As the result of genetics (heredity) and aging, the soft tissue of the eyelids shows the signs of aging by relaxing and producing lines of expression and wrinkles. This makes the eyes themselves look smaller and creates the impression we are tired even when we are not. When we are young, our eyelid skin acts like a rubber band, stretching when we blink or close our eyes and then tightening when our eye is open. As we get older, the skin behaves more like an accordion, folding upon itself when the eye is open. Also, our lower eyelid vertically lengthens through the years, making our eye opening (aperture) look smaller by comparison.
Surgery to remove the excess tissue of the eyelids is called a blepharoplasty. It involves the removal of redundant skin and muscle as well as removal and/or repositioning of bulging fat. Understandably, enough skin is left so that the eye may close effortlessly at night. Stretched out muscle is also carefully removed as well as bulging fat that makes the eyelids look puffy. The lower eyelid incision is made just below the eye lashes and the skin is separated from the underlying muscle that is attached to the firm part of the lid tarsus. Below this, the muscle is opened to gain access to the fat pockets so excess (bulging) fat can be removed and/or repositioned. The lower portion of the muscle is suspended with a temporary suture to the firm lining of the superior orbital bony rim. This serves to prevent the tendency for swelling, gravity and healing to pull the lower eyelid down or away from the eyeball. This temporary suture dissolves completely over time.
Eyelid surgery is performed on an outpatient basis which means one can usually go home within 1-2 hours after the operation. The procedure is done under local anesthesia with moderate to heavy sedation, depending upon the amount of surgery and the individual needs and wishes of a given patient. No two patients are exactly alike and the degree of sedation necessary for one to be both physically and psychologically comfortable will be discussed in detail prior to your operation. It is possible to sleep through the procedure but this does not require a traditional general aesthetic.
Post-operative care includes elevation of the head and cold compresses for 36-48 hours to help lessen post operative swelling. The swelling usually peaks during the first 1-2 days and then decreases rapidly over the ensuing 2-3 days. Sutures are removed usually 4-6 days after surgery.
There should only be minimal to moderate discomfort after eyelid surgery. Most patients require little pain medication for only a few days. Significant pain could be a symptom of pressure against the eyeball and especially if present with excessive swelling, would require an immediate phone call and evaluation. This has never happened in more than 27 years and thousands of surgeries but is the only complication that could constitute a surgical emergency requiring immediate attention. This is why it is critical that the first few days after surgery, a patient remain relatively inactive with the head elevated.
It is important to avoid strenuous activities for approximately three to four weeks after surgery. Anything that has the potential to increase body temperature causes a reflex dilatation of the blood vessels. This can worsen swelling and even cause bleeding in the early period after surgery.