Blepharoplasty is the surgery to reduce the amount of excess tissue (fat and skin) around the eyes. These changes can result in a tired or forelorn look, and many patients complain that others notice "bags under my eyes" or ask "if I'm tired even though I feel great". Some patients complain of an angry look or "scowl" due to heavy skin creases in the forehead or between the eyes.

In most cases the right and left eyelids are operated on at the same time.

However, it is not uncommon to do only the upper eyelids or the lower eyelids, as the patient wishes.

This procedure is sometimes performed in tandem with a facelift. It can also be combined with laser skin resurfacing or a chemical peel to smooth wrinkles or BOTOX injections to prevent further wrinkling.

What happens during the procedure?

The procedure is usually performed in the office or in an outpatient surgical center under local anesthesia. Blepharoplasty takes about 2 to 2 1/2 hours for both upper and lower lids. If you are having another procedure such as a facelift at the same time, then overnight hospitalization may be required.

The two most common methods of performing lower eyelid blepharoplasty are: the traditional approach and transconjunctival blepharoplasty. The goal is to remove sagging skin and fat from the upper and/or lower eyelids.

For the upper lids, the surgeon makes the incision right in the upper lid skin crease above your eylashes, so it is very well hidden. Excess skin is removed. Then the excess fat is removed as needed. The incision is sewn together with very small suture and usually heals quickly with a very good scar.

The same occurs for the lower lids. Here the surgeon can make an incision either right under the eyelashes or inside the lid so there is no skin incision. It depends on whether skin needs to be removed, and other factors. In either case, the incision is very well hidden. Again, fat is removed as needed.

What to expect post-procedure

Thin sterile bandages will be applied to the incision area after the surgery but is not in the case of transconjunctival blepharoplasty. An ointment to prevent dryness of the area may be applied but it is not necessary for the eyes to be covered. Some swelling and bruising is to be expected and while it reaches its peak in the first week, it can last for over two weeks. The extent of the post-operative swelling and bruising is dependent on whether you tend to bruise or swell easily.

The amount you can expect varies for each individual but past surgeries or injuries should be a good indication. Keep your head elevated, above the level of your heart, when lying down. Applying cold compresses, or small ice packs will reduce swelling and relieve discomfort. Many patients use a water-tight plastic sandwich bag filled with an ounce of frozen berries or peas. Regular icing is the key to relieving the swelling.

How soon does normal life resumes?

Most people feel ready to go out in public and be seen in a week to 10 days. By then, depending on your rate of healing, a little make-up should be sufficient to camouflage the bruising.

Because the eye area will be sensitive to sun, wind, and other irritants for several weeks, sunglasses and a special sunblock made for eyelids should be worn when going out. After five days, you should be able to return to normal activities but for the first three or four weeks after surgery, you should avoid any activity that increases blood flow to the eyes, including bending, lifting, crying and exercise or sports.

Healing is a gradual process, and although your scars can remain slightly pink for six months after surgery, they should eventually fade to a thin, barely visible white line.