EYELID SURGERY
Upper eyelids
There are many factors that contribute to the aged appearance of the upper eyelid. Skin of the upper eyelids can lose shape and tone over time, causing droopiness and hiding the natural arch of alert expression. The crisp upper eyelid crease associated with youth also changes and obvious asymmetry adds to the appearance of excess or overhanging tissue. To correct a sagging upper eyelid, incisions are made where the natural arch and crease of your eye will be. Through that incision, fat and skin may be removed or repositioned and muscles tightened. Your surgeon may also be able to correct frown lines that exist between the brows through upper-eyelid surgery.

A good surgeon will listen to your concerns and evaluate your anatomy. Even if you believe all you need is eyelid surgery, he or she will demonstrate exactly what eyelid surgery can accomplish, and what other procedures may be necessary to address the complete condition.

Lower eyelids
Creating the right position and proportion of fat in the lower lid can be addressed in a number of ways and often includes a combination of approaches. One way may utilize an incision hidden inside the lower eyelid, while another approach may rely on an external incision located just a sliver below the lower lashes. Removal of excess skin requires an external incision. The very young with the appearance of lower eyelid bags can get very satisfactory results with conservative removal of lower eyelid fat through the internal incision. The most comprehensive approach to rejuvenating the lower eyelids in most individuals, however, oftentimes requires addressing the loosened lower eyelid skin, muscle and tendons through an external incision. When performed accurately, it heals with an undetectable scar. Every case is individual to the patient, and fat may be reduced, redistributed or even grafted to create a smooth and bag-free lower eyelid.

Sad eyes
Canthoplasty and canthopexy are techniques in eyelid surgery that reposition or reinforce the tendons at the outer corner of the eye to correct a turned-down eye or support the lower eyelid. While a very intricate procedure targeted at one very tiny region of the eyelids, the inclusion can prevent alterations in lower eyelid shape and can support the lower eyelid for years to come. This is done without any additional incisions. The goal is usually not to alter the slant of the eye but rather to maintain the natural shape of the lower eyelid and outer corner for many years to come.

The facts
Eyelid surgery is very safe in well-trained hands, but there are some risks. For instance, diabetic patients and those with low tear-production ("dry eye") or thyroid disease may need clearance from their ophthalmologist or primary care physician before surgery.

Following eyelid surgery you may experience temporary dry eye symptoms or discomfort when blinking. In addition, don't expect your eyes to match perfectly, slight asymmetry is normal, and likely something only you will see. As the rate of healing varies from patient to patient and between your own eyes, asymmetry will usually subside in a short period of time. An extremely rare event is severe asymmetry or a lower lid that pulls downward (called ectropion), preventing effective closure of the lids. These conditions may require additional surgery to correct, and have the very rare potential of causing permanent difficulty in closing your eyes. This can almost always be prevented by an accurate evaluation with the appropriate surgery performed with ultimate precision and care.

The view on eyelid surgery
Eyelid surgery is most often performed as an outpatient procedure with local anesthesia and sedation or in some cases general anesthesia. You may feel some discomfort at the incision sites for a day or two and may wish to wear dark sunglasses in the days that follow for enhanced comfort. Your vision may also be slightly blurry due to the temporary swelling. Expect to sleep with your head elevated on several pillows for a few days to reduce swelling, and keep cold compresses on hand for at least the first 24 hours after surgery. Special drops and ointment will keep you comfortable, and may be required as you heal. Within five to seven days of surgery, any or all of the stitches will be removed. When your incisions are completely healed, you are ready for a little concealer and eye contact with the world.