People over 35 years of age are normally candidates for eyelid surgery, though younger people may undergo blepharoplasty if they have droopy eyelids and/or large under-eye bags. Over half of all blepharoplasty patients are over 50 years old. It is not unusual for both men and women to undergo eyelid surgery – in fact, surgical blepharoplasty is the third most popular cosmetic surgery procedure for both men and women.

A blepharoplasty operation may be suitable for you if you are bothered by:

1. Excess skin on the upper lid that sags interferes/could interfere with your vision
2. Excess skin on the upper lid that hides the eyelid skin above the lashes
3. Excessive wrinkling on the upper lid
4. Puffiness or bags under the lower lid
5. Excess skin and wrinkles on the lower lids

Blepharoplasty may be suitable for you as long as you:

1. Are in good health physically and emotionally
2. Have realistic expectations about what eyelid surgery can and cannot achieve for you

However, there are some reasons why some people are not good candidates for blepharoplasty, even if they fulfill some of the criteria above. There are some medical conditions which increase the risk of complications from eyelid surgery. Those at risk include people with:

1. Hyperthyroidism
2. High blood pressure (hypertension)
3. "Dry Eye" or problems with your tear ducts.
4. Graves' disease
5. Glaucoma
6. Detached retina
7. Cardiovascular disease
8. Diabetes

Your plastic surgeon will ask you about your health during the consultation. Make sure you tell him or her about any medical condition you have so that you and your blepharoplasty surgeon can make the best choice prior to an eyelid operation. If you are considering eyelid surgery but are being treated for or are concerned that you may be suffering from any of the conditions above, discuss your concerns with your own doctor beforehand.

Blepharoplasty (or eyelid surgery) is a cosmetic surgical procedure that removes fat deposits, excess tissue, or muscle from the eyelids to improve the appearance of the eyes. Blepharoplasty can be performed on the upper or lower eyelid and can be done to correct ptosis (sagging eyelids), remove fatty bulges around the eyes, and eliminate hanging skin from the eyelids. For people who feel that their eyes seem ‘hooded’, old or tired, Blepharoplasty is a highly effective procedure that can restore a more youthful appearance.

Many people seek cosmetic eyelid surgery because during the ageing process the region around your eyes shows the effects of ageing much sooner than other areas. Blepharoplasty is a procedure usually performed on otherwise healthy patients who may have excess skin, muscle, and fat around the eyelids that they feel makes them look older than they are.

If you are considering an eyelid operation, you will have an initial consultation with a Blepharoplasty surgeon. Your surgeon will ask about your general medical history and any previous eyelid surgery. He or she will also ask about any possible thyroid or kidney disease as these can produce swelling of the eyelids, and about any history of eyelid conditions and dryness of the eyes. Your surgeon will also discuss with you the results you can expect from your eyelid operation, the inherent limitations and the positioning of the scars.

Eyelid surgery may be performed in a clinic, or in the hospital. It's usually done on an outpatient basis and rarely requires an inpatient stay. The operation takes one to two hours, or less if just the upper or lower lids are being done. Your surgeon may use either conventional or laser techniques.

When you go in for your Blepharoplasty procedure, the surgeon will begin by deciding whether excess skin, fat deposits, or muscle looseness are at fault. While you are sitting upright, the surgeon will mark where the incisions will be made on your skin. Reputable Blepharoplasty Surgeons will take care to hide the incision lines in the natural skin folds above and below the eye. This helps to minimize scars. The patient then receives injections of a local anesthetic to numb the pain. Many surgeons also give the patient a sedative intravenously during the procedure.

For the upper eyelid surgery, the incision is made in the creases of the upper lids. For the lower eyelid surgery, the incision is made just below the lashes. If you are only having an upper eyelid surgery or a lower eyelid surgery, only upper or lower eyelid incisions will be made. If you have laughter lines (“crow’s feet”) that you would also like removed, your Blepharoplasty Surgeon may extend the incision to the outer corners of your eyes in order to reduce their appearance.

A small, semi-circle shaped section of eyelid skin is removed, and then the surgeon will gently tease out the little pockets of fat that have collected in the eyelids. If muscle looseness is also a problem, the surgeon may trim tissue or add a stitch to pull it tighter. Then the incision is closed using very fine sutures. Your Blepharoplasty Surgeon will then apply an ointment to your eye area to stop it from drying out and use sterile paper tape to support your eyelids.

If a patient only has fat deposits in the lower eyelid, the surgeon may carry out transconjunctival Blepharoplasty surgery. In this procedure the surgeon makes no incision on the surface of the eyelid, but instead enters from behind to tease out the fat deposits from a small incision. The advantage of this procedure is that there is no visible scar.

Depending upon whether you are having an upper blepharoplasty, a lower blepharoplasty or both upper and lower lids done, the surgery will last between one and three hours. If you are having other cosmetic surgery procedures done at the same time, you may be in surgery even longer.

Your blepharoplasty surgeon will give you specific instructions on how to prepare for eyelid surgery, including guidelines on eating and drinking, smoking, and taking or avoiding certain vitamins and medications. Listening to this advice and following these instructions will help your surgery to go more smoothly and will help to reduce the risk of possible blepharoplasty side effects and complications.

The blepharoplasty surgery operation is usually done as a day case procedure. You may go under local anesthesia, which numbs the area around your eyes. You'll be awake during the surgery but relaxed, and will not be sensitive to pain. Some patients may prefer general anesthetic, which means that you would be asleep during the operation. You may need to stay overnight in the hospital or clinic after your eyelid surgery.

Step 1 – Anesthesia

Your face will be swabbed with disinfectant and draped in sterile sheets. The blepharoplasty surgeon will measure the exact amount of skin to be removed and mark this on the skin on your eyelids and around your eyes. The surgeon will then admister local anesthesia starting at the outer aspect of the eyelids and continuing towards the inner eyelids.

Step 2 - The incisions

1. Your blepharoplasty surgeon will make incisions along the marks made on your skin, and the marks are made in such a way as to hide the scars in the natural creases of the skin. If your upper eyelids are being worked on, once the incisions are made, the excess skin and then excess muscle is carefully removed. Two pockets of fat underneath the muscle will be exposed and the fat is removed using a series of surgical instruments. You will probably have bruising or swelling from your eyelid surgery that will last up to a week or more.
2. If your lower eyelid is being worked on, you may have an incision inside the eyelid (normally this will be if you only need excess fatty tissue removed, not skin. The tissues are separated to obtain access to the fat pockets in the lower eyelid. The pockets of fat are exposed and a series of surgical instruments are used to remove the fat. Again, you will experience bruising and swelling following your blepharoplasty operation.
3. Alternatively, the surgeon may operate on your lower eyelid by making an incision outside the eyelid. An incision is made just underneath the lid margin and the skin is gently pulled back to allow the blepharoplasty surgeon to dissect the underlying fat pockets. The surgeon will gently press on the eye to better expose the fat that will be removed, then remove the fat and the excess skin. You will have swelling and bruising after this blepharoplasty procedure.

Step 3 – The sutures

1. Upper eyelids - The incision will be closed with small sutures that are usually underneath the skin, and may be absorbable. These sutures will normally be left in for three to five days.
2. Lower eyelid, incision inside the eyelid - sutures may or may not be used, depending on your blepharoplasty surgeon’s preference.
3. Lower eyelid, incision outside the eyelid - the wounds are closed with fine sutures which will be removed after three to five days.
4. Small adhesive strips are placed over the sutures, and the blepharoplasty surgeon will probably lubricate your eyes with ointment and may apply a compression bandage after your blepharoplasty operation. Your eyelids may feel tight and sore as the anesthesia wears off after your eyelid surgery, and your doctor will prescribe pain medication. If you feel severe pain, call your surgeon immediately.

Step 4 – The results

1. You will need to keep your head elevated for several days after your blepharoplasty procedure and use cold compresses to reduce swelling and bruising. The extent and severity of bruising varies from patient to patient. It is worst during the first week, but should clear after two to four weeks.
2. Before you leave the hospital or clinic after your eyelid surgery, you will be shown how to clean your eyes, which may be sticky for a week or so. Your doctor may recommend eye drops, as your eyelids will probably feel dry at first and may itch or burn.
3. In the first few weeks after your blepharoplasty operation, your eyes may feel “teary”, you may feel sensitive to light, and you may also experience blurring or double vision. The stitches will be removed about a week after eyelid surgery. Once they're removed, the swelling and bruising around your eyes will subside, and your new look will begin to emerge.

Blepharoplasty recovery times will vary patient by patient and by the extent of the eyelid surgery performed. Healing time after eyelid surgery depends on a patient's physical and emotional health and their response to surgery. Patients with a history of medical problems such as scarring or circulation problems, and patients who smoke may experience a longer or more arduous healing time after blepharoplasty. The rate of recovery also depends on the quality of a patient's after care, and whether or not any complications are experienced.

To increase your rate of recovery and lessen you risk of complications arising from blepharoplasty surgery, it is important to discuss your medical history, use of medications, supplements, recreational substances, and other psychological and physical health concerns with your surgeon prior to having a blepharoplasty procedure.

Eyelid swelling and bruising under the eyes are common post-operative blepharoplasty side effects in the first few days after eyelid surgery, though these can last up to two weeks. A rest regimen, sleeping with your head elevated and using ice compresses, applied with pressure, can all speed up the healing process.

You will be able to wear make up again after about two weeks, and return to sports and physical activities after three to four weeks. It is very important to avoid strong sunlight during your eyelid surgery recovery time, as the skin around the eyes will be even more sensitive than usual. Wear a sun cream with a very high SPF, sunglasses and hats for six to eight weeks after a blepharoplasty procedure.

Important things to remember for a faster blepharoplasty recovery:

1. Keep your head propped up on pillows when you are lying down to reduce swelling and bruising.
2. Avoid bending forward for a few days.
3. Carefully cleanse around your eyes and use the ointment prescribed by your surgeon
4. Don't wear contact lenses for at least two weeks.
5. Don't drive until your eyes have stopped watering and your vision has returned to normal

Blepharolpasty procedures should be performed by a qualified and experienced plastic surgeon. Blepharolpasty complications are infrequent and usually minor. Cosmetic eyelid surgery is commonly performed and generally safe. The possibility of complications arising depends on each patient‘s anatomy, their physical reactions, and their healing abilities. As with any surgery, the outcome is not predictable.

Side effects as a result of blepharoplasty are inevitable though they will vary from patient to patient, as with any surgical procedure. Blepharoplasty side effects can include:

1. Soreness, swelling and bruising around the eyes
2. Sticky, dry and itchy eyes
3. Watery eyes
4. Sensitivity to light
5. Double or blurred vision
6. Scarring

Blepharoplasty risks and complications may include an unexpected reaction to the anesthetic, excessive bleeding, infection, or developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT). Antibiotics may be needed to help prevent infection.

Complications that can occur specifically after blepharoplasty include:

1. Hematoma (a collection of blood under the skin that may require surgery to stop the bleeding and to drain the area)
2. Sensation disturbances (usually temporary)
3. Damage to the surface of the eyeball
4. Sunken or uneven appearance
5. Infection
6. Pigmentation changes
7. Poor healing of the skin – most likely to affect smokers
8. Allergic reactions to the anesthesia

If you have any concerns or worries about the blepharoplasty procedure and the risks and side effects involved, ask your surgeon to explain how they may apply to you.