Freshen up your eyes

By Miss Vickie Lee, Oculoplastic Surgeon



With maturity our skin loses its lift and elasticity and our muscles slacken. Our eyes take on a baggy and droopy look that wasn’t there before. What can be done to correct this and restore our youthful confidence?
Appearances can be deceptive. You may be well rested and in good spirits, yet appear to be tired and sad, all because of the way the skin looks around your eyes. Your eyes are a powerful communication tool and one of the most noticeable features in your face. If the eyelids or frames of these windows of facial expression have loose skin folds that hang down and slightly obstruct your vision; or ‘bags’ that sag downwards, they can seriously detract from the expression of your eyes. Many ladies also find that in these circumstances the use of eye makeup, instead of enhancing their appearance, often has a counterproductive effect instead.
Many of these problems can be corrected with surgery on the eyelids (blepharoplasty). An oculoplastic surgeon performs a relatively straightforward operation to remove the surplus skin and re-contour the protruding fat pockets. This is a popular procedure that ‘freshens up’ the eyes and gives a new look to an ageing face. As the thin skin around the eye area tend to age about 10 years ahead of the rest of the face, in many cases, people choose to have eyelid surgery first and then may consider a full face-lift many years later.

What to expect from a blepharoplasty?
Properly proportioned upper and lower eyelids rejuvenate the face and create a more alert appearance. If you have suffered from excessive skin on your upper eyelids, the procedure should also improve your peripheral vision. For many ladies, removing the loose excess upper eyelid skin allows a more ‘stable platform’ for the application of eye make up. However a blepharoplasty procedure cannot remove crow’s feet or other wrinkles, eliminate dark circles under your eyes, or lift sagging eyebrows. Blepharoplasty, however can be combined with other treatments such as Botox and fillers, which may be more effective in treating these other problems.

Who is a good candidate for such surgery?
You should be physically healthy, psychologically stable, and probably have passed your 35th birthday (although younger people with a family history of baggy eyelids also have the operation).

The preparation stages
Before your surgery, you need to inform your surgeon about your complete medical history and say whether you smoke. Your health record should specify if you have any allergies and are taking any vitamins, medications (prescription or over-the-counter), or other drugs. During the consultation, your surgeon or a nurse will test your vision and assess your eyes. If you wear glasses or contact lenses, be sure to bring them with you.

An important step during the preoperative consultation with your surgeon is to discuss your expectations frankly and in detail. The surgeon will then discuss the scope of the procedure – which eyelids you wish to alter (all four, just upper or just lower), whether skin as well as fat will be removed, and whether any additional procedures are appropriate. Other topics will cover the place where the surgery will be performed and the risks and costs involved. Note that most insurance policies will not cover eyelid surgery unless you can prove that it is necessary for medical reasons (such as drooping upper lids that interfere with your vision). Remember to plan for someone to drive you home after your operation and help you out for a few days if necessary.

How is blepharoplasty carried out?
The upper eyelid surgery is carried out through a thin incision in the skin of the upper lid, which is later closed with fine sutures. In the lower eyelid, the incision is made in two possible places: either hidden just underneath the eyelashes where excess fat and skin has to be removed; or from the inside of the eyelid so no scar is visible on the skin (where only excess fat has to be removed).

The surgery is usually performed on a day patient basis and the procedure usually takes one to three hours. After a short rest you can be taken home. You are given local anesthesia and light intravenous sedation to relax you. This means that you will be awake during the surgery, but relaxed and insensitive to pain (however, you may feel some tugging or occasional discomfort). Some surgeons prefer to use general anesthesia; in that case, you’ll sleep through the operation. In any case, this is a point to discuss.

After your surgery

Bearing in mind that any kind of surgery will cause some trauma from which your body has to recover. After the operation, your surgeon will probably lubricate your eyes with ointment and may apply bandages over both eyes for some hours to minimize the bruising. They will be removed so you could see your way home. It is normal to experience bruising and swelling, and your eyelids may feel quite tight. You can control any discomfort with the pain medication prescribed to you. Keeping your head elevated and using cold compresses to reduce the swelling and bruising will help. By the end of the second week you should feel much better.
Getting back to normal

You can expect the maximum bruising and swelling to settle after two weeks, but it often will take up to six weeks for the tissues around your eyes to settle down completely. You don’t have such an operation every day and therefore it is important to plan a significant amount of time (a couple of weeks) away from your regular activities. As the incisions in upper blepharoplasty are made in the normal creases in the eyelids, it should be  difficult to see any visible scars once healing is complete.

Three to four weeks after your operation, when you look in the mirror, you should see a fresher and more alert person looking back.