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 Droopy, tired-looking eyes can make people look sleepy, angry, or even unhealthy. Dr. Barry Citron commonly performs eyelid surgery to keep his cosmetic surgery patients looking healthy, happy, and enthusiastic. Eyelid surgery opens up the eyes by removing pockets of fat from beneath the lower eyelid and beneath the eyebrow. Scars are hidden along natural smile lines and, for lower eyelid surgery; incisions can usually be made from inside of the eyelid.
Am I a good candidate for eyelid surgery?
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, crepey wrinkles of the lower eyelids
- bags and dark circles under the eyes, often with a depression along the bony border of the lower eyelids
- droopiness of the lower eyelids, showing white below the iris (colored portion of the eye)
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 laser resurfacing procedures. Circles beneath the eyes caused by dark pigmentation may be treated with a bleaching solution or chemical peel. Your plastic surgeon can provide further information if you have an interest in any of these additional procedures.
How will my plastic surgeon evaluate me for aesthetic eyelid surgery?
You should come to the consultation prepared to discuss your medical history including previous surgeries, past and present medical conditions and current medications. It is important for you to provide complete information. High blood pressure, thyroid problems or diabetes are among the medical conditions that may increase the risks associated with eyelid surgery.
Your plastic surgeon will want to know if you have allergies, especially if they affect your eyes. He or she may ask whether you have ever tried and were unable to wear contact lenses, you should bring them with you in case your surgeon wants to test your vision.
It will be necessary for your surgeon to know if an ophthalmologist ever told you that you have a condition called "dry eye" or if you have any other problems with your eyes.
One of several surgical techniques may be suggested to improve the appearance of your eyelids. The particular technique that your plastic surgeon recommends will depend on many factors such as the amount of excess fat and skin in the eyelid areas, the position of your eyebrows, and the condition of muscles around your eyelids.
How is my plastic surgeon able to improve the appearance of my upper eyelids?
For upper eyelid surgery, generally, an incision is hidden within the natural fold of the upper eyelid and extends slightly beyond the outside corner into the laugh lines or other existing creases.
Through this incision, excess skin and fatty tissue are removed. Because the incision follows the natural contour of the upper eyelid, it will be well camouflaged when healed.
What is done to improve the appearance of my lower eyelids?
 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 fat may be redistributed to eliminate puffiness or bulges. Other adjustments to correct special problems such as muscle laxity may be performed. As in upper eyelid surgery, the incision is well camouflaged by natural creases.
In some cases, you and your surgeon may decide that the best approach for removing excess fat is through an incision placed inside the lower eyelid. This technique requires no external incision, but it cannot be used to remove excess skin. A laser may sometimes be used in conjunction with this method to tighten the lower eyelid skin.
How should I prepare for surgery?
If you are a smoker, you will be asked to stop smoking well in advance of surgery. Aspirin and certain anti-inflammatory drugs can cause increased bleeding, so you should avoid taking these medications for a period of time before surgery. Your surgeon will provide you with additional preoperative instructions.
Aesthetic eyelid surgery is usually performed on an outpatient basis. If this is the case, be sure to arrange for someone to drive you home after surgery and to stay with you at least the first night following surgery.
How will I look and feel initially?
It is important to realize that the amount of time it takes for recovery varies greatly among individuals.
The first evening after surgery, you should rest quietly with your head elevated. Your surgeon may instruct you to apply cold compresses to your eyelids. Remember, you must not take aspirin or certain anti-inflammatory medications.
Initially, you may feel a "tight" sensation around the eyes and some mild discomfort that can be controlled with oral medication. During the first 48 hours following surgery, patients experience varying degrees of swelling and bruising. Some patients find that mild swelling persists for several weeks, while others may see swelling resolve in as little as one week. Bruising typically disappears within seven to ten days. Within the first week you will be permitted to use makeup, if desired, to conceal any discoloration. Stitches are usually removed within a week of surgery.
Your vision may continue to be somewhat blurry for a few days or longer. Your eyes may be temporarily sensitive to light, and you may experience excess tearing or dryness. Some plastic surgeons recommend eye drops to help relieve any burning or itching. You may want to wear dark sunglasses for a couple of weeks to protect your eyes from wind and sun irritation.
When can I resume my normal activities?
Straining, bending and lifting should be avoided during the early postoperative period. In many instances, you will be able to resume most of your normal activities within ten days or less. Although you might feel like going back to work just a few days after surgery, your vision may still be slightly blurry which could make reading or other paperwork more difficult. You should not wear contact lenses for a week or two.
How long will the results last?
The results of aesthetic eyelid surgery are long lasting, but they may be affected by your heredity and lifestyle factors.
Removal of fat from your eyelids, which is usually the cause of puffiness and bags, is permanent, and these conditions generally will not recur. The skin continues to age, however, and skin laxity along the fine wrinkling of the eyelid area may, at some point, return. Sometimes loss of tone in the forehead causes additional sagging of the eyebrows, which mimics a recurrence of drooping upper eyelids. if this happens, correction may require a forehead lift or a secondary eyelid procedure.
Even though the aging process continues, patients are usually happy with their appearance for many years following eyelid surgery. Some patients find that they want to make additional improvements at a later time.
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