thyroxine, a hormone that regulates your body’s metabolism. Too much of it can accelerate your metabolism and cause an irregular heartbeat and unintentional weight loss.
  • Glaucoma is a group of eye disorders that may damage the optic nerve. It usually means there is too much pressure inside the eye called ocular hypertension.
  • High blood pressure is also called hypertension and may eventually damage your artery walls and cause several health problems.

During Your First Consultation

You may not understand all the benefits of upper and lower eyelid surgery and may wonder if you need a brow lift or a facelift. You may even wonder if Botox® injections or dermal fillers will solve your problems. The only way to be sure you are getting the treatment that will satisfy your goals is to talk to our surgeon. This is your chance to be clear about what you are doing.

You will be asked questions about any previous surgeries you have had including eyelid surgery. You should mention any prescription or over-the-counter drugs you take especially if you take blood-thinners. These include herbal remedies and dietary supplements. Smoking reduces blood flow, which slows tissue healing. This increases the risk of the incision becoming infected. If you smoke, you will need to quit for up to six weeks before and after the surgery. Before the surgery you will have:

  • A physical examination that may include testing of your tear production and measuring your eyelids.
  • A vision examination to test your vision and peripheral vision.
  • Photographs of your eyes from different angles to help our surgeon plan the surgery and to assess the immediate and long-term effects.
  • You will be asked to take only medications that are prescribed by the surgeon.
  • You may need to arrange for someone to drive you home after the procedure.

Each blepharoplasty is unique. How long the procedure takes will depend on your particular anatomy and goals. The average time for the procedure is one to three hours.

Recovery after Eyelid Surgery

Eyelid surgery has one of the shortest recovery periods compared to other cosmetic surgeries. As soon as the surgery is completed, your skin starts to heal. You may be asked to rest for about 30 minutes to an hour after the procedure to give your eyes time to begin recovery. You will remain in a comfortable chair and be given a cold eye mask. Your partner, friend, or relative can be with you during this time to help you relax.

After about 20 minutes you may be given a new cold eye mask. In order to accelerate the healing process and reduce swelling, we will ask you to rest for 48 hours and continue putting cold compresses on your eyes. You may feel some tightness around your eyes and mild discomfort for a few days but you can ask the surgeon to recommend painkillers if necessary. Some tips to follow during the recovery process:

  • Continue to apply cold compresses or a cold gel mask for a few days.
  • Don’t do anything strenuous after the surgery for a few days.
  • Keep your head upright as much as possible. This means to use two pillows at night and do not bend over or lift heavy items for two weeks.
  • Never rub your eyes. If you need to remove moisture or if you feel itching just dab them very gently with a clean piece of gauze.
  • Keep the wounds dry. Don’t go swimming or use a sauna. If you shower, make sure the wounds are sealed from the water.
  • Do not wear makeup around or near your eyes for at least two weeks after the surgery.
  • Along with avoiding strenuous exercise, do not engage in sporting events for two weeks after the surgery.
  • Do not expose the scars to sunlight or tanning beds for six weeks after the surgery. We recommend you wear sunglasses if you go outdoors.
  • Do not use any anti-inflammatory drugs such as aspirin or ibuprofen for 10 days before the procedure and seven days after.
  • Avoid alcohol consumption for two days before the surgery and four days after the procedure.

Most people return to work within one week. Many people feel fine during that time and don’t need a painkiller. There could be minor bruising around the eye that will disappear in a few days. The results are long-lasting and there is a good chance they will last the rest of your life. In some cases, the brow may drop causing excess skin to appear again on your upper eyelid. The treatment for that is a brow lift, not necessarily another eyelid surgery.

Scars will be virtually invisible while they last. The upper eyelid scar will be hidden in the crease in the lid and the lower eyelid scar will either be invisible behind the eyelid or just under the lash line and impossible to see.

More Benefits of Eyelid Surgery

Along with the benefits mentioned earlier, eyelid surgery is a relatively minor procedure that has a major impact on your appearance. Once your eyes look more youthful, the rest of you looks better too.

There are some things eyelid surgery doesn’t address such as crow’s feet, but these can easily be treated with Botox® at the same time. Eyelid surgery does not raise the eyebrows, because that requires a cosmetic procedure to lift the forehead called a brow lift. This, as well as a general facelift, can also be done at the same time as the eyelid surgery. Another condition that eyelid surgery doesn’t affect is called malar bags or festoons. These are large bags on the upper cheek and are usually filled with fluid and are beneath regular under eye bags. They may be the result of genetics, allergies, sinus problems, sun damage, or smoking.

If you do have multiple procedures done during the same session, your recovery time will take longer. The good news is, you will have accomplished many cosmetic goals with one surgical session.

Especially after lower eyelid surgery, some people choose to have a skin treatment such as a chemical peel or fractional laser treatment. These may help improve the texture of the skin and remove fine lines under the eyes.

Continuing Research

Eyelid surgery is in greater demand than ever and new techniques are being evolved. Our surgeon is constantly in touch with the latest research. For example, one such step is the addition of fractionated fat into specific places around the lower eyelid to make a more seamless line between the junction of the lower eyelid and the cheek. Other innovations are connected with treating the tear trough deformity. If this is deformed it may cause the underlying fat and muscle to appear dark and prominent.

Eyelid surgery is a minor procedure that provides amazing results. Your eyes always send a message and if they look older than they are, tired, angry or sad when none of these emotions are true, then you may need a bit of cosmetic help. People you meet at work or socially will interpret your appearance wrongly. The results of eyelid surgery are not overly obvious. You look rested and refreshed and many people may not even realize you have had the surgery.

When you look in the mirror you will see a person more in keeping with how you feel about yourself looking back. Your improved appearance may give you a better outlook on life. Call or visit us at My Cosmetic Clinic at one of our many locations include Newcastle, Baulkham Hills, Botany, Crows Nest, Erina, Frenchs Forest, Newcastle, Nowra, and Wollongong. Contact us today to schedule your consultation!

Dr Masood Ansari
About The Author

Dr Masood Ansari

Dr Ansari has undergone nine years of extensive surgical training around the globe. He received his initial surgical training under the auspices of the National Health Services (NHS) in the United Kingdom and obtained Membership in the Royal College of Surgeons (Edinburgh) in 2006. Due to his particularly keen interest in surgical research, Dr Ansari has been involved in multiple academic research projects and was awarded a Masters (MSc) in Advanced Surgical Practice from Cardiff University in the United Kingdom.

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